Coronary tortuosity in patients with acetylcholine-induced coronary microvascular spasm

Abstract Background Angina pectoris in the absence of relevant epicardial stenoses (ANOCA) is frequently caused by coronary microvascular spasm. It has been speculated that morphology arteries associated with One hypothesis vasoconstriction microvessels leads to intraluminal pressure increase vascular segments proximal spasm, which may shift balance vessel forces toward elongation resulting tortuosity. Purpose We assessed relationship between tortuosity and spasm elucidate a potential structural functional abnormalities. Methods 610 patients (39% male, mean age 61 years) stable angina yet unobstructed (<50% stenosis) were included this study. All underwent invasive diagnostic angiography followed intracoronary acetylcholine (ACh) testing according standardized protocol. The ACh test was considered “positive” presence (a) angina, ischemic ECG shifts during ≥90% diameter reduction (“epicardial spasm”) or (b) all above without (“microvascular spasm”). Assessment performed using left right images multiple projections blinded fashion. number angles curves late diastole determined severity previously defined Eleid. Patients divided into those at least moderate versus no mild Results ACh-testing revealed 179 (29%) 172 (28%) patients. ACh-test negative/inconclusive remaining 259 (43%). There 298 (49%) 312 had (51%). more likely have (99 (58%) vs. 76 (43%) 126 (49%), p=0.017). Analysis positive showed (n=175) significantly (57%) than (p=0.005). also found often hypertension compared (230/438 71/172, p=0.015). Conclusions In large cohort ANOCA Our results provide interesting insights vasomotor function. Funding Acknowledgement Type funding sources: Foundation. Main source(s): Berthold-Leibinger-Foundation, Ditzingen, Germany