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Smilowitz NR, Prasad M, Widmer RJ, Toleva O, Quesada O, Sutton NR, Lerman A, Reynolds HR, Kesarwani M, Savage MP, Sweeny JM, Janaszek KB, Barseghian El-Farra A, Holoshitz N, Park K, Albadri A, Blair JA, Jeremias A, Kearney KE, Kobayashi Y, Miner SES, Samuels BA, Shah SM, Taqueti VR, Wei J, Fearon WF, Moses JW, Henry TD, Tremmel JA. Comprehensive Management of ANOCA, Part 2-Program Development, Treatment, and Research Initiatives: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:1264-1279. [PMID: 37704316 DOI: 10.1016/j.jacc.2023.06.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/15/2023] [Indexed: 09/15/2023]
Abstract
Centers specializing in coronary function testing are critical to ensure a systematic approach to the diagnosis and treatment of angina with nonobstructive coronary arteries (ANOCA). Management leveraging lifestyle, pharmacology, and device-based therapeutic options for ANOCA can improve angina burden and quality of life in affected patients. Multidisciplinary care teams that can tailor and titrate therapies based on individual patient needs are critical to the success of comprehensive programs. As coronary function testing for ANOCA is more widely adopted, collaborative research initiatives will be fundamental to improve ANOCA care. These efforts will require standardized symptom assessments and data collection, which will propel future large-scale clinical trials.
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Affiliation(s)
- Nathaniel R Smilowitz
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA; Cardiology Section, Department of Medicine, VA New York Harbor Healthcare System, New York, New York, USA
| | - Megha Prasad
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York, USA
| | | | - Olga Toleva
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Odayme Quesada
- Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA
| | - Nadia R Sutton
- Department of Internal Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Harmony R Reynolds
- Sarah Ross Soter Center for Women's Cardiovascular Research, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, New York, USA
| | - Manoj Kesarwani
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Michael P Savage
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joseph M Sweeny
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Noa Holoshitz
- Ascension Columbia St Mary's, Milwaukee, Wisconsin, USA
| | - Ki Park
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Ahmed Albadri
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - John A Blair
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Allen Jeremias
- St Francis Hospital & Heart Center, Roslyn, New York, USA
| | - Kathleen E Kearney
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Yuhei Kobayashi
- New York Presbyterian Brooklyn Methodist Hospital/Weill Cornell Medical College, New York, New York, USA
| | - Steven E S Miner
- Southlake Regional Medical Centre, Newmarket, Ontario, Canada, School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bruce A Samuels
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Samit M Shah
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut USA
| | - Viviany R Taqueti
- Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Janet Wei
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - William F Fearon
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Jeffery W Moses
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York, USA; St Francis Hospital & Heart Center, Roslyn, New York, USA
| | - Timothy D Henry
- Carl and Edyth Lindner Center for Research and Education, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA
| | - Jennifer A Tremmel
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA.
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Pourhoseini S, Bakhtiari M, Babaee A, Ostovan MA, Eftekhar-Vaghefi SH, Ostovan N, Dehghani P. Increased risk of coronary perforation during percutaneous intervention of myocardial bridge: What histopathology says. J Cardiovasc Thorac Res 2017; 9:108-112. [PMID: 28740631 PMCID: PMC5516050 DOI: 10.15171/jcvtr.2017.18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/09/2017] [Indexed: 12/12/2022] Open
Abstract
Introduction: Myocardial bridge (MB) is a segment of a major epicardial coronary artery that goes intramurally under a bridge of overlying myocardium. Complications have been reported during or after stent implantation particularly coronary perforation. The aim of this study was to determine histological differences between proximal left anterior descending artery (LAD) and the tunneled segment that may have a possible role in increased risk of coronary artery perforation during percutaneous coronary intervention.
Methods: Twenty specimens of MB were obtained from dissection of 45 cadavers. Sections were stained using hematoxylin and eosin (H&E), and trichrome methods. The proximal section and the tunneled artery were compared with a normal sample in terms of the characteristics of a muscle artery.
Results: The findings of this study showed an MB prevalence of 51%, as 23 out of the 45 examined cadavers were discovered to be afflicted by the MB. The intima layer in the suffering artery had gone through significant hypertrophy, while it had remained thin in the tunneled artery section. The epithelial cells under the bridge were spindle-shaped, while they were polygonal in the proximal section. In the myocardium the nuclei of the muscle fibers in the MB section were smaller than the normal section. Adventitial layer was almost normal.
Conclusion: The histopathological differences between MB and proximal part of vessel combined with small vessel diameter in the tunneled segment can explain the high incidence of the LAD rupture and perforation in the section under the bridge.
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Affiliation(s)
- Somayeh Pourhoseini
- Department of Anatomy, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Bakhtiari
- Department of Anatomical Science and Molecular Biology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abdolreza Babaee
- Department of Anatomy, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Ali Ostovan
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Shiraz Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Nikan Ostovan
- Shiraz Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pooyan Dehghani
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Shiraz Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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