Relationship of dyspnea vs. typical angina to coronary artery disease severity, burden, composition and location on coronary CT angiography

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• 作者：Rine Nakanishi ; Jamal S. Rana ; Alan Rozanski ; Victor Y. Cheng ; Heidi Gransar ; Louise E.J. Thomson ; Romalisa Mir ; a-Peats ; Sean W. Hayes ; John D. Friedman ; Daniel S. Berman ; James K. Min
• 关键词：Dyspnea ; Typical angina ; Plaque stenosis ; Plaque location ; Coronary computed tomographic angiography
• 刊名：Atherosclerosis
• 出版年：2013
• 出版时间：September, 2013
• 年：2013
• 卷：230
• 期：1
• 页码：61-66
• 全文大小：324 K

文摘

Objective

Symptom presentations suspicious for coronary artery disease (CAD) vary widely. While dyspnea is associated with worse prognosis than typical angina (TypAng) for patients referred for non-invasive CAD imaging, the relation of dyspnea vs. TypAng to adverse measures of CAD prognosis¡ªincluding severity, burden, composition, and myocardium at risk¡ªhas not been examined.

Methods

We studied 1443 consecutive individuals without known CAD (mean 61?¡À?13 years, 61.6 % men) undergoing coronary computed tomographic angiography (CCTA) who presented with dyspnea (n?=?170), TypAng (n?=?249) or no dyspnea or TypAng (n?=?1024). Multivariable logistic regression was performed to evaluate the association of dyspnea or TypAng to obstructive CAD (¡Ý70 % stenosis), plaque burden (total segments with plaque), composition (noncalcified, partially calcified) and location (proximal, mid, or distal location in a coronary artery).

Results

By multivariable logistic regression, both dyspnea (OR1.9, 95 % CI 1.1-3.3, p?=?0.02) and TypAng (OR1.9, 95 % CI 1.2-3.1, p?=?0.01) were associated with obstructive CAD as compared to individuals without dyspnea or TypAng, while dyspnea (OR1.8, 95 % CI 1.1-3.1, p?=?0.02), but not TypAng (OR1.1, 95 % CI 0.7-1.6, p?=?0.76) was associated with plaque in the proximal portions of coronary arteries. Neither symptom type was associated with differences in plaque burden nor composition.

Conclusion

Both dyspnea and TypAng are associated with higher rates of obstructive CAD compared to those without dyspnea or TypAng, but only dyspnea is associated with coronary plaque in proximal vessel portions.