Effect of Coronary Tortuosity on Exercise Stress Test/Koroner Tortiyozitenin Egzersiz Stres Testi Uzerindeki Etkisi

• Published in: Istanbul medical journal Vol. 21; no. 6; p. 408
• Main Authors: Alsancak, Yakup, Gurbuz, Ahmet Seyfeddin, Ozcelik, Abdullah, Icli, Abdullah
• Format: Journal Article
• Language: English; Turkish
• Published: Galenos Yayinevi Tic. Ltd 01.11.2020; AVES
• Subjects: Coronary heart disease; CT imaging; Medical research; Medicine, Experimental; Stress (Physiology)
• ISSN: 2619-9793; 1304-8503
• DOI: 10.4274/imj.galenos.2020.29052

Introduction: Coronary tortuosity (CT) is a common anatomical finding during coronary angiography (CA); however, its aetiology and clinical importance have not been clearly defined. We aimed to evaluate the effect of the presence or severity of CT and effect of the sigma-shaped right coronary artery (RCA) on the exercise stress test (EST). Methods: The study included 175 patients who underwent CA due to cardiac symptoms and positive EST and had no obstructive coronary artery disease in a single centre between 2017 and 2018 June. The patients were divided into two groups: Group 1, patients with CT (n=88), and group 2, patients without CT (n=87). The patients were also categorised as low and moderate-to-high risk based on Duke treadmill score (DTS). Results: The running distance and DTS were lower, and the rate of sigma-shaped RCA was higher in the CT group (p<0.006). The DTS was lower (p=0.024) in the presence of tortuosity in the left anterior descending coronary artery and negatively influenced as the number of coronary arteries affected by tortuosity increased (p<0.001). Based on the DTS score, patients with moderate-to-high risk have a higher number of vessels affected by tortuosity, involvement of left anterior descending coronary artery, and proportion of sigma-shaped RCA (p<0.001). Conclusion: In the presence of CT, the rate of positivity is significantly higher, and the DTS is lower in the stress test. Keywords: Coronary artery, Duke score, exercise stress test, sigma-shaped RCA, tortuosity Amac: Koroner tortiyozite (KT), koroner anjiyografi (KA) sirasinda karsilasilan yaygin bir anatomik bulgudur; ancak etiyolojisi ve klinik onemi net olarak tanimlanmamistir. Biz de KT varligi ve siddeti ile sigma sekilli sag koroner arter (SKA) varliginin egzersiz stres testi (EST) uzerine etkisini incelemeyi amacladik. Yontemler: Calismaya 2017-2018 Haziran tarihleri arasinda tek bir merkezde kardiyak semptomlar ve pozitif EST nedeniyle KA uygulanan ve obstruktif koroner arter hastaligi bulunmayan 175 hasta dahil edildi. Hastalar iki gruba ayrildi: Grup 1, KT'si olan hastalar (n=88) ve grup 2, KT'si olmayan hastalar (n=87). Ayrica hastalar Duke kosu bandi skoruna (DTS) gore siniflandirildi. Bulgular: KT grubunda kosma mesafesi ve DTS daha dusuktu ve sigma seklindeki SKA orani daha yuksekti (p<0,006). Sol on inen koroner arterde KT varliginda DTS'nin daha dusuk (p=0,024) oldugu ve tortiyoziteden etkilenen koroner arterlerin sayisi arttikca DTS'nin olumsuz etkilendigi bulundu (p<0,001). DTS skoruna gore orta-yuksek risk grubunda olan hastalarda tortiyoziteden etkilenen damar sayisi ile sol on inen koroner arter tutulumu ve sigma sekilli SKA orani daha yuksekti (p<0,001). Sonuc: KT varliginda, stres testinde pozitiflik orani daha yuksektir ve DTS daha dusuktur. Anahtar Kelimeler: Koroner arter, Duke skoru, egzersiz stres testi, sigma RCA, tortiyozite