Division of Pediatric Cardiology, Department of Pediatrics, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Biostatistics, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
World J Pediatr Congenit Heart Surg. 2020 Nov;11(6):712-719. doi: 10.1177/2150135120947689.
Congenital coronary artery anomalies are uncommon and may result in sudden death. Management of asymptomatic patients with anomalous aortic origin of the right coronary artery (AAORCA) remains controversial with a lack of evidence to guide decision-making. We hypothesized that patients with AAORCA may have exercise-inducible ischemia detectable as abnormalities in regional myocardial deformation on exercise stress echocardiography (ESE).
We reviewed clinical data, computed tomography angiography, and treadmill ESE from 33 AAORCA patients (21 unoperated, 12 operated) and 11 controls. Regional wall motion on ESE was visually assessed. Doppler tissue imaging was done pre and post exercise to evaluate regional myocardial wall deformation. The post- to pre-exercise time to peak systolic strain corrected for heart rate ratio (TPScR) for the left ventricular inferior and anterior walls of AAORCA patients was compared to controls.
No regional wall motion abnormalities were noted. The TPScR of the inferior wall was higher in unoperated (0.96 ± 0.41) but not operated (0.84 ± 0.28) AAORCA patients compared to controls (0.76 ± 0.18, = .03 vs .23, respectively). There was no significant difference in TPScR of the anterior wall between unoperated patients and controls ( = .08).
In some AAORCA patients undergoing ESE, TPScR of the left ventricular inferior wall is elevated, suggestive of ischemia induced by exercise in myocardium supplied by the right coronary artery. Further work is needed to understand the potential role of this finding in risk assessment.
先天性冠状动脉异常并不常见，但可能导致猝死。对于无症状的右冠状动脉异常起源（AAORCA）患者，其管理仍存在争议，缺乏决策依据。我们假设，AAORCA 患者可能会在运动应激超声心动图（ESE）上出现局部心肌变形异常，从而产生运动诱导的缺血。
我们回顾了 33 例 AAORCA 患者（21 例未手术，12 例手术）和 11 例对照者的临床资料、计算机断层扫描血管造影和踏车 ESE。ESE 上的局部壁运动通过目测评估。在运动前后行多普勒组织成像，以评估局部心肌壁变形。与对照组相比，测量 AAORCA 患者左心室下壁和前壁的运动到峰值收缩应变校正心率比（TPScR）的运动后至运动前时间。
未观察到局部壁运动异常。与对照组相比，未手术的 AAORCA 患者（0.96 ± 0.41）下壁的 TPScR 较高，但手术的 AAORCA 患者（0.84 ± 0.28）则不然（分别为 0.76 ± 0.18， =.03 与.23， =.03 与.23）。未手术患者和对照组的前壁 TPScR 无显著差异（ =.08）。
在接受 ESE 的一些 AAORCA 患者中，左心室下壁的 TPScR 升高，提示右冠状动脉供血的心肌发生运动诱导的缺血。需要进一步研究以了解这一发现在风险评估中的潜在作用。
