Author + information
- Received October 17, 2018
- Revision received December 20, 2018
- Accepted January 4, 2019
- Published online March 13, 2019.
- Robert Jackson, BSc, MBChBa,
- Abtehale Al-Hussaini, MBBSa,b,
- Shiju Joseph, PhDa,
- Gijs van Soest, PhDc,
- Alice Wood, BSc, MBBSa,
- Fernando Macaya, MDd,e,
- Nieves Gonzalo, MD, PhDd,
- Jamil Cade, MD, PhDf,
- Adriano Caixeta, MD, PhDf,
- Ota Hlinomaz, MD, PhDg,
- Pavel Leinveber, MScg,
- Peter O’Kane, BSc, MDh,
- Marcos García-Guimaraes, MDi,
- Bernardo Cortese, MDj,
- Nilesh J. Samani, MDa,
- Javier Escaned, MD, PhDd,
- Fernando Alfonso, MD, PhDi,
- Thomas Johnson, BSc, MBBS, MDk and
- David Adlam, DPhila,∗ ()
- aDepartment of Cardiovascular Sciences, Glenfield Hospital, Leicester, United Kingdom, and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
- bDepartment of Cardiology, Royal Brompton Hospital, London, United Kingdom
- cErasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- dHospital Clínico San Carlos and Universidad Complutense,, Madrid, Spain
- eDepartment of Cardiology, King’s College Hospital, London, United Kingdom
- fDepartment of Cardiology, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
- gInternational Clinical Research Centre, St. Anne's University Hospital and Masaryk University, Brno, Czech Republic
- hDepartment of Cardiology, Bournemouth Hospital, Bournemouth, United Kingdom
- iDepartment of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
- jSan Carlo Clinic, Milano, Italy
- kDepartment of Cardiology, Bristol Heart Institute, Bristol Royal Infirmary, Bristol, United Kingdom
- ↵∗Address for correspondence:
Dr. David Adlam, University of Leicester, Department of Cardiovascular Sciences, Glenfield Hospital, Groby Road, Leicester LE3 9QP, United Kingdom.
Objectives This study used optical coherence tomography to investigate the mechanism of false lumen (FL) formation in spontaneous coronary artery dissection (SCAD) by studying: 1) differences between fenestrated and nonfenestrated SCAD; 2) vasa vasorum density; and 3) light attenuation characteristics of the FL.
Background SCAD is an increasingly recognized cause of acute coronary syndromes, characterized by FL formation and compression of the true lumen (TL). The mechanisms underlying FL formation remain poorly understood.
Methods A total of 65 SCAD patients (68 vessels) who underwent acute OCT imaging as part of routine clinical care were included. Images were classified by the absence or presence of a connection (fenestration) between the TL and FL. Indexed measurements of TL stenosis, external elastic lamina (EEL) area, FL area, and light attenuation of the FL were assessed. Vasa vasorum densities of SCAD cases were compared with those in control non-SCAD myocardial infarction cases.
Results In nonfenestrated cases, there was significantly larger expansion of the EEL area (9.1% vs. −1.9%; p <0.05) and a larger FL area (73.6% vs. 53.2%, respectively; p <0.05) in dissected segments. No significant differences were found between vasa vasorum density in SCAD and those in control subjects. The FL contents were heterogeneous but attenuated less light than whole blood or thrombus (4.28 ± 0.55 mm−1 vs. 5.08 ± 0.56 mm−1; p < 0.05; vs. 4.96 ± 0.56 mm−1; p < 0.05).
Conclusions These observational data suggest that the absence of a fenestration leads to increased FL pressure and compression of the TL. Although vasa vasorum may still be implicated in pathogenesis, increased vasa vasorum density could be an epiphenomenon of vascular healing.
Supported by the British Heart Foundation, the National Institute for Health Research (NIHR) rare disease translational collaboration, the Leicester NIHR Biomedical Research Centre, and the Beat Spontaneous Coronary Artery Dissection (SCAD) organization. Dr. Joseph has received support from St. Jude Medical. Dr Adlam has received support from St. Jude Medical and AstraZeneca. Drs. Johnson and O’Kane are compensated speakers and consultants for Abbott Vascular and Terumo Corp. Dr. Van Soest has received research support and royalties from Terumo Corp. Dr. Macaya has received support from Fundación Interhospitalaria Investigación Cardiovascular. Dr. Gonzalo has received speaker fees for educational events sponsored by Abbott Vascular. Dr. Escaned is a compensated speaker and consultant for Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 17, 2018.
- Revision received December 20, 2018.
- Accepted January 4, 2019.
- 2019 American College of Cardiology Foundation
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