The etiology and significance of coronary artery tortuosity (TCA) among patients with spontaneous coronary artery dissection (SCAD) are unknown. The aim of this prospective imaging cohort study was to report echocardiographic findings and evaluate whether TCA correlates with cardiac anatomy and function among patients with SCAD. Comorbidities including fibromuscular dysplasia (FMD) and outcomes were also assessed. TCA was determined on coronary angiography performed during the diagnosis of SCAD, and cardiac structure and function were evaluated using prospective comprehensive echocardiography. Among 116 patients with SCAD, the mean age at echocardiography was 50.8 ± 8.8 years, a median of 10.9 months after SCAD. Sixty-two patients (53.4%) had FMD, 41 (35.3%) had histories of hypertension, and 17 (14.8%) were hypertensive during echocardiography. Most patients ( = 78 [69%]) had normal left ventricular geometry with normal median ejection fraction (61%; interquartile range, 56% to 64%) and normal global longitudinal strain (−22.2%; interquartile range, −24.0% to −19.9%). Fifteen patients (13.4%) had diastolic dysfunction that was associated with hypertension at the time of echocardiography. Patients with TCA ( = 96 [82.8%]) were older (mean age, 52.1 ± 8.0 vs 44.7 ± 9.9 years; < .001) with a higher prevalence of FMD (59.4% vs 25%, = .007) but a similar prevalence of hypertension (35% vs 35%, > .99) compared with patients without TCA. Across the age range (31.5 to 66.9 years), each decade of age was associated with an approximately 0.89-unit increase in coronary tortuosity score ( < .0001). Echocardiographic parameters were not significantly different between the two groups. Median follow-up duration was 4.4 years (95% CI, 3.8 to 5.2 years). The Kaplan-Meier 3-year SCAD recurrence rate was 9.4% (95% CI, 3.7% to 14.8%). There were no deaths. The majority of patients with SCAD had normal or near normal echocardiographic results, including global longitudinal strain, with no differences according to TCA. However, patients with SCAD with TCA were older, with a higher prevalence of FMD.

中文翻译：

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冠状动脉迂曲和自发性冠状动脉夹层：与超声心动图和整体纵向应变、纤维肌发育不良和结果的关联

自发性冠状动脉夹层（SCAD）患者冠状动脉迂曲（TCA）的病因和意义尚不清楚。这项前瞻性影像队列研究的目的是报告超声心动图结果并评估 TCA 是否与 SCAD 患者的心脏解剖结构和功能相关。还评估了包括纤维肌性发育不良（FMD）在内的合并症和结果。 TCA 通过 SCAD 诊断期间进行的冠状动脉造影确定，​​并使用前瞻性综合超声心动图评估心脏结构和功能。在 116 名 SCAD 患者中，超声心动图检查的平均年龄为 50.8 ± 8.8 岁，中位 SCAD 后 10.9 个月。 62 例患者（53.4%）有 FMD，41 例（35.3%）有高血压病史，17 例（14.8%）超声心动图显示高血压。大多数患者 (= 78 [69%]) 具有正常的左心室几何形状，中位射血分数正常（61%；四分位数范围，56% 至 64%）和正常的总体纵向应变（−22.2%；四分位数范围，-24.0% 至−19.9%）。 15 名患者 (13.4%) 在超声心动图检查时存在与高血压相关的舒张功能障碍。 TCA 患者 (= 96 [82.8%]) 年龄较大（平均年龄，52.1 ± 8.0 vs 44.7 ± 9.9 岁；< .001），FMD 患病率较高（59.4% vs 25%，= .007），但相似与未使用 TCA 的患者相比，高血压患病率 (35% vs 35%, > .99)。在整个年龄范围（31.5 至 66.9 岁）中，年龄每增长 10 岁，冠状动脉迂曲度评分就会增加约 0.89 个单位 (< .0001)。两组之间的超声心动图参数没有显着差异。中位随访时间为 4.4 年（95% CI，3.8 至 5.2 年）。 Kaplan-Meier 3 年 SCAD 复发率为 9.4%（95% CI，3.7% 至 14.8%）。没有死亡。大多数 SCAD 患者的超声心动图结果正常或接近正常，包括整体纵向应变，根据 TCA 没有差异。然而，接受 TCA 治疗的 SCAD 患者年龄较大，FMD 患病率较高。