Coronary reserve in Takayasu's arteritis: transesophageal echocardiographic analysis.
BACKGROUND
The incidence of coronary arteries lesion in Takayasu's arteritis varies from 9% to 10% and is usually discovered at autopsy. Recent studies have demonstrated the value of echocardiography in noninvasive detection of significant coronary stenosis.


OBJECTIVE
The aim of our study was to evaluate coronary reserve in 15 patients with Takayasu's arteritis using contrast transesophageal echocardiography (Optison).


METHODS
Transesophageal echocardiogram under basal conditions and in the hyperemic phase with dipyridamole challenge, myocardial perfusion studies and coronary angiography were performed on all patients. Seventy-three percent of them had histories of systemic hypertension, and the most frequent cardiovascular symptoms were shortness of breath (80%), headache (46%), angina (40%), and dizziness (33%).


RESULTS
The transthoracic echocardiogram showed left ventricular systolic dysfunction in 6% and diastolic dysfunction in 53%. Aortic regurgitation was found in 67% of the patients, and 60% had mitral and/or tricuspid regurgitation. Coronary reserve was diminished in 3 patients with significant coronary lesions and in 2 patients with coronary dilation (33%). In the 3 patients with obstructive lesions and diminished coronary reserve, reversible perfusion defects were found with thallium-201 single-photon emission computed tomography. One patient with coronary dilation had normal perfusion, while the other demonstrated reversible and irreversible perfusion defects. One patient without coronary lesions and with normal coronary reserve had an irreversible fibrotic changes and the other reversible defects due to abnormal microcirculation.


CONCLUSIONS
Transesophageal echocardiography is a feasible and promising technique for assessing coronary reserve in patients with Takayasu's arteritis.
Espinola-Zavaleta
Nilda
N
Statistical Department, Instituto Nacional de Cardiologia, Ignacio Chavez, Delegación Tlalpan, Mexico. niesza2001@hotmail.com
Soto
María Elena
ME
Bauk
Lucas
L
Miguel Casanova
José
J
Keirns
Candace
C
Avila Vanzzini
Nydia
N
Reyes
Pedro
P
D000293:Adolescent; D000328:Adult; D000418:Albumins; D003287:Contrast Media; D017023:Coronary Angiography; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging; D004176:Dipyridamole; D017548:Echocardiography, Transesophageal; D005260:Female; D005466:Fluorocarbons; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D013625:Takayasu Arteritis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging
D000418:Albumins; D003287:Contrast Media; C099458:FS 069; D005466:Fluorocarbons; D013794:Thallium Radioisotopes; D004176:Dipyridamole