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When Chest Pain Isn’t Coronary: Could a Hidden Gradient Be the Heart of the Problem?
Session:
Sessão de Posters 22 - Imagem em hemodinâmica complexa e doença valvular
Speaker:
Nuno Cotrim
Congress:
CPC 2026
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Nuno Cotrim; Beatriz Vargas Andrade; Bruno Miranda Castilho; Marisa Peres; Maria Luz Pitta; Carlos Cotrim; Vítor Martins
Abstract
<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif">INTRODUCTION: Angina without obstructive coronary artery disease (CAD) is reported more frequently in women than in men.<sup>1</sup> An intraventricular gradient (IVG) during exercise is a recognised non-ischaemic mechanism of chest pain.<sup>2</sup> This study evaluated whether a substantial proportion of women develop exercise-induced IVG as a potential explanation for their symptoms, and whether this prevalence differs from that in men, thereby supporting the need for targeted assessment in women presenting with angina and no obstructive CAD.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif">METHODS: Prospective, multicentre trial with 3 years duration including consecutive patients referred for exercise stress echocardiography (ESE) due to angina without prior CAD. IVG was defined as ≥ 50 mmHg.</span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif">RESULTS: A total of 150 patients were included, 48 women and 102 men, mean age of approximately ±55 years. Among women, 10 showed an IVG during exercise (20.8%), and 5 demonstrated ischemia (10.4%). Among men, 5 exhibited an IVG (4.9%), and 16 showed ischemia (15.7%).</span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif">IVG was significantly higher in women than in men (20.8% vs. 4.9%; p = 0.006). The distribution of ischemia did not differ meaningfully between women and men (10.4% vs. 15.7%; p = 0.54).</span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif">CONCLUSION: IVG was significantly higher in women than in men. This study highlights that dynamic intraventricular obstruction may be an important, often overlooked contributor to symptoms in women, reinforcing the need to actively search for this cause when evaluating female patients with chest pain and no obstructive CAD.</span></span></p> <p style="text-align:justify"> </p> <ol> <li style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif">Kobayashi Y, Fearon WF, Honda Y, et al. Effect of Sex Differences on Invasive Measures of Coronary Microvascular Dysfunction in Patients With Angina in the Absence of Obstructive Coronary Artery Disease. <em>JACC Cardiovasc Interv</em>. 2015;8(11):1433-1441. doi:10.1016/j.jcin.2015.03.045</span></span></li> <li style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif">Cotrim C, Almeida AG, Carrageta M. Exercise-induced intra-ventricular gradients as a frequent potential cause of myocardial ischemia in cardiac syndrome X patients. <em>Cardiovasc Ultrasound</em>. 2008;6:3. Published 2008 Jan 14. doi:10.1186/1476-7120-6-3</span></span></li> </ol>
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