Impact of Diastolic Vessel Restriction on Quality of Life in Symptomatic Myocardial Bridging Patients Treated With Surgical Unroofing: Preoperative Assessments With Intravascular Ultrasound and Coronary Computed Tomography Angiography

Background: Despite optimal medical therapy, a myocardial bridge (MB) can cause life-limiting symptoms in a subset of patients. While surgical unroofing has been shown to improve MB-derived refractory angina, diagnostic indices of clinical symptoms and predictors of improvement following surgery are yet to be elucidated. Methods: To identify determinants of preoperative symptoms and their improvement following the surgery, preoperative intravascular ultrasound (IVUS) and coronary computed tomography angiography were evaluated in 111 patients with symptomatic MB who underwent surgical unroofing. The primary outcome was the Seattle Angina Questionnaire summary score (the average of physical limitation, angina frequency, and quality of life scores). In addition to standard anatomic variables of an MB, degrees of extrinsic vessel restriction at end-diastole and end-systole were evaluated by IVUS using the ratio of measured vessel area and interpolated reference at the maximum compression site. The diastolic restriction was also evaluated by coronary computed tomography angiography as the maximum lumen area stenosis within the MB segment. Results: Even during diastole, IVUS revealed vessel restriction in 87% of the patients. Among the variables evaluated, vessel restriction was the strongest parameter correlating with the preoperative Seattle Angina Questionnaire summary score, particularly when assessed in diastole ( P <0.0001 in IVUS, P =0.006 in coronary computed tomography angiography). The diastolic restriction by IVUS also showed a weak, but significant correlation with improvement in Seattle Angina Questionnaire summary score 6 months after surgery ( P =0.004). Conclusions: Restricted arterial relaxation in diastole, rather than the degree of systolic compression or extent of an MB, seems to be the primary determinant of clinical symptoms and improvement in quality of life following surgical unroofing.

Improving Quality of Life with Percutaneous Coronary Intervention in Chronic Coronary Syndrome Patients with SYNTAX Score of More than 22

Background : The benefit of PCI to improve quality of life (QoL) in chronic coronary syndrome (CCS) is still unclear. Objectives : This study aimed to assess the benefit of percutaneous coronary intervention (PCI) in improving QoL among CCS patients receiving OMT. Methods : We conducted a retrospective cohort study. CCS patients who underwent coronary angiography (CAG) and/or PCI were grouped into OMT plus PCI and OMT groups. The SYNTAX score was used to assess the complexity and severity of coronary artery lesions. The outcome measured was QoL assessed using Seattle Angina Questionnaire (SAQ) and rehospitalization. Results: A total of 57 patients in the OMT plus PCI group and 49 patients in the OMT group were included. The percentage of patients with good QoL was higher in the OMT plus PCI group than OMT only group (64.5% vs. 35.5%; p = 0.007). The OMT plus PCI group revealed a better activities of daily living (85.11 ± 12.46 vs. 12.46 ± 21.87; p = 0.014) and angina stability (84.32 ± 23.63 vs. 71.81 ± 27.89; p = 0.014) than OMT group. Among patients with SYNTAX scores of more than 22, achievement of good QoL was greater in the OMT plus PCI group than the OMT group (80.8% vs. 45.5%; p = 0.025). Conclusion: PCI improved the QoL in CCS patients treated with OMT. Second, OMT plus PCI improves physical limitation and angina stability. For patients with a SYNTAX score of more than 22, OMT plus PCI was correlated with good QoL achievement.

Measurement Invariance of the Seattle Angina Questionnaire in Coronary Artery Disease

PurposeThe Seattle Angina Questionnaire (SAQ) is a widely used patient-reported measure of health status in patients with coronary artery disease. Comparisons of SAQ scores amongst population groups and over time rely on the assumption that its factorial structure is invariant (i.e., equivalent). This study evaluates the measurement invariance of the SAQ across different demographic and clinical groups as well as over time.MethodsData were obtained from the Alberta Provincial Project on Outcome Assessment in Coronary Heart Disease registry, a population-based registry of patients who received coronary angiogram in Alberta, Canada. Health-related quality of life was measured using the 16-item Canadian version of the SAQ (SAQ-CAN). Multi-group confirmatory factor analysis was used to assess configural, weak, strong, and strict measurement invariance (MI) across age groups, sex, disease type, treatment, and over time. Model fit was assessed using the comparative fit index (CFI), and root mean square error of approximation (RMSEA).ResultsOf the 8101 patients who completed the measure at baseline, 1300 (16.1%) were at least 75 years old, while 1755 (21.7%) were female, 5154 (63.6%) were diagnosed with acute coronary syndrome, while 1177(14.5%) received coronary artery bypass graft treatment. There was evidence of strict invariance across age, sex, and disease groups, but partial strict invariance was established across treatment sub-groups and over time.ConclusionSAQ-CAN is a valid measure for comparing health-related quality of life of coronary artery disease patients across population groups and over time.

Psychometric evaluation of a Canadian version of the Seattle Angina Questionnaire (SAQ-CAN)

Background The Seattle Angina Questionnaire (SAQ) is a widely-used patient-reported outcomes measure in patients with heart disease. This study assesses the validity and reliability of the SAQ in a Canadian cohort of individuals with stable angina. Methods and results Data are from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) registry, a population-based registry of patients who received cardiac catheterization in Alberta, Canada. The cohort consists of 4052 patients undergoing cardiac catheterization for stable angina and completed the SAQ within 2 weeks. Exploratory factor analysis and confirmatory factor analysis (CFA) were used to assess the factorial structure of the SAQ. Internal and test–retest reliabilities of a new measure (i.e., SAQ-CAN) was measured using Cronbach α and intraclass correlation coefficient, respectively. CFA model fit was assessed using the root mean square error of approximation (RMSEA) and comparative fit index (CFI). Construct validity of the SAQ-CAN was assessed in relation to Hospital Anxiety and Depression Scales (HADS), Euro Quality of life 5 dimension (EQ5D), and original SAQ. Of the 4052 patients included in this analysis, 3281 (80.97%) were younger than 75 years old, while 3239 (79.94%) were male. Both exploratory and confirmatory factor analyses revealed a four-factorial structure consisting of 16 items that provided a better fit to the data (RMSEA = 0.049 [90% CI = (0.047, 0.052)]; CFI = 0.975). The 16-item SAQ demonstrated good to excellent internal reliability (Cronbach’s α range from 0.77 to 0.90), moderate to strong correlation with the Original SAQ and EQ5D but negligible correlations with HADS. Conclusion The SAQ-CAN has acceptable psychometric properties that are comparable to the original SAQ. We recommend its use for assessing coronary health outcomes in Canadian patients with Coronary Artery Disease.

Health Status and Quality of Life of Patients Enrolled in a Specialized Refractory Angina Clinic

As the mortality of coronary artery disease improves and the population ages, an increasing number of patients with refractory angina are not candidates for percutaneous or surgical revascularization. We evaluated the impact of a dedicated refractory angina clinic on quality of life. In 76 patients who completed the Medical Outcomes Study 36-Item Short-Form Health Survey and Seattle Angina Questionnaire at baseline and 1 year, the Medical Outcomes Study results showed the proportion of patients who rated their health as “good” or “excellent” more than doubled from baseline to 1 year (15.8% vs. 42.2%; P < .001). Similarly, the Seattle Angina Questionnaire score was significantly improved at 1 year compared to baseline (P = .025), as were angina stability (P = 0.017) and angina frequency (P = .010). In conclusion, treatment in a dedicated clinic is associated with improved quality of life in patients with refractory angina.