Echocardiographic and Morphological Correlation of Winking Coronary Sign on Coronary Angiography
Background: A serious complication of acute myocardial infarction is a ventricular septal rupture (VSR), which is lethal if untreated. Hemodynamic and mechanical theories have been proposed for the Winking coronary sign (WCS) of the infarct-related culprit artery on coronary angiography (CAG) in VSR...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2025-01-01
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| Series: | Journal of Clinical and Preventive Cardiology |
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| Online Access: | https://journals.lww.com/10.4103/jcpc.jcpc_13_25 |
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| author | Kamal Sharma Gunjan Shah Sharad Jain Iva Patel Devratsinh Parma Maulik Kalyani Dixit Dhorajiya Arjun Lal |
| author_facet | Kamal Sharma Gunjan Shah Sharad Jain Iva Patel Devratsinh Parma Maulik Kalyani Dixit Dhorajiya Arjun Lal |
| author_sort | Kamal Sharma |
| collection | DOAJ |
| description | Background:
A serious complication of acute myocardial infarction is a ventricular septal rupture (VSR), which is lethal if untreated. Hemodynamic and mechanical theories have been proposed for the Winking coronary sign (WCS) of the infarct-related culprit artery on coronary angiography (CAG) in VSR patients. However, whether other structural (aneurysm) or hemodynamic changes (raised left ventricular end-diastolic pressure [LVEDP]) alone can cause WCS is not evaluated. We aimed to evaluate echocardiographic and angiographic findings in patients with WCS on CAG.
Methods:
The study was observational single centre study enrolling 251 patients which comprised of 132 consecutive VSR cases (Group A) and age and gender matched 51 LV Aneurysm/Dyskinetic/Akinetic segments (Group B) and 68 raised LVEDP (Group C) patients as control arms.
Results:
The baseline characteristics were matched between all three groups. Among 132 patients with VSR, WCS was observed in 40.15% of patients, while Group B and C had no WCS. A significantly higher number of patients with time in myocardial infarction (TIMI) flow 0 with VSR had absent WCS, while patients with TIMI 1–3 flow were significantly higher to have WCS in Group A. As compared to Group A (n = 1; 1.9%), a significantly higher number of patients had left circumflex artery (left circumflex involvement) involvement in Group B (n = 2; 3.9%) and Group C (n = 6; 8.8%) without WCS. There was no significant correlation between the size and location of VSR to the occurrence of WCS.
Conclusions:
WCS is only observed in VSR patients and not seen in patients with LV aneurysm/dyskinetic or akinetic segment or in patients with raised LVEDP, suggesting Venturi effect and mechanical instability of inter ventricular septum as the primary mechanism behind WCS. |
| format | Article |
| id | doaj-art-3a7763887d0e45fcbc2942fe768805de |
| institution | OA Journals |
| issn | 2250-3528 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Clinical and Preventive Cardiology |
| spelling | doaj-art-3a7763887d0e45fcbc2942fe768805de2025-08-20T02:02:47ZengWolters Kluwer Medknow PublicationsJournal of Clinical and Preventive Cardiology2250-35282025-01-01141151910.4103/jcpc.jcpc_13_25Echocardiographic and Morphological Correlation of Winking Coronary Sign on Coronary AngiographyKamal SharmaGunjan ShahSharad JainIva PatelDevratsinh ParmaMaulik KalyaniDixit DhorajiyaArjun LalBackground: A serious complication of acute myocardial infarction is a ventricular septal rupture (VSR), which is lethal if untreated. Hemodynamic and mechanical theories have been proposed for the Winking coronary sign (WCS) of the infarct-related culprit artery on coronary angiography (CAG) in VSR patients. However, whether other structural (aneurysm) or hemodynamic changes (raised left ventricular end-diastolic pressure [LVEDP]) alone can cause WCS is not evaluated. We aimed to evaluate echocardiographic and angiographic findings in patients with WCS on CAG. Methods: The study was observational single centre study enrolling 251 patients which comprised of 132 consecutive VSR cases (Group A) and age and gender matched 51 LV Aneurysm/Dyskinetic/Akinetic segments (Group B) and 68 raised LVEDP (Group C) patients as control arms. Results: The baseline characteristics were matched between all three groups. Among 132 patients with VSR, WCS was observed in 40.15% of patients, while Group B and C had no WCS. A significantly higher number of patients with time in myocardial infarction (TIMI) flow 0 with VSR had absent WCS, while patients with TIMI 1–3 flow were significantly higher to have WCS in Group A. As compared to Group A (n = 1; 1.9%), a significantly higher number of patients had left circumflex artery (left circumflex involvement) involvement in Group B (n = 2; 3.9%) and Group C (n = 6; 8.8%) without WCS. There was no significant correlation between the size and location of VSR to the occurrence of WCS. Conclusions: WCS is only observed in VSR patients and not seen in patients with LV aneurysm/dyskinetic or akinetic segment or in patients with raised LVEDP, suggesting Venturi effect and mechanical instability of inter ventricular septum as the primary mechanism behind WCS.https://journals.lww.com/10.4103/jcpc.jcpc_13_25acute myocardial infarctionleft circumflex involvementventricular septal rupturewinking coronary sign |
| spellingShingle | Kamal Sharma Gunjan Shah Sharad Jain Iva Patel Devratsinh Parma Maulik Kalyani Dixit Dhorajiya Arjun Lal Echocardiographic and Morphological Correlation of Winking Coronary Sign on Coronary Angiography Journal of Clinical and Preventive Cardiology acute myocardial infarction left circumflex involvement ventricular septal rupture winking coronary sign |
| title | Echocardiographic and Morphological Correlation of Winking Coronary Sign on Coronary Angiography |
| title_full | Echocardiographic and Morphological Correlation of Winking Coronary Sign on Coronary Angiography |
| title_fullStr | Echocardiographic and Morphological Correlation of Winking Coronary Sign on Coronary Angiography |
| title_full_unstemmed | Echocardiographic and Morphological Correlation of Winking Coronary Sign on Coronary Angiography |
| title_short | Echocardiographic and Morphological Correlation of Winking Coronary Sign on Coronary Angiography |
| title_sort | echocardiographic and morphological correlation of winking coronary sign on coronary angiography |
| topic | acute myocardial infarction left circumflex involvement ventricular septal rupture winking coronary sign |
| url | https://journals.lww.com/10.4103/jcpc.jcpc_13_25 |
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