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Wang X, Wu J, Zhu D, You J, Zou Y, Qian J, Ge J. Characterization of coronary flow reserve and left ventricular remodeling in a mouse model of chronic aortic regurgitation with carvedilol intervention. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:483-493. [PMID: 25715369 DOI: 10.7863/ultra.34.3.483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES We hypothesized that left ventricular (LV) remodeling might be exaggerated by an impaired coronary flow reserve in mice with chronic severe aortic regurgitation, and carvedilol, a β-adrenoceptor blocker, could regress the course. METHODS Severe aortic regurgitation was induced by retrograde puncture of the aortic valve leaflets under sonographic guidance in 12-week-old male C57BL/6J mice. Four weeks after regurgitation, the mice were treated with carvedilol (30 mg/kg/d) or not treated (control). Before and 4 weeks after carvedilol treatment, the coronary flow reserve and LV structure and function were evaluated by echocardiography. Cardiomyocytes and fibrosis were validated by histologic analysis. RESULTS Four-week aortic regurgitation caused a decreased LV ejection fraction and an increased LV end-systolic volume index. Regurgitation also impaired the coronary flow reserve due to an increase in the basal coronary peak diastolic velocity and velocity-time integral combined with the absence of substantial changes in the hyperemic coronary peak diastolic velocity and velocity-time integral. Four more weeks of regurgitation further deteriorated LV remodeling and coronary perfusion in the control group. In contrast, the carvedilol-treated group showed attenuated LV remodeling and a higher coronary flow reserve by decreasing the basal peak diastolic velocity and velocity-time integral without substantial changes in the hyperemic peak diastolic velocity and velocity-time integral. The coronary flow reserve and its pretreatment versus posttreatment difference were positively correlated with the pretreatment versus posttreatment LV ejection fraction and end-systolic volume index differences. In the carvedilol-treated group, subendocardial fibrosis was significantly reduced (P < .05), and the cardiomyocyte cross-sectional area tended to be smaller. CONCLUSIONS In mice with chronic severe aortic regurgitation, carvedilol therapy significantly improves the impaired coronary flow reserve and sufficiently attenuates adverse LV remodeling. Sustained coronary flow reserve impairment indicates progressive LV remodeling.
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Affiliation(s)
- Xiangfei Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China (X.W., J.W., J.Y., Y.Z., J.Q., J.G.); Department of Physiology, University of Toronto, Toronto, Ontario, Canada (J.W.); and Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China (D.Z.)
| | - Jian Wu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China (X.W., J.W., J.Y., Y.Z., J.Q., J.G.); Department of Physiology, University of Toronto, Toronto, Ontario, Canada (J.W.); and Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China (D.Z.)
| | - Dan Zhu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China (X.W., J.W., J.Y., Y.Z., J.Q., J.G.); Department of Physiology, University of Toronto, Toronto, Ontario, Canada (J.W.); and Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China (D.Z.)
| | - Jieyun You
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China (X.W., J.W., J.Y., Y.Z., J.Q., J.G.); Department of Physiology, University of Toronto, Toronto, Ontario, Canada (J.W.); and Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China (D.Z.)
| | - Yunzeng Zou
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China (X.W., J.W., J.Y., Y.Z., J.Q., J.G.); Department of Physiology, University of Toronto, Toronto, Ontario, Canada (J.W.); and Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China (D.Z.)
| | - Juying Qian
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China (X.W., J.W., J.Y., Y.Z., J.Q., J.G.); Department of Physiology, University of Toronto, Toronto, Ontario, Canada (J.W.); and Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China (D.Z.)
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China (X.W., J.W., J.Y., Y.Z., J.Q., J.G.); Department of Physiology, University of Toronto, Toronto, Ontario, Canada (J.W.); and Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China (D.Z.).
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Rabkin SW. Differences in coronary blood flow in aortic regurgitation and systemic arterial hypertension have implications for diastolic blood pressure targets: a systematic review and meta-analysis. Clin Cardiol 2013; 36:728-36. [PMID: 24037941 DOI: 10.1002/clc.22194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 07/09/2013] [Indexed: 11/06/2022] Open
Abstract
The objective was to evaluate coronary blood flow (CBF) in patients with systemic arterial hypertension (HTN) and to compare it with CBF in patients with aortic regurgitation (AR). A systematic literature search was conducted using the reference terms "coronary blood flow" and either "aortic regurgitation" or "hypertension." The selection criteria included CBF measurement in a concomitant control group, except studies evaluating CBF with aortic-valve replacement surgery. Twenty-two studies met the inclusion criteria. There were 318 persons with HTN, with 185 controls; and 102 persons with AR, with 144 controls. Despite an overall increase in CBF in HTN, CBF per gram of left ventricular mass was significantly (P < 0.0001) reduced. In contrast, CBF per gram of left ventricular mass was significantly (P = 0.004) increased in AR. Aortic regurgitation was associated with a significant (P < 0.0001) increase in CBF during systole and away from diastole, in contrast to persons with HTN. Aortic-valve replacement reversed the increase in systolic CBF. These data suggest that patients with HTN are more vulnerable than patients with AR to lower diastolic blood pressure (DBP), because resting CBF is compromised in HTN. Furthermore, patients with HTN may not compensate for DBP reductions by shifting CBF to systole, such as can occur with the low DBP in AR. Lower DBP in patients with AR cannot be used to justify treating patients with HTN to similar DBP because of the dramatic differences in CBF between the 2 conditions.
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Affiliation(s)
- Simon W Rabkin
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Aksoy S, Cam N, Guney MR, Gurkan U, Oz D, Poyraz E, Eksik A, Agirbasli M. Myocardial Ischemia in Severe Aortic Regurgitation Despite Angiographically Normal Coronary Arteries. TOHOKU J EXP MED 2012; 226:69-73. [DOI: 10.1620/tjem.226.69] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Sukru Aksoy
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Nese Cam
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Mehmet Rasit Guney
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Ufuk Gurkan
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Dilaver Oz
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Esra Poyraz
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Abdurrahman Eksik
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Mehmet Agirbasli
- Department of Cardiology, Marmara University, Faculty of Medicine
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Kasprzak JD, Drozdz J, Peruga JZ, Rafalska K, Krzemińska-Pakuła M. Definition of flow parameters in proximal nonstenotic coronary arteries using transesophageal Doppler echocardiography. Echocardiography 2000; 17:141-50. [PMID: 10978972 DOI: 10.1111/j.1540-8175.2000.tb01115.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Transesophageal echocardiography (TEE) enables the visualization of proximal coronary arteries. We investigated the feasibility of coronary flow evaluation using TEE, as well as to define flow parameters found in normal proximal coronary arteries. The subgroups of patients with normal proximal segments of coronary arteries were selected from the cohort of 210 patients undergoing routine coronary angiography. The left main coronary artery (LMCA), proximal segment of left anterior descending coronary artery (LAD), left circumflex artery (LCx), and right coronary artery (RCA) were analyzed separately in 147, 64, 53, and 70 patients, respectively. Proximal coronary arteries were evaluated in the transverse plane using a 5-MHz TEE probe, and the flow in normal arteries was registered using pulsed-wave Doppler. The registration of flow with pulsed-wave Doppler was feasible in 88% of studies for the LMCA, 85% for the LAD, 58% for the LCx, and 65% for the RCA. Normal flow was laminar with distinct phasic character (diastolic predominance). Mean +/- SD values of peak coronary flow velocity were (systole/diastole) for the LMCA, 36 +/- 11/71 +/- 19 cm/sec; the LAD, 31 +/- 9/67 +/- 19 cm/sec; the LCx, 36 +/- 13/75 +/- 24 cm/sec; and the RCA, 25 +/- 8/39 +/- 12 cm/sec. Peak diastolic coronary flow velocity was most significantly correlated with heart rate. Doppler evaluation of proximal coronary flow is feasible using TEE in the majority of patients. The knowledge of normal flow values, which is different for the left and the right coronary artery, provides the background for proper interpretation of flow in diseased coronary arteries.
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Affiliation(s)
- J D Kasprzak
- Department of Cardiology, Biegański Hospital, Institute of Internal Medicine, Medical University of Lódz, ul. Kniaziewicza 1/5, 91-347, Lódz, Poland
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Miyazono Y, Kisanuki A, Toyonaga K, Matsushita R, Otsuji Y, Arima S, Nakao S, Tanaka H. Usefulness of adenosine triphosphate-atropine stress echocardiography for detecting coronary artery stenosis. Am J Cardiol 1998; 82:290-4. [PMID: 9708655 DOI: 10.1016/s0002-9149(98)00345-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There have been few studies on adenosine triphosphate (AT) stress echocardiography. The AT stress test may have fewer adverse effects than the adenosine stress test. The addition of atropine to AT echocardiography may enhance the sensitivity for detection of coronary artery disease (CAD). The purpose of this study was to determine the utility of AT-atropine echocardiography for detection of CAD. The group studied consisted of 112 patients with suspected CAD. Sixty-one patients did not have a history of prior myocardial infarction (group I) and 51 patients did (group II). AT was infused intravenously at 180 microg/kg/min for 14 minutes. Atropine (0.25 mg intravenously, repeated up to maximum total dose of 1 mg) was administered starting after 8 minutes of AT infusion. Ischemic response was defined as new or worsening wall motion abnormality occurring during the infusion. The sensitivity and specificity for detection of CAD were assessed using the representative echocardiograms during single AT infusion and AT-atropine infusion. Sixty-two patients had CAD. Fifty-eight patients (52%) developed minor side effects that resolved promptly. The rate-pressure product (10(3)/mm Hg beats/min) was significantly increased at 12 minutes of infusion (12.4+/-3.2) compared with that at baseline (9.1+/-2.3) and that at 6 minutes of infusion (9.4+/-2.1). The sensitivity for detection of CAD was 45% for AT echocardiography and 74% for AT-atropine echocardiography. The specificity was 94% for AT echocardiography and 90% for AT-atropine echocardiography. The sensitivity and specificity of AT-atropine echocardiography was 78% and 93%, respectively, in group I, and 70% and 86%, respectively, in group II. In conclusion, AT-atropine stress echocardiography seems to be well tolerated, safe, and useful for detection of CAD.
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Affiliation(s)
- Y Miyazono
- First Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Kagoshima City, Japan
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