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Civieri G, Kerkhof PLM, Montisci R, Iliceto S, Tona F. Sex differences in diagnostic modalities of coronary artery disease: Evidence from coronary microcirculation. Atherosclerosis 2023; 384:117276. [PMID: 37775426 DOI: 10.1016/j.atherosclerosis.2023.117276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/16/2023] [Accepted: 09/01/2023] [Indexed: 10/01/2023]
Abstract
Although atherosclerosis is usually considered a disease of the large arteries, risk factors for atherosclerosis also trigger structural and functional abnormalities at a microvascular level. In cardiac disease, microvascular dysfunction is especially relevant in women, among whom the manifestation of ischemic disease due to impaired coronary microcirculation is more common than in men. This sex-specific clinical phenotype has important clinical implications and, given the higher pre-test probability of coronary microvascular dysfunction in females, different diagnostic modalities should be used in women compared to men. In this review, we summarize invasive and non-invasive diagnostic modalities to assess coronary microvascular function, ranging from catheter-based evaluation of endothelial function to Doppler echocardiography and positron emission tomography. Moreover, we discuss different clinical settings in which microvascular disease plays an important role, underlining the importance of choosing the right diagnostic modality depending on the sex of the patients.
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Affiliation(s)
- Giovanni Civieri
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Peter L M Kerkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, VUmc, Amsterdam, the Netherlands
| | - Roberta Montisci
- Clinical Cardiology, AOU Cagliari, Department of Medical Science and Public Health, University of Cagliari, Italy
| | - Sabino Iliceto
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Francesco Tona
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
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2
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Garber L, Khodaei S, Maftoon N, Keshavarz-Motamed Z. Impact of TAVR on coronary artery hemodynamics using clinical measurements and image-based patient-specific in silico modeling. Sci Rep 2023; 13:8948. [PMID: 37268642 DOI: 10.1038/s41598-023-31987-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/21/2023] [Indexed: 06/04/2023] Open
Abstract
In recent years, transcatheter aortic valve replacement (TAVR) has become the leading method for treating aortic stenosis. While the procedure has improved dramatically in the past decade, there are still uncertainties about the impact of TAVR on coronary blood flow. Recent research has indicated that negative coronary events after TAVR may be partially driven by impaired coronary blood flow dynamics. Furthermore, the current technologies to rapidly obtain non-invasive coronary blood flow data are relatively limited. Herein, we present a lumped parameter computational model to simulate coronary blood flow in the main arteries as well as a series of cardiovascular hemodynamic metrics. The model was designed to only use a few inputs parameters from echocardiography, computed tomography and a sphygmomanometer. The novel computational model was then validated and applied to 19 patients undergoing TAVR to examine the impact of the procedure on coronary blood flow in the left anterior descending (LAD) artery, left circumflex (LCX) artery and right coronary artery (RCA) and various global hemodynamics metrics. Based on our findings, the changes in coronary blood flow after TAVR varied and were subject specific (37% had increased flow in all three coronary arteries, 32% had decreased flow in all coronary arteries, and 31% had both increased and decreased flow in different coronary arteries). Additionally, valvular pressure gradient, left ventricle (LV) workload and maximum LV pressure decreased by 61.5%, 4.5% and 13.0% respectively, while mean arterial pressure and cardiac output increased by 6.9% and 9.9% after TAVR. By applying this proof-of-concept computational model, a series of hemodynamic metrics were generated non-invasively which can help to better understand the individual relationships between TAVR and mean and peak coronary flow rates. In the future, tools such as these may play a vital role by providing clinicians with rapid insight into various cardiac and coronary metrics, rendering the planning for TAVR and other cardiovascular procedures more personalized.
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Affiliation(s)
- Louis Garber
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - Seyedvahid Khodaei
- Department of Mechanical Engineering (Mail to JHE-310), McMaster University, Hamilton, ON, L8S 4L7, Canada
| | - Nima Maftoon
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
- Centre for Bioengineering and Biotechnology, University of Waterloo, Waterloo, ON, Canada
| | - Zahra Keshavarz-Motamed
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.
- Department of Mechanical Engineering (Mail to JHE-310), McMaster University, Hamilton, ON, L8S 4L7, Canada.
- School of Computational Science and Engineering, McMaster University, Hamilton, ON, Canada.
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Nagai H, Okuda S, Nakao F, Ueyama T, Ikeda Y. The usefulness of subcostal view for the detection of severe stenosis in the middle segment of right coronary artery using coronary artery Doppler echocardiography. J Echocardiogr 2023; 21:59-60. [PMID: 34449027 DOI: 10.1007/s12574-021-00549-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/14/2021] [Accepted: 08/18/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Hitoshi Nagai
- Division of Central Clinical Laboratory, Yamaguchi Prefectural Grand Medical Center, 10077, Oaza-Osaki, Hofu, Yamaguchi, 747-8511, Japan.
| | - Shinichi Okuda
- Department of Cardiology, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
| | - Fumiaki Nakao
- Department of Cardiology, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
| | - Takeshi Ueyama
- Department of Cardiology, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
| | - Yasuhiro Ikeda
- Department of Cardiology, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
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Heart Rate Lowering Significantly Increases Feasibility in Doppler Recording Blood Flow Velocity in Coronaries during Transthoracic Doppler Echocardiography. Diagnostics (Basel) 2023; 13:diagnostics13040670. [PMID: 36832158 PMCID: PMC9955744 DOI: 10.3390/diagnostics13040670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/25/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
Background: Coronary blood flow Doppler recording by Transthoracic Doppler in convergent mode (E-Doppler TTE) might be further improved by lowering heart rate (HRL) down to <60 bpm, since low HR < 60 b/m causes a disproportional lengthening of the diastole, so the coronaries are still for a longer time, very much improving the Doppler signal/noise ratio. Methods: A group of 26 patients underwent E-Doppler TTE before and after HR lowering in four branches of the coronary tree, namely, the left main (LMCA); left anterior descending (LAD), subdivided into three segments: proximal, mid and distal; proximal left circumflex (LCx); and obtuse marginal (OM). Color and PW coronary Doppler signal was judged by two expert observers as undetectable (SCORE 1), weak or with clutter artifacts (SCORE 2), or well delineated (SCORE 3). In addition, local accelerated stenotic flow (AsF) was measured in the LAD before and after HRL. Results: Beta-blockers significantly decreased the mean HR from 76 ± 5 to 57 ± 6 bpm (p < 0.001). Before HRL, the Doppler quality was very poor in the proximal and mid-LAD segments (median score value = 1 in both), while in the distal LAD, it was significantly better but still suboptimal (median score value = 1.5, p = 0.009 vs. proximal and mid-LAD score). After HRL, blood flow Doppler recording in the three LAD segments was strikingly improved (median score value = 3, 3 and 3, p = ns), so the effect of HRL was more efficacious in the two more proximal LAD segments. In 10 patients undergoing coronary angiography (CA), no AsF as expression of transtenotic velocity was detected at baseline. After HRL, thanks to the better quality and length of color flow, ASF was detected in five patients while in five others, it was not in perfect agreement with CA (Spearman correlation coefficient = 1, p < 0.01). The color flow in the proximal LCx and OM was extremely poor at baseline (color flow length 0 and 0, median (interquartile range) mm, respectively) and improved considerably after HRL (color flow length 23 [13.5] and 25 [12.0] mm, respectively, p < 0.001). Conclusions: HRL greatly improved the success rate of blood flow Doppler recording in coronaries, not only in the LAD, but also in the LCx. Therefore, AsF for stenosis detection and coronary flow reserve assessment can have wider clinical applications. However, further studies with larger samples are needed to confirm these results.
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Leo I, Nakou E, Artico J, Androulakis E, Wong J, Moon JC, Indolfi C, Bucciarelli-Ducci C. Strengths and weaknesses of alternative noninvasive imaging approaches for microvascular ischemia. J Nucl Cardiol 2023; 30:227-238. [PMID: 35918590 DOI: 10.1007/s12350-022-03066-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/19/2022] [Indexed: 11/26/2022]
Abstract
Structural and functional abnormalities of coronary microvasculature are highly prevalent in several clinical settings and often associated with worse clinical outcomes. Therefore, there is a growing interest in the detection and treatment of this, often overlooked, disease. Coronary angiography allows the assessment of the Coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR). However, the measurement of these parameters is not always feasible because of limited technical availability and the need for a cardiac catheterization with a small but real risk of potential complications. Recent advances in non-invasive imaging techniques allow the assessment of coronary microvascular function with good accuracy and reproducibility. The objective of this review is to discuss the strengths and weaknesses of alternative non-invasive approaches used in the diagnosis of coronary microvascular dysfunction (CMD), highlighting the most recent advances for each imaging modality.
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Affiliation(s)
- Isabella Leo
- Royal Brompton and Harefield Hospitals, Guys's and St Thomas' NHS Foundation Trust, London, UK
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Eleni Nakou
- Royal Brompton and Harefield Hospitals, Guys's and St Thomas' NHS Foundation Trust, London, UK
| | - Jessica Artico
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- St Bartholomew's Hospital, Barts Heart Centre, West Smithfield, London, UK
| | - Emmanouil Androulakis
- Royal Brompton and Harefield Hospitals, Guys's and St Thomas' NHS Foundation Trust, London, UK
| | - Joyce Wong
- Royal Brompton and Harefield Hospitals, Guys's and St Thomas' NHS Foundation Trust, London, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- St Bartholomew's Hospital, Barts Heart Centre, West Smithfield, London, UK
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys's and St Thomas' NHS Foundation Trust, London, UK.
- Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King's College University, London, UK.
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Civieri G, Montisci R, Kerkhof PLM, Iliceto S, Tona F. Coronary Flow Velocity Reserve by Echocardiography: Beyond Atherosclerotic Disease. Diagnostics (Basel) 2023; 13:diagnostics13020193. [PMID: 36673004 PMCID: PMC9858233 DOI: 10.3390/diagnostics13020193] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023] Open
Abstract
Coronary flow velocity reserve (CFVR) is defined as the ratio between coronary flow velocity during maximal hyperemia and coronary flow at rest. Gold-standard techniques to measure CFVR are either invasive or require radiation and are therefore inappropriate for large-scale adoption. More than 30 years ago, echocardiography was demonstrated to be a reliable tool to assess CFVR, and its field of application rapidly expanded. Although initially validated to assess the hemodynamic relevance of a coronary stenosis, CFVR by echocardiography was later used to investigate coronary microcirculation. Microvascular dysfunction was detected in many different conditions, ranging from organ transplantation to inflammatory disorders and from metabolic diseases to cardiomyopathies. Moreover, it has been proven that CFVR by echocardiography not only detects coronary microvascular involvement but is also an effective prognostic factor that allows a precise risk stratification of the patients. In this review, we will summarize the many applications of CFVR by echocardiography, focusing on the coronary involvement of systemic diseases.
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Affiliation(s)
- Giovanni Civieri
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy
| | - Roberta Montisci
- Clinical Cardiology, AOU Cagliari, Department of Medical Science and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Peter L. M. Kerkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, VUmc, 1081 HV Amsterdam, The Netherlands
| | - Sabino Iliceto
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy
| | - Francesco Tona
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy
- Correspondence: ; Tel.: +39-049-8211844
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Detection of left coronary ostial obstruction during transcatheter aortic valve replacement by coronary flow velocity measurement in the left main trunk by intraoperative transesophageal echocardiography. J Cardiol 2023; 81:97-104. [PMID: 36114119 DOI: 10.1016/j.jjcc.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/27/2022] [Accepted: 08/09/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Coronary obstruction is a rare but catastrophic complication of transcatheter aortic valve replacement (TAVR) and occurs mostly at the left coronary artery (LCA) ostium. However, some patients do not show any clinical findings, and thus, its detection is sometimes difficult. The peak diastolic flow velocity in left main coronary artery (LM) was reportedly increased in significant stenosis lesions. We evaluated the effectiveness of measuring blood flow velocities in LM by transesophageal echocardiography (TEE) for the detection of LCA ostial obstruction during a TAVR procedure. METHODS A total of 1105 consecutive patients who underwent TAVR in Sendai Kousei Hospital between September 2014 and December 2020 were enrolled. The LM blood flow velocity was measured at pre- and post-valve implantation. RESULTS Among the 1105 patients, 9 had LCA ostial obstruction. The peak LM blood flow velocity at post-TAVR [0.90 (0.39-1.15) vs. 0.37 (0.28-0.50) m/s; p = 0.0046) was significantly higher in 9 patients who had LCA ostial obstruction, compared with the remaining 1096 patients who had not (controls), although no significant difference was observed before the TAVR procedures between the two groups. The post- to pre-TAVR LM flow velocity ratio [2.26 (1.31-3.42) vs. 1.06 (0.82-1.36); p = 0.0030] was also significantly higher in patients with LCA obstruction, compared to the controls. Furthermore, the post- to pre-TAVR LM blood flow velocity ratio was >2.0 in all six hemodynamically stable patients with LCA obstruction, whereas <2.0 in all three patients with LCA obstruction who showed hemodynamic collapse at post-TAVR procedure. CONCLUSION Coronary blood flow velocity in LM significantly increased in hemodynamically stable LCA obstruction patients. The intraprocedural TEE measurement of the LM flow velocities would be potentially useful to detect asymptomatic and hemodynamically stable LCA ostial obstruction.
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Serial changes of coronary flow reserve over one year after transcatheter aortic valve implantation in patients with severe aortic stenosis. IJC HEART & VASCULATURE 2022; 42:101090. [PMID: 35873862 PMCID: PMC9304717 DOI: 10.1016/j.ijcha.2022.101090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 01/09/2023]
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Correlation between Cardiac Ultrasound-Related Indicators and Cardiac Function in Patients with Coronary Heart Disease and Heart Failure. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5754922. [PMID: 35845576 PMCID: PMC9279035 DOI: 10.1155/2022/5754922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 11/17/2022]
Abstract
Objective The purpose of this paper is to analyse the correlation between cardiac ultrasound-related indicators and cardiac function in patients with coronary heart disease and heart failure. Methods In this experiment, a total of 160 patients with coronary heart disease and heart failure who were diagnosed and treated in our hospital from June 2019 to March 2021 were recruited as the study group. All were examined by colour Doppler ultrasound instrument, SPSS statistical software was used to analyse the data obtained, and Spearman correlation was used to analyse the correlation between cardiac ultrasound-related indicators and cardiac function in patients with coronary heart disease and heart failure. Results In the study group, there were 68 patients with grade II cardiac function, accounting for 42.50%; 74 patients with grade III, accounting for 46.25%; and 18 patients with grade IV, accounting for 11.25%. The ultrasound parameters of the patients in the study group were profiled and calculated, and then statistically analysed with cardiac function grading. Cardiac function classification was significantly positively correlated with LVMI, LAD, and LVEDd (r = 0.689/0.915/0.928, P=0.001) and significantly negatively correlated with CI, LVFS, and LVEF (r = −0.689/−0.878/−0.912), P=0.001). Conclusion Cardiac ultrasound-related indicators are associated with patients with coronary heart disease and heart failure. With the decline of cardiac function in patients with coronary heart disease and heart failure, the patient's condition is aggravated. Therefore, cardiac ultrasound-related indicators play a major role in the diagnosis of clinical disease progression.
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Mangiacapra F, Viscusi MM, Verolino G, Paolucci L, Nusca A, Melfi R, Ussia GP, Grigioni F. Invasive Assessment of Coronary Microvascular Function. J Clin Med 2021; 11:jcm11010228. [PMID: 35011968 PMCID: PMC8745537 DOI: 10.3390/jcm11010228] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 01/01/2023] Open
Abstract
The critical role of the coronary microvascular compartment and its invasive functional assessment has become apparent in light of the significant proportion of patients presenting signs and symptoms of myocardial ischemia, despite the absence of epicardial disease, or after the adequate treatment of it. However, coronary microvascular dysfunction (CMD) represents a diagnostic challenge because of the small dimensions of the coronary microvasculature, which prevents direct angiographic visualization. Several diagnostic tools are now available for the invasive assessment of the coronary microvascular function, which, in association with the physiological indices used to investigate the epicardial department, may provide a comprehensive evaluation of the coronary circulation as a whole. Recent evidence suggests that the physiology-guided management of CMD, although apparently costly and time-consuming, may offer a net clinical benefit in terms of symptom improvement among patients with angina and ischemic heart disease. However, despite the results of several observational studies, the prognostic effect of the physiology-driven management of CMD within this population is currently a matter of debate, and therefore represents an unmet clinical need that urgently deserves further investigation.
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Aleksandric SB, Djordjevic-Dikic AD, Giga VL, Tesic MB, Soldatovic IA, Banovic MD, Dobric MR, Vukcevic V, Tomasevic MV, Orlic DN, Boskovic N, Jovanovic I, Nedeljkovic MA, Stankovic G, Ostojic MC, Beleslin BD. Coronary Flow Velocity Reserve Using Dobutamine Test for Noninvasive Functional Assessment of Myocardial Bridging. J Clin Med 2021; 11:jcm11010204. [PMID: 35011945 PMCID: PMC8745827 DOI: 10.3390/jcm11010204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/18/2022] Open
Abstract
Background: It has been shown that coronary flow velocity reserve (CFVR) measurement by transthoracic Doppler echocardiography (TTDE) during dobutamine (DOB) provocation provides a more accurate functional evaluation of myocardial bridging (MB) compared to adenosine. However; the cut-off value of CFVR during DOB for identification of MB associated with myocardial ischemia has not been fully clarified. Purpose: This prospective study aimed to determine the cut-off value of TTDE-CFVR during DOB in patients with isolated-MB, as compared with stress-induced wall motion abnormalities (VMA) during exercise stress-echocardiography (SE) as reference. Methods: Eighty-one symptomatic patients (55 males [68%], mean age 56 ± 10 years; range: 27–74 years) with the existence of isolated-MB on the left anterior descending artery (LAD) and systolic MB-compression ≥50% diameter stenosis (DS) were eligible to participate in the study. Each patient underwent treadmill exercise-SE, invasive coronary angiography, and TTDE-CFVR measurements in the distal segment of LAD during DOB infusion (DOB: 10–40 μg/kg/min). Using quantitative coronary angiography, both minimal luminal diameter (MLD) and percent DS at MB-site at end-systole and end-diastole were determined. Results: Stress-induced myocardial ischemia with the occurrence of WMA was found in 23 patients (28%). CFVR during peak DOB was significantly lower in the SE-positive group compared with the SE-negative group (1.94 ± 0.16 vs. 2.78 ± 0.53; p < 0.001). ROC analyses identified the optimal CFVR cut-off value ≤ 2.1 obtained during high-dose dobutamine (>20 µg/kg/min) for the identification of MB associated with stress-induced WMA, with a sensitivity, specificity, positive and negative predictive value of 96%, 95%, 88%, and 98%, respectively (AUC 0.986; 95% CI: 0.967–1.000; p < 0.001). Multivariate logistic regression analysis revealed that MLD and percent DS, both at end-diastole, were the only independent predictors of ischemic CFVR values ≤2.1 (OR: 0.023; 95% CI: 0.001–0.534; p = 0.019; OR: 1.147; 95% CI: 1.042–1.263; p = 0.005; respectively). Conclusions: Noninvasive CFVR during dobutamine provocation appears to be an additional and important noninvasive tool to determine the functional severity of isolated-MB. A transthoracic CFVR cut-off ≤2.1 measured at a high-dobutamine dose may be adequate for detecting myocardial ischemia in patients with isolated-MB.
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Affiliation(s)
- Srdjan B. Aleksandric
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (A.D.D.-D.); (V.L.G.); (M.B.T.); (M.D.B.); (M.R.D.); (V.V.); (M.V.T.); (D.N.O.); (N.B.); (I.J.); (M.A.N.); (G.S.); (B.D.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.A.S.); (M.C.O.)
- Correspondence:
| | - Ana D. Djordjevic-Dikic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (A.D.D.-D.); (V.L.G.); (M.B.T.); (M.D.B.); (M.R.D.); (V.V.); (M.V.T.); (D.N.O.); (N.B.); (I.J.); (M.A.N.); (G.S.); (B.D.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.A.S.); (M.C.O.)
| | - Vojislav L. Giga
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (A.D.D.-D.); (V.L.G.); (M.B.T.); (M.D.B.); (M.R.D.); (V.V.); (M.V.T.); (D.N.O.); (N.B.); (I.J.); (M.A.N.); (G.S.); (B.D.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.A.S.); (M.C.O.)
| | - Milorad B. Tesic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (A.D.D.-D.); (V.L.G.); (M.B.T.); (M.D.B.); (M.R.D.); (V.V.); (M.V.T.); (D.N.O.); (N.B.); (I.J.); (M.A.N.); (G.S.); (B.D.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.A.S.); (M.C.O.)
| | - Ivan A. Soldatovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.A.S.); (M.C.O.)
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marko D. Banovic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (A.D.D.-D.); (V.L.G.); (M.B.T.); (M.D.B.); (M.R.D.); (V.V.); (M.V.T.); (D.N.O.); (N.B.); (I.J.); (M.A.N.); (G.S.); (B.D.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.A.S.); (M.C.O.)
| | - Milan R. Dobric
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (A.D.D.-D.); (V.L.G.); (M.B.T.); (M.D.B.); (M.R.D.); (V.V.); (M.V.T.); (D.N.O.); (N.B.); (I.J.); (M.A.N.); (G.S.); (B.D.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.A.S.); (M.C.O.)
| | - Vladan Vukcevic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (A.D.D.-D.); (V.L.G.); (M.B.T.); (M.D.B.); (M.R.D.); (V.V.); (M.V.T.); (D.N.O.); (N.B.); (I.J.); (M.A.N.); (G.S.); (B.D.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.A.S.); (M.C.O.)
| | - Miloje V. Tomasevic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (A.D.D.-D.); (V.L.G.); (M.B.T.); (M.D.B.); (M.R.D.); (V.V.); (M.V.T.); (D.N.O.); (N.B.); (I.J.); (M.A.N.); (G.S.); (B.D.B.)
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Dejan N. Orlic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (A.D.D.-D.); (V.L.G.); (M.B.T.); (M.D.B.); (M.R.D.); (V.V.); (M.V.T.); (D.N.O.); (N.B.); (I.J.); (M.A.N.); (G.S.); (B.D.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.A.S.); (M.C.O.)
| | - Nikola Boskovic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (A.D.D.-D.); (V.L.G.); (M.B.T.); (M.D.B.); (M.R.D.); (V.V.); (M.V.T.); (D.N.O.); (N.B.); (I.J.); (M.A.N.); (G.S.); (B.D.B.)
| | - Ivana Jovanovic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (A.D.D.-D.); (V.L.G.); (M.B.T.); (M.D.B.); (M.R.D.); (V.V.); (M.V.T.); (D.N.O.); (N.B.); (I.J.); (M.A.N.); (G.S.); (B.D.B.)
| | - Milan A. Nedeljkovic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (A.D.D.-D.); (V.L.G.); (M.B.T.); (M.D.B.); (M.R.D.); (V.V.); (M.V.T.); (D.N.O.); (N.B.); (I.J.); (M.A.N.); (G.S.); (B.D.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.A.S.); (M.C.O.)
| | - Goran Stankovic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (A.D.D.-D.); (V.L.G.); (M.B.T.); (M.D.B.); (M.R.D.); (V.V.); (M.V.T.); (D.N.O.); (N.B.); (I.J.); (M.A.N.); (G.S.); (B.D.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.A.S.); (M.C.O.)
| | - Miodrag C. Ostojic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.A.S.); (M.C.O.)
- Institute for Cardiovascular Diseases Dedinje, 11000 Belgrade, Serbia
| | - Branko D. Beleslin
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (A.D.D.-D.); (V.L.G.); (M.B.T.); (M.D.B.); (M.R.D.); (V.V.); (M.V.T.); (D.N.O.); (N.B.); (I.J.); (M.A.N.); (G.S.); (B.D.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.A.S.); (M.C.O.)
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12
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Blanken CPS, Schrauben EM, Peper ES, Gottwald LM, Coolen BF, van Wijk DF, Piek JJ, Strijkers GJ, Planken RN, van Ooij P, Nederveen AJ. Coronary Flow Assessment Using Accelerated 4D Flow MRI With Respiratory Motion Correction. Front Bioeng Biotechnol 2021; 9:725833. [PMID: 34869250 PMCID: PMC8634777 DOI: 10.3389/fbioe.2021.725833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/02/2021] [Indexed: 11/29/2022] Open
Abstract
Magnetic resonance imaging (MRI) can potentially be used for non-invasive screening of patients with stable angina pectoris to identify probable obstructive coronary artery disease. MRI-based coronary blood flow quantification has to date only been performed in a 2D fashion, limiting its clinical applicability. In this study, we propose a framework for coronary blood flow quantification using accelerated 4D flow MRI with respiratory motion correction and compressed sensing image reconstruction. We investigate its feasibility and repeatability in healthy subjects at rest. Fourteen healthy subjects received 8 times-accelerated 4D flow MRI covering the left coronary artery (LCA) with an isotropic spatial resolution of 1.0 mm3. Respiratory motion correction was performed based on 1) lung-liver navigator signal, 2) real-time monitoring of foot-head motion of the liver and LCA by a separate acquisition, and 3) rigid image registration to correct for anterior-posterior motion. Time-averaged diastolic LCA flow was determined, as well as time-averaged diastolic maximal velocity (VMAX) and diastolic peak velocity (VPEAK). 2D flow MRI scans of the LCA were acquired for reference. Scan-rescan repeatability and agreement between 4D flow MRI and 2D flow MRI were assessed in terms of concordance correlation coefficient (CCC) and coefficient of variation (CV). The protocol resulted in good visibility of the LCA in 11 out of 14 subjects (six female, five male, aged 28 ± 4 years). The other 3 subjects were excluded from analysis. Time-averaged diastolic LCA flow measured by 4D flow MRI was 1.30 ± 0.39 ml/s and demonstrated good scan-rescan repeatability (CCC/CV = 0.79/20.4%). Time-averaged diastolic VMAX (17.2 ± 3.0 cm/s) and diastolic VPEAK (24.4 ± 6.5 cm/s) demonstrated moderate repeatability (CCC/CV = 0.52/19.0% and 0.68/23.0%, respectively). 4D flow- and 2D flow-based diastolic LCA flow agreed well (CCC/CV = 0.75/20.1%). Agreement between 4D flow MRI and 2D flow MRI was moderate for both diastolic VMAX and VPEAK (CCC/CV = 0.68/20.3% and 0.53/27.0%, respectively). In conclusion, the proposed framework of accelerated 4D flow MRI equipped with respiratory motion correction and compressed sensing image reconstruction enables repeatable diastolic LCA flow quantification that agrees well with 2D flow MRI.
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Affiliation(s)
- Carmen P S Blanken
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Eric M Schrauben
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Eva S Peper
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Lukas M Gottwald
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Bram F Coolen
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | | | - Jan J Piek
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Gustav J Strijkers
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - R Nils Planken
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Pim van Ooij
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Aart J Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
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13
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Tsuda E, Hashimoto S. Characteristics of coronary flow velocity reserve on transthoracic Doppler echocardiography in patients with a history of Kawasaki disease. Cardiol Young 2021; 32:1-5. [PMID: 34763747 DOI: 10.1017/s104795112100439x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Whether the acute inflammation caused by Kawasaki disease will have an effect on the endothelial function of coronary arteries in the future is unknown. METHODS The coronary flow velocity reserve of the left anterior descending artery was examined by transthoracic Doppler echocardiography in 189 patients (male 125, female 64) with a history of Kawasaki disease and 10 volunteers (control). Their ages ranged from 6 to 40 years (median 22 years). The patients were divided into nine groups based on the left anterior descending artery lesions. The coronary flow velocity reserve was measured by intravenous administration of adenosine triphosphate (0.15 mg/kg/minute) while fasting. The coronary flow velocity reserve was calculated as the ratio of hyperaemic to basal mean diastolic flow velocities. The respective groups were as follows: control, no coronary artery lesions (n = 39), no coronary artery lesions in the right coronary artery (n = 29), regression (n = 11), aneurysm at the bifurcation of the left coronary artery (n = 26), aneurysm of the left anterior descending artery (n = 15), localised stenosis <75% (n = 12), localised stenosis ≥75% (n = 17), segmental stenosis (n = 5) and coronary artery bypass grafting (n = 36). One-factor ANOVA followed by Tukey's test was used to compare the coronary flow velocity reserve among the groups. RESULTS The coronary flow velocity reserve was significantly lower in the localised stenosis ≥75%, segmental stenosis and coronary artery grafting groups than in the other groups (p < 0.05). CONCLUSIONS The endothelial function in the epicoronary artery was preserved in patients with a history of Kawasaki disease and dilated coronary artery lesions.
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Affiliation(s)
- Etsuko Tsuda
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Shuji Hashimoto
- Department of Physiological Laboratory, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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14
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Zhou X, Toulemonde M, Zhou X, Hansen-Shearer J, Senior R, Tang MX. Volumetric Flow Estimation in a Coronary Artery Phantom Using High-Frame-Rate Contrast-Enhanced Ultrasound, Speckle Decorrelation, and Doppler Flow Direction Detection. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:3299-3308. [PMID: 34133277 DOI: 10.1109/tuffc.2021.3089723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The coronary flow reserve (CFR), relating to the volumetric flow rate, is an effective functional parameter to assess the stenosis in the left anterior descending (LAD) coronary artery. We have recently proposed to use high-frame-rate (HFR) contrast-enhanced ultrasound (CEUS) to estimate the volumetric flow rate using ultrasound (US) speckle decorrelation (SDC) without any assumptions about the velocity profile. However, this method still has challenges in imaging deep and small vessels, such as LAD. In this study, we proposed to address the challenges and demonstrate the feasibility of volumetric flow rate measurement in a coronary mimicking phantom with pulsatile flow using a 1-D array cardiac probe, vector Doppler, and an optimal probe rotation/tilting for flow direction detection. Both simulations and in vitro experiments were conducted to validate the proposed method. It is shown that in-plane velocities estimated by vector Doppler under a 10° probe tilting resulted in smaller percentage error (+5.2%) in flow rate estimates than that in US imaging velocimetry (-20.2%) although their relative standard deviations were very close, being 2.6 and 2.8 ml/min, respectively. The flow rate estimated by SDC without direction detection had an error higher than 70%. A 10° tilting of the probe had the best results in flow rate estimation compared to the 5° or 15° tilting. Realistic global motions in the LAD increased the flow rate estimation error from 5.2% to 14.2%. It is concluded that it is feasible to measure the volumetric flow rate in a coronary artery flow phantom with a conventional cardiac probe, using HFR acquisition, Doppler, and SDC analysis. Potentially, this technique could also be applied to investigate the volumetric flow rate in other small vessels similar to the LAD.
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15
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Schroder J, Prescott E. Doppler Echocardiography Assessment of Coronary Microvascular Function in Patients With Angina and No Obstructive Coronary Artery Disease. Front Cardiovasc Med 2021; 8:723542. [PMID: 34778394 PMCID: PMC8585781 DOI: 10.3389/fcvm.2021.723542] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/22/2021] [Indexed: 01/18/2023] Open
Abstract
Echocardiographic evaluation is an essential part of the diagnostic work-up in patients with known or suspected cardiovascular disease. Transthoracic Doppler echocardiography (TTDE) enables straightforward and reliable visualization of flow in the left anterior descending artery. In the absence of obstructive coronary artery disease, low TTDE-derived coronary flow velocity reserve (CFVR) is considered a marker of coronary microvascular dysfunction (CMD). TTDE CFVR is free from ionizing radiation and widely available, utilizing high-frequency transducers, pharmacologic vasodilator stress, and pulsed-wave Doppler quantification of diastolic peak flow velocities. European Society of Cardiology guidelines recommend TTDE CFVR evaluation only following preceding anatomic invasive or non-invasive coronary imaging excluding obstructive CAD. Accordingly, clinical use of TTDE CFVR is limited and CMD frequently goes undiagnosed. An evolving body of evidence underlines that low CFVR is an important and robust predictor of adverse prognosis and continuing symptoms in angina patients both with and without obstructive CAD. The majority of angina patients have no obstructive CAD, particularly among women. This has led to the suggestion that there may be a gender-specific female atherosclerotic phenotype with less epicardial obstruction, and a low CFVR signifying CMD instead. Nevertheless, available evidence indicates low CFVR is an equally important prognostic marker in both men and women. In this review, TTDE CFVR was evaluated regarding indication, practical and technical aspects, and interpretation of results. Association with symptoms and prognosis, comparison with alternative invasive and non-invasive imaging modalities, and possible interventions in angina patients with low CFVR were discussed, and key research questions were proposed.
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Affiliation(s)
- Jakob Schroder
- Department of Cardiology, Bispebjerg Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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16
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The evolving role of cardiac imaging in patients with myocardial infarction and non-obstructive coronary arteries. Prog Cardiovasc Dis 2021; 68:78-87. [PMID: 34600948 DOI: 10.1016/j.pcad.2021.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 08/29/2021] [Indexed: 01/02/2023]
Abstract
Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) represents a heterogeneous clinical conundrum accounting for about 6%-8% of all acute MI who are referred for coronary angiography. Current guidelines and consensus documents recommend that these patients are appropriately diagnosed, uncovering the causes of MINOCA, so that specific therapies can be prescribed. Indeed, there are a variety of causes that can result in this clinical condition, and for this reason diagnostic cardiac imaging has an emerging critical role in the assessment of patients with suspected or confirmed MINOCA. In last years, different cardiac imaging techniques have been evaluated in this context, and the comprehension of their strengths and limitations is of the utmost importance for their effective use in clinical practice. Moreover, recent evidence is clearly suggesting that a multimodality cardiac imaging approach, combining different techniques, seems to be crucial for a proper management of MINOCA. However, great variability still exists in clinical practice in the management of patients with suspected MINOCA, also depending on the availability of diagnostic tools and local expertise. Herein, we review the current knowledge supporting the use of different cardiac imaging techniques in patients with MINOCA, underscoring the importance of a comprehensive multimodality cardiac imaging approach and proposing a practical diagnostic algorithm to properly identify and treat the specific causes of MINOCA, in order to improve prognosis and the quality of life in these patients.
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17
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Yamagishi M, Tamaki N, Akasaka T, Ikeda T, Ueshima K, Uemura S, Otsuji Y, Kihara Y, Kimura K, Kimura T, Kusama Y, Kumita S, Sakuma H, Jinzaki M, Daida H, Takeishi Y, Tada H, Chikamori T, Tsujita K, Teraoka K, Nakajima K, Nakata T, Nakatani S, Nogami A, Node K, Nohara A, Hirayama A, Funabashi N, Miura M, Mochizuki T, Yokoi H, Yoshioka K, Watanabe M, Asanuma T, Ishikawa Y, Ohara T, Kaikita K, Kasai T, Kato E, Kamiyama H, Kawashiri M, Kiso K, Kitagawa K, Kido T, Kinoshita T, Kiriyama T, Kume T, Kurata A, Kurisu S, Kosuge M, Kodani E, Sato A, Shiono Y, Shiomi H, Taki J, Takeuchi M, Tanaka A, Tanaka N, Tanaka R, Nakahashi T, Nakahara T, Nomura A, Hashimoto A, Hayashi K, Higashi M, Hiro T, Fukamachi D, Matsuo H, Matsumoto N, Miyauchi K, Miyagawa M, Yamada Y, Yoshinaga K, Wada H, Watanabe T, Ozaki Y, Kohsaka S, Shimizu W, Yasuda S, Yoshino H. JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases. Circ J 2021; 85:402-572. [PMID: 33597320 DOI: 10.1253/circj.cj-19-1131] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine Graduate School
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School
| | - Kenji Ueshima
- Center for Accessing Early Promising Treatment, Kyoto University Hospital
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | | | | | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, University of Fukui
| | | | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | | | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa Universtiy
| | | | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Atsushi Nohara
- Division of Clinical Genetics, Ishikawa Prefectural Central Hospital
| | | | | | - Masaru Miura
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center
| | | | | | | | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Toshihiko Asanuma
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School
| | - Yuichi Ishikawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital
| | - Takahiro Ohara
- Division of Community Medicine, Tohoku Medical and Pharmaceutical University
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Kinen Hospital
| | - Eri Kato
- Department of Cardiovascular Medicine, Department of Clinical Laboratory, Kyoto University Hospital
| | | | - Masaaki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University
| | - Keisuke Kiso
- Department of Diagnostic Radiology, Tohoku University Hospital
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School
| | | | | | | | - Akira Kurata
- Department of Radiology, Ehime University Graduate School
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Eitaro Kodani
- Department of Internal Medicine and Cardiology, Nippon Medical School Tama Nagayama Hospital
| | - Akira Sato
- Department of Cardiology, University of Tsukuba
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | - Junichi Taki
- Department of Nuclear Medicine, Kanazawa University
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of the University of Occupational and Environmental Health, Japan
| | | | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Ryoichi Tanaka
- Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University
| | | | | | - Akihiro Nomura
- Innovative Clinical Research Center, Kanazawa University Hospital
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine, Kanazawa University Hospital
| | - Masahiro Higashi
- Department of Radiology, National Hospital Organization Osaka National Hospital
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Naoya Matsumoto
- Division of Cardiology, Department of Medicine, Nihon University
| | | | | | | | - Keiichiro Yoshinaga
- Department of Diagnostic and Therapeutic Nuclear Medicine, Molecular Imaging at the National Institute of Radiological Sciences
| | - Hideki Wada
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Yukio Ozaki
- Department of Cardiology, Fujita Medical University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Imamura S, Hirata K, Takemoto K, Orii M, Shimamura K, Shiono Y, Tanimoto T, Matsuo Y, Ino Y, Kitabata H, Kubo T, Tanaka A, Hozumi T, Akasaka T. Assessment of myocardial damage after acute myocardial infarction by diastolic deceleration time of coronary flow velocity using echocardiography and contrast‐enhanced magnetic resonance imaging. Echocardiography 2020; 37:1981-1988. [DOI: 10.1111/echo.14903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 09/25/2020] [Accepted: 10/03/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sari Imamura
- Department of Cariology Wakayama Medical University Wakayama Japan
| | - Kumiko Hirata
- Division of Medical Science Department of Education Osaka Educational University Osaka Japan
| | - Kazushi Takemoto
- Department of Cariology Wakayama Medical University Wakayama Japan
| | - Makoto Orii
- Department of Cariology Wakayama Medical University Wakayama Japan
| | | | - Yasutsugu Shiono
- Department of Cariology Wakayama Medical University Wakayama Japan
| | - Takashi Tanimoto
- Department of Cariology Wakayama Medical University Wakayama Japan
| | - Yoshiki Matsuo
- Department of Cariology Wakayama Medical University Wakayama Japan
| | - Yasushi Ino
- Department of Cariology Wakayama Medical University Wakayama Japan
| | | | - Takashi Kubo
- Department of Cariology Wakayama Medical University Wakayama Japan
| | - Atsushi Tanaka
- Department of Cariology Wakayama Medical University Wakayama Japan
| | - Takeshi Hozumi
- Department of Cariology Wakayama Medical University Wakayama Japan
| | - Takashi Akasaka
- Department of Cariology Wakayama Medical University Wakayama Japan
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19
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Kono T, Uetani T, Inoue K, Nagai T, Nishimura K, Suzuki J, Tanabe Y, Kido T, Kurata A, Mochizuki T, Ogimoto A, Okura T, Higaki J, Yamaguchi O, Ikeda S. Diagnostic accuracy of stress myocardial computed tomography perfusion imaging to detect myocardial ischemia: a comparison with coronary flow velocity reserve derived from transthoracic Doppler echocardiography. J Cardiol 2020; 76:251-258. [PMID: 32354493 DOI: 10.1016/j.jjcc.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Our aim was to evaluate the ability of adenosine triphosphate (ATP)-stress myocardial computed tomography perfusion (CTP) imaging to detect myocardial ischemia in the left anterior descending artery (LAD) territory, and to compare this method with coronary flow velocity reserve (CFVR) measured by transthoracic Doppler echocardiography (TTDE). METHODS ATP-stress CTP and CFVR were performed in 50 patients with stable angina pectoris. Myocardial ischemia assessed from CTP imaging was defined as qualitative visual perfusion defects and reduced myocardial blood flow (MBF) based on quantitative assessment. A cut-off value of CFVR of 2.0 was used. RESULTS The mean CFVR was 1.9 ± 0.6 in ischemic regions by CTP, whereas it was 2.9 ± 0.8 in non-ischemic regions (p < 0.001). CTP imaging could accurately predict CFVR <2.0 with 84.0% diagnostic accuracy (94.7% sensitivity, 77.4% specificity, 72.0% positive predictive value, and 96.0% negative predictive value). When receiver operating characteristic curve analysis of the MBF data was performed to detect CFVR <2.0, the area under the curve was 0.89, and the optimal MBF cut-off value was 1.43 mL/g/min. CONCLUSIONS This study suggests that qualitative and quantitative assessment of ATP-stress CTP exhibits a good correlation with CFVR for evaluation of myocardial ischemia.
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Affiliation(s)
- Tamami Kono
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Teruyoshi Uetani
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan.
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Takayuki Nagai
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kazuhisa Nishimura
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Jun Suzuki
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Akira Kurata
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Teruhito Mochizuki
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | | | - Takafumi Okura
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Jitsuo Higaki
- Department of Cardiology, South Matsuyama Hospital, Matsuyama, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Shuntaro Ikeda
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
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20
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Stress Echocardiography in the Era of Fractional Flow Reserve. CURRENT CARDIOVASCULAR IMAGING REPORTS 2020. [DOI: 10.1007/s12410-020-9528-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Purpose of Review
It is the aim of this review to demonstrate the relevance of stress echocardiography in the era of fractional flow reserve by establishing the current use of stress echocardiography and fractional flow reserve, underlining their physiological basis and through this demonstrating the clear differences in their application.
Recent Findings
The importance of the microcirculation is only now being understood, no more so than in the fact that abnormalities in the microcirculation, determined by abnormal coronary flow reserve, predict adverse mortality regardless of the normality of the epicardial coronary lesions. Stress echocardiography therefore gives a fuller picture of the overall cardiovascular risk to our patients in its ability to interrogate the epicardial vessels down to the microcirculation, with a number of techniques available to measure coronary flow reserve such as myocardial perfusion stress echocardiography and transthoracic Doppler stress echocardiography of epicardial coronary vessels. Fractional flow reserve can then add further information by determining whether a coronary artery lesion is responsible for myocardial ischaemia.
Summary
In an era of fractional flow reserve affording the resolution of myocardial ischaemia down to the specific lesion, it can be tempting to think that other generally non-invasive techniques no longer have a role in the investigation and management of coronary artery disease. This, however, betrays a lack of understanding of the scope and complexity of coronary artery disease from epicardial vessels down to the microvasculature, the physiological basis of the tests available and therefore what, in fact, is actually being measured. For some, fractional flow reserve is held as a gold standard by which to compare other techniques such as stress echocardiography as correct or incorrect. However, these tests do not measure the same thing, and therefore, they cannot be directly compared. Stress echocardiography gives a fuller picture through its ability to account for the coronary flow reserve, considering the epicardial vessels down to the microvasculature. Fractional flow reserve is far more specific, looking at the effect of the lesion being interrogated. Furthermore, where fractional flow reserve is normal, we now know that knowledge of the coronary flow reserve is critical as it is this that allows us to predict the overall mortality risk of our patient. We therefore require a combination of the two techniques.
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Pellikka PA, Arruda-Olson A, Chaudhry FA, Chen MH, Marshall JE, Porter TR, Sawada SG. Guidelines for Performance, Interpretation, and Application of Stress Echocardiography in Ischemic Heart Disease: From the American Society of Echocardiography. J Am Soc Echocardiogr 2020; 33:1-41.e8. [DOI: 10.1016/j.echo.2019.07.001] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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22
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Dregoesc MI, Iancu AC, Ober CD, Homorodean C, Bãlãnescu Ş, Bolboacã S. In ST-segment elevation myocardial infarction, the echocardiographic parameters of microvascular obstruction are not associated with left ventricular remodeling at five years of follow-up. Echocardiography 2019; 36:1103-1109. [PMID: 31116460 DOI: 10.1111/echo.14371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/17/2019] [Accepted: 05/05/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The correlation between the echocardiographic Doppler flow parameters of microvascular obstruction (MVO) and coronary wedge pressure (CWP) measured as a marker of severe compressive microvascular dysfunction and a predictor of adverse left ventricular remodeling was evaluated in a group of high-risk acute anterior myocardial infarction survivors. METHODS Twenty-four patients with mechanically reperfused anterior STEMI were divided into two groups based on the 38 mm Hg CWP cutoff for adverse left ventricular remodeling. Diastolic deceleration time (DDT), coronary flow reserve (CFR), systolic retrograde flow, peak systolic and peak diastolic velocities in the infarct-related artery were determined 3-5 days after revascularization. An echocardiographic 20% increase in left ventricular volumes defined adverse remodeling. RESULTS No significant differences were recorded between groups with regard to the echocardiographic parameters of MVO. No significant correlation was identified between CWP on one side and DDT (P = 0.30) and CFR (P = 0.39) on the other, irrespective of total ischemic time and extracted thrombus length. No difference in 5 years of follow-up left ventricular remodeling was detected in patients with DDT<900 msec as compared to those with DDT≥900 msec. The medium increase in left ventricular end-systolic volume in patients with low CWP was 24.78%, while it reached 127.27% (P = 0.03) in patients with CWP>38 mm Hg. CONCLUSIONS Coronary wedge pressure did not correlate with the surrogate parameters for MVO, but it was a predictor of left ventricular remodeling. None of the echocardiographic MVO parameters was associated with adverse remodeling at 5 years of follow-up.
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Affiliation(s)
- Mihaela Ioana Dregoesc
- Department of Cardiology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,"Niculae Stãncioiu" Heart Institute, Cluj-Napoca, Romania
| | - Adrian Corneliu Iancu
- Department of Cardiology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,"Niculae Stãncioiu" Heart Institute, Cluj-Napoca, Romania
| | | | - Cãlin Homorodean
- 1st Medical Department, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Şerban Bãlãnescu
- "Carol Davila", "Elias" University Hospital, University of Medicine and Pharmacy, Bucharest, Romania
| | - Sorana Bolboacã
- Department of Medical Informatics and Biostatistics, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Higashikawa T, Ichikawa Y, Ishida M, Kitagawa K, Hirano T, Sakuma H. Assessment of coronary flow velocity reserve with phase-contrast cine magnetic resonance imaging in patients with heavy coronary calcification. Int J Cardiovasc Imaging 2019; 35:897-905. [PMID: 30805755 DOI: 10.1007/s10554-019-01531-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
Coronary flow velocity reserve (CFVR) can be noninvasively measured by phase-contrast cine magnetic resonance imaging (PC-MRI). Heavy coronary calcification degrades the diagnostic accuracy for the detection of coronary arterial stenosis on computed tomography (CT). The aim of this study was to evaluate the value of CFVR measurement with PC-MRI for detecting significant coronary stenoses in patients with heavy coronary calcification. Sixteen patients (71 ± 8 years) with coronary calcium score above 400 who had suspected moderate coronary stenosis (50-69% diameter stenosis) on CT angiography were prospectively studied. The CFVR values, calculated as the ratio of peak flow velocity during hyperemia to the peak flow velocity at rest, were measured using breath-hold PC-MRI with 3 T system, and were compared with the results of quantitative coronary angiography (QCA). The mean coronary calcium score was 985 ± 378. CFVR was successfully determined with PC-MRI in 17/18 (94%) vessels. Using a threshold of 1.4 for CFVR, the sensitivity, specificity, and positive and negative predictive value for detecting ≥ 50% stenosis on QCA was 88% (7/8), 89% (8/9), 88% (7/8), 89% (8/9), respectively. When MRI CFVR measurements was added to CT angiography for the evaluation of coronary stenosis, the positive predictive value was 88% (7/8), while the positive predictive value of CT angiography alone was 44% (8/18). PC-MRI can provide noninvasive detection of altered CFVR caused by significant stenosis in patient. CFVR measurement by PC-MRI is useful for diagnosing physiologically significant coronary stenosis in patients with high calcium score on CT.
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Affiliation(s)
- Takatoshi Higashikawa
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Yasutaka Ichikawa
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masaki Ishida
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Kakuya Kitagawa
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Tadanori Hirano
- Department of Radiology, Matsusaka Central Hospital, 102 Kobou, Kawai, Matsusaka, Mie, 515-8566, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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Mahfouz RA, Gouda M, Ghareb MS, Galal I. Association between fragmented QRS and exercise intolerance in hypertensive patients: the relation with coronary flow. Blood Press 2019; 28:124-130. [PMID: 30669874 DOI: 10.1080/08037051.2019.1569462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE We aimed to investigate the relation between the presence of fragmented QRS (FQRS) and exercise intolerance as assessed by 6 minute walking test (6MWT) and its association with coronary flow reserve (CFR). METHODS One hundred and twenty patients with hypertension (age: 47.3 + 6.9) who were never treated and without left ventricular hypertrophy underwent 6MWT. Echocardiographic examination was obtained for all patients. CFR was calculated as the hyperemic to baseline mean velocity ratio (hyperemia was induced by intravenous adenosine 0.14 mg/kg/min). Patients were stratified into one group with FQRS and another group without FQRS. Forty-eight normotensive subjects with a mean age of 45.7 + 5.3 were recruited and served as a control group. RESULTS The frequency of FQRS was 49% in hypertensive patients versus 2% in control subjects. Patients with FQRS had higher systolic blood pressure (p < .05; <.01), a significant lower 6MWTD (p < .001), increased LAVI (p <.05), increased E/e' ratio (p < .01) and lower CFR (p < .001) compared with those without FQRS and controls. FQRS was inversely correlated with CFR (-0.531; p < .001) and 6 MWTD (-0.415; p < .001) and positively correlated with E/e' (0.352, p < .02) and LAVI (0.296; p < .05). By a multivariate regression analysis, FQRS (OR = 6.13; p < .001) and CFR (OR = 3.28; p < .001) were the only two independent predictors for decreased 6 MWTD in hypertensive patients. Importantly the ≥3 cutoff number of leads was found to be the best predictor of CFR < 2.0 in hypertensive patients. CONCLUSION FQRS is frequent and an independent predictor of reduced exercise tolerance in hypertensive patients. More so, it is significantly associated with decreased CFR and left ventricular diastolic dysfunction. In light of these findings, fragmented QRS might be considered a simple marker for risk stratification of hypertensive patients.
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Affiliation(s)
- Ragab A Mahfouz
- a Cardiology Department , Zagazig University Hospital , Zagazig , Egypt
| | - Mohammad Gouda
- a Cardiology Department , Zagazig University Hospital , Zagazig , Egypt
| | - Mohamed S Ghareb
- a Cardiology Department , Zagazig University Hospital , Zagazig , Egypt
| | - Islam Galal
- a Cardiology Department , Zagazig University Hospital , Zagazig , Egypt
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Honda K, Yuzaki M, Kaneko M, Nakai T, Kunimoto H, Nagashima M, Nishimura Y. Functional Evaluation of the Myocardial Ischemia After Coronary Artery Bypass Surgery Using Coronary Flow Velocity Reserve in Left Ventricular Hypertrophy. Semin Thorac Cardiovasc Surg 2019; 31:166-173. [DOI: 10.1053/j.semtcvs.2018.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 09/21/2018] [Indexed: 12/31/2022]
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26
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Mahfouz RA, Gouda M, Alawady W. Determinants and impact of masked hypertension in offspring of patients with diabetes: relation with coronary flow and cardiac function. Blood Press 2018; 28:57-63. [PMID: 30560695 DOI: 10.1080/08037051.2018.1524261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE We aimed to evaluate the prevalence, determinants and clinical impact of masked hypertension in offspring of patients with diabetes. Masked hypertension was defined according to guidelines as daytime ambulatory blood pressure monitoring "ABPM" ≥135/85 mmHg and clinic BP <140/90 mmHg. METHODS 100 nondiabetic offspring of patients with diabetes and 60 offspring of healthy people were enrolled; 24-h ABPM was applied to evaluate mean 24-h systolic/diastolic blood pressure "BP", daytime, nighttime and night dipping readings. Left ventricular parameters and coronary flow reserve of the left anterior descending artery (induced by adenosine 0.14 mg/kg/min) was calculated in all offspring. RESULTS 29% of offspring of patients with diabetes had masked hypertension compared to only 3.3% offspring in healthy people (p < 0.001). Compared with those without masked hypertension, offspring with masked hypertension had a significantly reduced coronary flow reserve (p < 0.001), significantly higher E/e' (p < 0.01), [a surrogate marker of left ventricular filling pressure], more microalbuminuria (p < 0.01), and higher values of high-sensitive C-reactive protein "CRP" (p < 0.001). Multivariate regression analysis showed that, fasting blood glucose, and high-sensitive CRP, were independently associated with masked hypertension, whilst daytime systolic BP and non-dipping systolic BP were the strongest predictors for masked hypertension. Logistic regression analysis revealed that masked hypertension was independently associated with reduced coronary flow reserve (p < 0.0001) and diastolic dysfunction (p < 0.001). CONCLUSION Masked hypertension is prevalent in offspring of patients with diabetes and significantly associated with reduced coronary flow reserve and left ventricular diastolic dysfunction. These findings suggest that offspring of patients with diabetes constitute a high risk group and deserve close follow up, mainly with the use of ABPM.
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Affiliation(s)
- Ragab A Mahfouz
- a Cardiology Department , Zagazig University Hospital , Zagazig , Egypt
| | - Mohammad Gouda
- a Cardiology Department , Zagazig University Hospital , Zagazig , Egypt
| | - Waleed Alawady
- a Cardiology Department , Zagazig University Hospital , Zagazig , Egypt
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Yufu K, Kondo H, Shinohara T, Ishii Y, Yoshimura S, Abe I, Saito S, Fukui A, Okada N, Akioka H, Teshima Y, Nakagawa M, Takahashi N. Assessment of coronary flow reserve predicts long-term outcome of responders to cardiac resynchronization therapy. Heart Vessels 2018; 34:763-770. [PMID: 30483876 DOI: 10.1007/s00380-018-1308-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022]
Abstract
Cardiac resynchronization therapy (CRT) has been established as a treatment for patients with chronic heart failure (HF). We tested the hypothesis that assessment of coronary flow reserve (CFR) predicts the long-term outcome of CRT. The study consisted of 114 HF patients implanted with a CRT device for the treatment of advanced HF between April 2010 and April 2018. After excluding patients that withdrew from long-term follow-up and patients missing a baseline CFR measurement, we enrolled 53 eligible patients. CFR was determined non-invasively by transthoracic echocardiography. Based on the ROC curve for predicting the appearance of major adverse cerebral and cardiovascular events (MACCE), the level of preserved CFR was set at >1.35 in responders. Accurate follow-up information (mean 873 ± 498 days) was obtained in 23 patients with a preserved CFR (16 females; mean age 71 ± 7.9 years) and 11 patients with a depressed CFR (5 females; mean age, 73 ± 7.6 years) in responders. Kaplan-Meier survival analysis demonstrated that the depressed CFR group had a higher prevalence of MACCE than the preserved CFR group (log rank, 9.83; p = 0.0021). Multivariate analysis revealed that depressed CFR was associated with MACCE (hazard ratio 4.88, 95% confidence interval 1.13-26.5, p = 0.0329). Our results suggest that the assessment of CFR predicts the outcome in responders to CRT. Preservation of coronary circulation flow might underlie one of the mechanisms for a better response to CRT in responders.
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Affiliation(s)
- Kunio Yufu
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu City, Oita, 879-5593, Japan.
| | - Hidekazu Kondo
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu City, Oita, 879-5593, Japan
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu City, Oita, 879-5593, Japan
| | - Yumi Ishii
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu City, Oita, 879-5593, Japan
| | - Seiichiro Yoshimura
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu City, Oita, 879-5593, Japan
| | - Ichitaro Abe
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu City, Oita, 879-5593, Japan
| | - Shotaro Saito
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu City, Oita, 879-5593, Japan
| | - Akira Fukui
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu City, Oita, 879-5593, Japan
| | - Norihiro Okada
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu City, Oita, 879-5593, Japan
| | - Hidefumi Akioka
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu City, Oita, 879-5593, Japan
| | - Yasushi Teshima
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu City, Oita, 879-5593, Japan
| | - Mikiko Nakagawa
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu City, Oita, 879-5593, Japan
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu City, Oita, 879-5593, Japan
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Zagatina A, Zhuravskaya N. The additive prognostic value of coronary flow velocity reserve during exercise echocardiography. Eur Heart J Cardiovasc Imaging 2018; 18:1179-1184. [PMID: 27502295 DOI: 10.1093/ehjci/jew164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/13/2016] [Indexed: 02/06/2023] Open
Abstract
Aims The aim of the study was to assess the additive prognostic value of coronary flow velocity reserve (CFVR) alongside wall motion analysis during exercise echocardiography in patients with known or suspected coronary artery disease (CAD). Methods and results In a prospective, single-centre, observational study, we evaluated 689 patients (449 males; 56 + 9 years) who underwent supine bicycle stress echo (ESE) with CFVR evaluation of the left anterior descending artery (LAD) by Doppler. ESE was positive for regional wall motion abnormalities in 359 (52%) patients. Mean CFVR was 1.9 ± 0.8. During a median follow-up of 36.6 months, there were 200 patients with major adverse cardiac events (MACE): 15 deaths, 17 non-fatal myocardial infarctions [11 of them also had percutaneous coronary intervention with stenting (PCI) or/and coronary artery bypass graft surgery (CABG)] and 179 patients underwent revascularization. The 37 months' event-free survival showed the best outcome for those patients with negative ESE by wall motion criteria and normal CFVR, and the worst outcome for patients with positive ESE by wall motion and abnormal CVFR (99 vs. 42%, P < 0.0001). At multivariable analysis, CFVR in LAD (OR 0.53, 95% CI 0.35-0.79, P < 0.0001), positivity for regional wall motion abnormalities during testing (OR 0.10, 95% CI 0.04-0.25, P < 0.000), previous PCI (OR 0.38, 95% CI 0.16-0.90, P < 0.003), male sex (OR 0.44, 95% CI 0.27-0.71, P < 0.0009), and heart rate reached during exercise (OR 0.98, 95% CI 0.96-0.99, P < 0.02) were independent prognostic predictors of MACE. Conclusion In patients with known or suspected CAD, exercise stress tests measuring wall motion criteria and CFVR are additive and complementary for the identification of patients at risk of experiencing major adverse events.
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Affiliation(s)
- Angela Zagatina
- Medika Cardiology Clinic, 8-2, Dundicha St., Saint Petersburg 192283, Russia
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van Mil ACCM, Tymko MM, Kerstens TP, Stembridge M, Green DJ, Ainslie PN, Thijssen DHJ. Similarity between carotid and coronary artery responses to sympathetic stimulation and the role of α 1-receptors in humans. J Appl Physiol (1985) 2018; 125:409-418. [PMID: 29565771 DOI: 10.1152/japplphysiol.00386.2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Carotid artery (CCA) dilation occurs in healthy subjects during cold pressor test (CPT), while the magnitude of dilation relates to cardiovascular risk. To further explore this phenomenon and mechanism, we examined carotid artery responses to different sympathetic tests, with and without α1-receptor blockade and assessed similarity to these responses between carotid and coronary arteries. In randomized order, 10 healthy participants (25 ± 3 yr) underwent sympathetic stimulation using the CPT (3-min left-hand immersion in ice-slush) and lower-body negative pressure (LBNP). Before and during sympathetic tests, CCA diameter and velocity (Doppler ultrasound) and left anterior descending (LAD) coronary artery velocity (echocardiography) were recorded across 3 min. Measures were repeated 90 min following selective α1-receptor blockade via oral prazosin (0.05 mg/kg body wt). CPT significantly increased CCA diameter, LAD maximal velocity, and velocity-time integral area-under-the-curve (all P < 0.05). In contrast, LBNP resulted in a decrease in CCA diameter, LAD maximal velocity, and velocity time integral (VTI; all P < 0.05). Following α1-receptor blockade, CCA and LAD velocity responses to CPT were diminished. In contrast, during LBNP (-30 mmHg), α1-receptor blockade did not alter CCA or LAD responses. Finally, changes in CCA diameter and LAD VTI responses to sympathetic stimulation were positively correlated ( r = 0.66, P < 0.01). We found distinct carotid artery responses to different tests of sympathetic stimulation, where α1 receptors partly contribute to CPT-induced responses. Finally, we found agreement between carotid and coronary artery responses. These data indicate similarity between carotid and coronary responses to sympathetic tests and the role of α1 receptors that is dependent on the nature of the sympathetic challenge. NEW & NOTEWORTHY We showed distinct carotid artery responses to cold pressor test (CPT; i.e., dilation) and lower-body negative pressure (LBNP; i.e., constriction). Blockade of α1-receptors significantly attenuated dilator responses in carotid and coronary arteries during CPT, while no changes were found during LBNP. Our findings indicate strong similarity between carotid and coronary artery responses to distinct sympathetic stimuli, and for the role of α-receptors.
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Affiliation(s)
- Anke C C M van Mil
- Department of Physiology, Radboudumc, Nijmegen , The Netherlands.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University , Liverpool , United Kingdom
| | - Michael M Tymko
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia , Kelowna , Canada
| | - Thijs P Kerstens
- Department of Physiology, Radboudumc, Nijmegen , The Netherlands
| | - Mike Stembridge
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia , Kelowna , Canada.,Cardiff School of Sport, Cardiff Metropolitan University , Cardiff , United Kingdom
| | - Daniel J Green
- School of Sports Science, Exercise and Health, the University of Western Australia , Nedlands , Australia
| | - Philip N Ainslie
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia , Kelowna , Canada
| | - Dick H J Thijssen
- Department of Physiology, Radboudumc, Nijmegen , The Netherlands.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University , Liverpool , United Kingdom
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Sampietro T, Sbrana F, Pasanisi EM, Bigazzi F, Petersen C, Coceani M, Dal Pino B, Ripoli A, Pianelli M, Luciani R. LDL apheresis improves coronary flow reserve on the left anterior descending artery in patients with familial hypercholesterolemia and chronic ischemic heart disease. ATHEROSCLEROSIS SUPP 2017; 30:135-140. [DOI: 10.1016/j.atherosclerosissup.2017.05.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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31
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Correlation of carotid artery reactivity with cardiovascular risk factors and coronary artery vasodilator responses in asymptomatic, healthy volunteers. J Hypertens 2017; 35:1026-1034. [PMID: 28129249 DOI: 10.1097/hjh.0000000000001274] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Carotid artery reactivity (CAR%), involving carotid artery diameter responses to a cold pressor test (CPT), is a noninvasive measure of conduit artery function in humans. This study examined the impact of age and cardiovascular risk factors on the CAR% and the relationship between CAR% and coronary artery vasodilator responses to the CPT. METHODS Ultrasound was used to measure resting and peak carotid artery diameters during the CPT, with CAR% being calculated as the relative change from baseline (%). We compared CAR% between young (n = 50, 24 ± 3 years) and older participants (n = 44, 61 ± 8 years), and subsequently assessed relationships between CAR% and traditional cardiovascular risk factors in 50 participants (44 ± 21 years). Subsequently, we compared left anterior descending (LAD) artery velocity (using transthoracic Doppler) with carotid artery diameter (i.e. CAR%) during the CPT (n = 33, 37 ± 17 years). RESULTS A significantly larger CAR% was found in young versus older healthy participants (4.1 ± 3.7 versus 1.8 ± 2.6, P < 0.001). Participants without cardiovascular risk factors demonstrated a higher CAR% than those with at least two risk factors (2.9 ± 2.9 versus 0.5 ± 2.9, P = 0.019). Carotid artery diameter and LAD velocity increased during CPT (P < 0.001). Carotid diameter and change in velocity correlated with LAD velocity (r = 0.486 and 0.402, P < 0.004 and 0.02, respectively). CONCLUSION Older age and cardiovascular risk factors are related to lower CAR%, while CAR% shows good correlation with coronary artery responses to the CPT. Therefore, CAR% may represent a valuable technique to assess cardiovascular risk, while CAR% seems to reflect coronary artery vasodilator function.
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Lembo M, Sicari R, Esposito R, Rigo F, Cortigiani L, Lo Iudice F, Picano E, Trimarco B, Galderisi M. Association Between Elevated Pulse Pressure and High Resting Coronary Blood Flow Velocity in Patients With Angiographically Normal Epicardial Coronary Arteries. J Am Heart Assoc 2017; 6:e005710. [PMID: 28663250 PMCID: PMC5586295 DOI: 10.1161/jaha.117.005710] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/17/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim of our study was to evaluate the relationship of pulse pressure (PP), a raw index of arterial stiffness, with noninvasively determined coronary flow reserve (CFR) and its components, in patients with angiographically normal epicardial coronary arteries. METHODS AND RESULTS The study population included 398 patients without angiographic evidence of coronary stenosis, who underwent high-dose dipyridamole stress echocardiography with transthoracic-derived CFR evaluation on the left anterior descending artery. CFR was calculated as the ratio between high-dose dipyridamole and resting coronary diastolic peak velocities. Patients were divided into 2 groups: the first group included the first and second PP tertiles (n=298, PP ≤60 mm Hg) and the second group included the highest PP tertile (n=100, PP >60 mm Hg). Mean blood pressure, systolic blood pressure (both P<0.0001), age (P<0.002), and left ventricular mass index (P=0.013) were higher in the highest PP tertile, which also showed higher resting coronary flow velocity (31.6±9.6 cm/s versus 27.7±6.4 cm/s, P<0.0001) and marginally lower CFR (2.5±0.6 versus 2.6±0.6, P=0.044). Hyperemic coronary flow velocity did not differ between the 2 groups. By separate multiple linear regression analyses, after adjusting for sex, age, the highest systolic blood pressure tertile (≥140 mm Hg), left ventricular mass index, and cardiovascular risk factors, the highest PP tertile was associated with resting coronary flow velocity (P=0.003) and only marginally with hyperemic coronary flow velocity (P<0.02), whereas its association with CFR was not significant. CONCLUSIONS In patients without epicardial coronary artery stenosis, the highest PP tertile is associated with an increased coronary flow velocity at rest.
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Affiliation(s)
- Maria Lembo
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Rosa Sicari
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Fausto Rigo
- Department of Cardiology, Dell'Angelo Hospital, Mestre, Italy
| | | | - Francesco Lo Iudice
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Eugenio Picano
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
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Abreu JSD, Rocha EA, Machado IS, Parahyba IO, Rocha TB, Paes FJVN, Diogenes TCP, Abreu MEBD, Farias AGLP, Carneiro MM, Paes JN. Prognostic Value of Coronary Flow Reserve Obtained on Dobutamine Stress Echocardiography and its Correlation with Target Heart Rate. Arq Bras Cardiol 2017; 108:417-426. [PMID: 28444062 PMCID: PMC5444888 DOI: 10.5935/abc.20170041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 11/30/2016] [Indexed: 11/20/2022] Open
Abstract
Background: Normal coronary flow velocity reserve (CFVR) (≥ 2) obtained in the left anterior descending coronary artery (LAD) from transthoracic echocardiography is associated with a good prognosis, but there is no study correlating CFVR with submaximal target heart rate (HR). Objective: To evaluate the prognostic value of CFVR obtained in the LAD of patients with preserved (>50%) left ventricular ejection fraction (LVEF) who completed a dobutamine stress echocardiography (DSE), considering target HR. Methods: Prospective study of patients with preserved LVEF and CFVR obtained in the LAD who completed DSE. In Group I (GI = 31), normal CFVR was obtained before achieving target HR, and, in Group II (GII = 28), after that. Group III (G III=24) reached target HR, but CFVR was abnormal. Death, acute coronary insufficiency, coronary intervention, coronary angiography without further intervention, and hospitalization were considered events. Results: In 28 ± 4 months, there were 18 (21.6%) events: 6% (2/31) in GI, 18% (5/28) in GII, and 46% (11/24) in GIII. There were 4 (4.8%) deaths, 6 (7.2%) coronary interventions and 8 (9.6%) coronary angiographies without further intervention. In event-free survival by regression analysis, GIII had more events than GI (p < 0.001) and GII (p < 0.045), with no difference between GI and GII (p = 0.160). After adjustment, the only difference was between GIII and GI (p = 0.012). Conclusion: In patients with preserved LVEF and who completed their DSE, normal CFVR obtained before achieving target HR was associated with better prognosis. Fundamento: A reserva de velocidade de fluxo coronariano (RVFC) adequada (≥ 2) obtida na artéria descendente anterior (ADA) através do ecocardiograma transtorácico associa-se a bom prognóstico, mas não há estudo correlacionando-a com a frequência cardíaca (FC) alvo (submáxima). Objetivo: Avaliar o valor prognóstico da RVFC obtida na ADA de pacientes com fração de ejeção do ventrículo esquerdo (FEVE) preservada (>50%) e ecocardiograma sob estresse com dobutamina (EED) concluído, considerando a FC alvo submáxima. Métodos: studo prospectivo de pacientes com FEVE preservada e RVFC obtida na ADA durante EED concluído. No Grupo I (GI=31), a RVFC adequada foi obtida antes de se atingir a FC alvo, e no Grupo II (G II=28), após. O Grupo III (G III=24) atingiu a FC alvo, mas a RVFC foi inadequada. Foram considerados eventos: óbito, insuficiência coronariana aguda, intervenção coronariana, coronariografia sem intervenção subsequente e internamento hospitalar. Resultados: Em 28 ± 4 meses, ocorreram 18 (21,6%) eventos, sendo 6% (2/31) no GI, 18% (5/28) no GII e 46% (11/24) no GIII. Foram 4 (4,8%) óbitos, 6 (7,2%) intervenções coronarianas e 8 (9,6%) coronariografias sem intervenção subsequente. Na sobrevida livre de eventos pela análise de regressão, GIII apresentou mais eventos do que GI (p < 0,001) ou GII (p < 0,045), não havendo diferença entre GI e GII (p = 0,160). Após o ajustamento, foi mantida a diferença apenas entre GIII e GI (p = 0,012). Conclusão: Em pacientes com FEVE preservada e EED concluído, a RVFC adequada obtida antes da FC alvo associou-se ao melhor prognóstico.
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Affiliation(s)
- José Sebastião de Abreu
- Clínica Clinicárdio, de Fortaleza, CE - Brazil.,Hospital Prontocárdio, Fortaleza, CE - Brazil.,Hospital das Clínicas da Universidade Federal do Ceará, Fortaleza, CE - Brazil
| | - Eduardo Arrais Rocha
- Clínica Clinicárdio, de Fortaleza, CE - Brazil.,Hospital Prontocárdio, Fortaleza, CE - Brazil.,Hospital das Clínicas da Universidade Federal do Ceará, Fortaleza, CE - Brazil
| | | | | | | | | | | | | | | | | | - José Nogueira Paes
- Clínica Clinicárdio, de Fortaleza, CE - Brazil.,Hospital Prontocárdio, Fortaleza, CE - Brazil
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Coronary flow reserve in mitral stenosis before and after percutaneous balloon mitral valvuloplasty. Int J Cardiovasc Imaging 2017; 33:1371-1376. [PMID: 28378162 DOI: 10.1007/s10554-017-1121-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
Abstract
We aimed to evaluate the coronary flow reserve (CFR) before and after percutaneous balloon mitral valvuloplasty (PBMV) in patients with mitral stenosis (MS) and its association to clinical events. A prospective study included 45 patients with mitral stenosis candidate for PBMV (age 38 ± 19 years, 27 were females) and 20 with matched age and sex, healthy controls were included in the study. Noninvasive CFR was measured using transthoracic echocardiography and utilizing adenosine stress echocardiography (0.14 mg/kg/min) before PMBV, and one weak post PBMV using multi-tract balloon valvuloplasty technique. CFR was significantly lower in patients with MS compared to controls (P < 0.001). Moreover the CFR was significantly increased post-PBMV (P < 0.001) associated with significant increase in LVEF% (P < 0.05), decrease in systolic pulmonary artery pressure (P < 0.001), significant increase in TAPSE (P < 0.001). CFR was significantly correlated with the degree of change (Δ) in MVA, TAPSE, LVEF%, mean mitral PG and sPAP (r = 0.77, P < 0.001, r = 0.63; P < 0.001; r = 0.42; P < 0.05; r = -0.81; P < 0.001 and r = -0.65; P < 0.001). Mitral valve stenosis was associated with significantly impaired coronary flow reserve that significantly improved after PMBV. The improved CFR values were significantly correlated with the gain in the MVA and the improvement in the functions of both left and right ventricles.
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Shome JS, Perera D, Plein S, Chiribiri A. Current perspectives in coronary microvascular dysfunction. Microcirculation 2017; 24. [DOI: 10.1111/micc.12340] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 12/06/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Joy S. Shome
- Division of Imaging Sciences and Biomedical Engineering; The Rayne Institute; King's College London; St. Thomas’ Hospital; London UK
| | - Divaka Perera
- Cardiovascular Division; The Rayne Institute; King's College London; St. Thomas’ Hospital; London UK
| | - Sven Plein
- Division of Imaging Sciences and Biomedical Engineering; The Rayne Institute; King's College London; St. Thomas’ Hospital; London UK
- Division of Biomedical Imaging; Multidisciplinary Cardiovascular Research Centre; Leeds Institute of Cardiovascular and Metabolic Medicine; University of Leeds; Leeds UK
| | - Amedeo Chiribiri
- Division of Imaging Sciences and Biomedical Engineering; The Rayne Institute; King's College London; St. Thomas’ Hospital; London UK
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Watanabe N. Noninvasive assessment of coronary blood flow by transthoracic Doppler echocardiography: basic to practical use in the emergency room. J Echocardiogr 2017; 15:49-56. [DOI: 10.1007/s12574-016-0324-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/14/2016] [Accepted: 11/19/2016] [Indexed: 10/20/2022]
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Wittfeldt A, Jeppsson A, Gan LM. Effects of nitroglycerine on coronary flow velocity before and during adenosine provocation. Cardiovasc Ultrasound 2016; 14:48. [PMID: 27919286 PMCID: PMC5139021 DOI: 10.1186/s12947-016-0091-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transthoracic echocardiography-assessed coronary flow velocity reserve (CFVR) evaluates coronary microvascular arterial function. Coronary flow velocity measurements at baseline and during hyperemia are used to calculate CFVR. Adenosine infusion induces hyperemia but it is not known if it causes a maximal response. We hypothesized that pre-treatment with nitroglycerine before adenosine provocation enhances hyperemia. METHODS Twenty-three healthy study subjects (mean age 27.5 ± 5.5, 35% women) underwent CFVR measurements before and after pretreatment with sublingual nitroglycerine (0.5 mg). Hyperemia was induced by adenosine infusion (140 μg/kg/min). In addition, the effect of nitroglycerin on left main coronary artery diameter was assessed. RESULTS Pretreatment with nitroglycerine increased median CFVR from 3.6 (range 2.8-4.3) to 5.0 (4.1-6.0), p = 0.002. The increase was caused by a marked reduction in baseline coronary flow velocity 17 (15-24) vs 27 (19-31) cm/s, p < 0.0001) while hyperemic velocity remained unchanged (90 (68-116) vs 93 (75-105) cm/s, p = 0.48). Nitroglycerin significantly dilated the left main coronary artery (from median 3.1 (2.7-3.6) mm to 3.8 (3.1-4.3) mm, p = 0.018). CONCLUSION Pretreatment with nitroglycerine dilates coronary arteries and increases coronary flow velocity reserve indicating that adenosine alone causes a submaximal hyperemia.
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Affiliation(s)
- Ann Wittfeldt
- Dept of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, 41345, Gothenburg, Sweden. .,Department of Cardiology, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden.
| | - Anders Jeppsson
- Dept of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, 41345, Gothenburg, Sweden.,Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden
| | - Li-Ming Gan
- Dept of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, 41345, Gothenburg, Sweden.,AstraZeneca R & D, 43150, Molndal, Sweden
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Meimoun P, Clerc J, Ardourel D, Djou U, Martis S, Botoro T, Elmkies F, Zemir H, Luycx-Bore A, Boulanger J. Assessment of left anterior descending artery stenosis of intermediate severity by fractional flow reserve, instantaneous wave-free ratio, and non-invasive coronary flow reserve. Int J Cardiovasc Imaging 2016; 33:999-1007. [PMID: 27752796 DOI: 10.1007/s10554-016-1000-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/07/2016] [Indexed: 01/14/2023]
Abstract
To test the usefulness of non-invasive coronary flow reserve (CFR) by transthoracic Doppler echocardiography by comparison to invasive fractional flow reserve (FFR) and instantaneous wave-free ratio (IFR), a new vasodilator-free index of coronary stenosis severity, in patients with left anterior descending artery (LAD) stenosis of intermediate severity (IS) and stable coronary artery disease. 94 consecutive patients (mean age 68 ± 10 years) with angiographic LAD stenosis of IS (50-70 % diameter stenosis), were prospectively studied. IFR was calculated as a trans-lesion pressure ratio during the wave-free period in diastole; FFR as distal pressure divided by mean aortic pressure during maximal hyperemia (using 180 μg intracoronary adenosine); and CFR as hyperemic peak LAD flow velocity divided by baseline flow velocity using intravenous adenosine (140 μg/kg/min over 2 min). The mean values of IFR, FFR, and CFR were 0.88 ± 0.07, 0.81 ± 0.09, and 2.4 ± 0.6 respectively. A significant correlation was found between CFR and FFR (r = 0. 68), FFR and IFR (r = 0.6), and between CFR and IFR (r = 0.5) (all, p < 0.01). Using a ROC curve analysis, the best cut-off to detect a significant lesion based on FFR assessment (FFR ≤ 0.8, n = 31) was IFR ≤ 0.88 with a sensitivity (Se) of 74 %, specificity (Sp) of 73 %, AUC 0.81 ± 0.04, accuracy 72 %; and CFR ≤ 2 with a Se = 77 %, Sp = 89 %, AUC 0.88 ± 0.04, accuracy 85 % (all, p < 0.001). In stable patients with LAD stenosis of IS, non-invasive CFR is a useful tool to detect a significant lesion based on FFR. Furthermore, there was a better correlation between CFR and FFR than between CFR and IFR, and a trend to a better diagnostic performance for CFR versus IFR.
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Affiliation(s)
- P Meimoun
- Department of Cardiology, Centre Hospitalier de Compiègne, 8 rue Henri Adnot, 60200, Compiègne, France.
| | - J Clerc
- Department of Cardiology, Centre Hospitalier de Compiègne, 8 rue Henri Adnot, 60200, Compiègne, France
| | - D Ardourel
- Department of Cardiology, Centre Hospitalier de Compiègne, 8 rue Henri Adnot, 60200, Compiègne, France
| | - U Djou
- Department of Cardiology, Centre Hospitalier de Compiègne, 8 rue Henri Adnot, 60200, Compiègne, France
| | - S Martis
- Department of Cardiology, Centre Hospitalier de Compiègne, 8 rue Henri Adnot, 60200, Compiègne, France
| | - T Botoro
- Department of Cardiology, Centre Hospitalier de Compiègne, 8 rue Henri Adnot, 60200, Compiègne, France
| | - F Elmkies
- Department of Cardiology, Centre Hospitalier de Compiègne, 8 rue Henri Adnot, 60200, Compiègne, France
| | - H Zemir
- Department of Cardiology, Centre Hospitalier de Compiègne, 8 rue Henri Adnot, 60200, Compiègne, France
| | - A Luycx-Bore
- Department of Cardiology, Centre Hospitalier de Compiègne, 8 rue Henri Adnot, 60200, Compiègne, France
| | - J Boulanger
- Department of Cardiology, Centre Hospitalier de Compiègne, 8 rue Henri Adnot, 60200, Compiègne, France
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Aleksandric S, Djordjevic-Dikic A, Beleslin B, Parapid B, Teofilovski-Parapid G, Stepanovic J, Simic D, Nedeljkovic I, Petrovic M, Dobric M, Tomasevic M, Banovic M, Nedeljkovic M, Ostojic M. Noninvasive assessment of myocardial bridging by coronary flow velocity reserve with transthoracic Doppler echocardiography: vasodilator vs. inotropic stimulation. Int J Cardiol 2016; 225:37-45. [PMID: 27710800 DOI: 10.1016/j.ijcard.2016.09.101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 09/25/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND To consider hemodynamic assessment of myocardial bridging (MB) adequate, it is believed that inotropic stimulation with dobutamine should be estimated because its dynamic nature depends on the degree of extravascular coronary compression. This study evaluated comparative assessment of hemodynamic relevance of MB using coronary flow velocity reserve (CFVR) measurements by transthoracic Doppler echocardiography (TTDE) with vasodilatative and inotropic challenges. METHODS This prospective study included forty-four patients with angiographic evidence of isolated MB of the left anterior descending coronary artery (LAD) and systolic compression of ≥50% diameter stenosis. All patients were evaluated by exercise stress-echocardiography (ExSE) test for signs of myocardial ischemia, and CFVR of the distal segment of LAD during iv.infusion of adenosine (ADO:140μg/kg/min) and iv.infusion of dobutamine (DOB:10-40μg/kg/min), separately. RESULTS Exercise-SE was positive for myocardial ischemia in 8/44 (18%) of patients. CFVR during ADO was significantly higher than CFVR during peak DOB (2.85±0.68 vs. 2.44±0.48, p=0.002). CFVR during peak DOB was significantly lower in SE-positive group in comparison to SE-negative group (2.01±0.16 vs. 2.54±0.47, p<0.001), but not for ADO (2.47±0.51 vs. 2.89±0.70, p=0.168), respectively. Multivariable logistic analysis showed that CFVR peak DOB was the most significant predictor of functional significant MB (OR 0.011, 95%CI: 0.001-0.507, p=0.021). Receiver-operating characteristic curves have shown that TTDE-CFVR obtained by high-dose of dobutamine infusion is better than those by adenosine regarding to functional status of MB (AUC 0.861, p=0.004; AUC 0.674, p=0.179, respectively). CONCLUSIONS Non-invasive CFVR measurement by TTDE during inotropic stimulation, in comparison to vasodilation, provides more reliable functional evaluation of MB.
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Affiliation(s)
| | - Ana Djordjevic-Dikic
- Division of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Branko Beleslin
- Division of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Biljana Parapid
- Division of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia
| | | | - Jelena Stepanovic
- Division of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Dragan Simic
- Division of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Ivana Nedeljkovic
- Division of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Milan Petrovic
- Division of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Milan Dobric
- Division of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Miloje Tomasevic
- Division of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; University of Kragujevac, School of Medicine, Kragujevac, Serbia
| | - Marko Banovic
- Division of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Milan Nedeljkovic
- Division of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Miodrag Ostojic
- University of Belgrade, School of Medicine, Belgrade, Serbia; Serbian Academy of Sciences and Arts, Belgrade, Serbia
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Epicardial adipose tissue in patients with end-stage renal disease on haemodialysis. Curr Opin Nephrol Hypertens 2016; 24:517-24. [PMID: 26335554 DOI: 10.1097/mnh.0000000000000161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW Epicardial adipose tissue (EAT) is the visceral fat of the heart, sharing many of the pathophysiological properties of other visceral fat depots. EAT is a metabolically active paracrine and vasocrine organ that causes local cardiac inflammation and is strongly implicated in the pathogenesis of coronary atherosclerosis. This article highlights the findings of recent observational studies in patients on haemodialysis that link the quantity of EAT to increased rates of cardiovascular and coronary artery disease and review the proposed methods of pathogenesis and the possible role of EAT quantification to improve cardiovascular risk assessment. RECENT FINDINGS Increasing volumes of EAT in patients on haemodialysis correlate with increased inflammatory mediators, higher rates of cardiovascular disease and coronary artery calcification, independent of general adiposity. EAT is an independent predictor of mortality and a potentially modifiable target for therapeutic interventions. SUMMARY EAT is likely to play a central role in the pathogenesis of cardiovascular disease in patients on haemodialysis, adds incrementally to conventional cardiovascular risk stratification models and is a potential target for therapeutic intervention.
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Abstract
Coronary artery imaging with transthoracic Doppler echocardiography is a simple and useful technique to diagnose significant coronary artery stenosis. The visualization of mosaic flow in the proximal left coronary artery provides a direct indication of the presence of significant stenosis at the corresponding site during routine echocardiography. Coronary flow velocity reserve (CFVR) has a high diagnostic accuracy and feasibility in detecting the presence of functionally significant coronary stenosis in the left anterior descending coronary artery (LAD) and in the right coronary artery. The measurement of CFVR in the LAD also provides prognostic information in patients with intermediate coronary stenosis. This review summarizes the utility of transthoracic coronary artery imaging.
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Human Mesenchymal Stem Cell Delivery System Modulates Ischemic Cardiac Remodeling With an Increase of Coronary Artery Blood Flow. Mol Ther 2016; 24:805-11. [PMID: 26782638 DOI: 10.1038/mt.2016.22] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 01/10/2016] [Indexed: 12/25/2022] Open
Abstract
Ways for extending the longevity of stem cells are imperative to attain diverse expected therapeutic effects. Here, we constructed a three-dimentional (3D) scaffold system for human mesenchymal stem cell (hMSC) delivery. Intramyocardial injections of porous PEI1.8k blended with poly(lactic-co-glycolic acid) (PLGA) (PLGA/PEI1.8k) (PPP) microparticles by physical electrostatic conjugation and structural entrapment of hMSCs demonstrated enhanced functional and geometric improvements on post-infarct cardiac remodeling in rats. In the hMSC-loaded PPP delivery, increases of coronary artery blood flow rate and in vivo engraftment rate as well as time-dependent functional, geometric, and pathologic findings reversing post-infarct cardiac remodeling account for improved left ventricular (LV) systolic function up to the level of sham thoracotomy group. This study expands our understanding by proving that increase of coronary artery blood flow augmented functional recovery of hMSC-loaded PPP delivery system after myocardial infarction (MI).
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Calderan J, Mao W, Sirois E, Sun W. Development of an In Vitro Model to Characterize the Effects of Transcatheter Aortic Valve on Coronary Artery Flow. Artif Organs 2015; 40:612-9. [PMID: 26510926 DOI: 10.1111/aor.12589] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Impairment of coronary artery flow, in either acute or chronic conditions, is a severe complication of transcatheter aortic valve (TAV) implantation, which can arise due to improper TAV positioning. However, little work has been done to quantify the effects of the TAV positioning on the coronary flow. In this study, a realistic in vitro model of coronary artery flow was developed and used to investigate the impact of TAV deployed orientations on coronary flow. The coronary hemodynamics was first replicated mathematically using a lumped parameter model with time-varying myocardial resistance. Based on the analytical model, two stepper motor controlled stopcock valves were integrated in a left heart simulator to represent the variable myocardial resistance in the experimental setup. The coronary flow and pressure waveforms obtained from the in vitro system were consistent with published data. With a TAV deployed in different orientations, the measured results demonstrated that TAV orientation does not have a significant impact on the coronary flow. The developed in vitro model can be further utilized to simulate coronary flow under various pathological conditions.
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Affiliation(s)
- Joseph Calderan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Wenbin Mao
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Eric Sirois
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Wei Sun
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
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Longitudinal Strain by Automated Function Imaging Detects Single-Vessel Coronary Artery Disease in Patients Undergoing Dipyridamole Stress Echocardiography. J Am Soc Echocardiogr 2015; 28:1214-21. [DOI: 10.1016/j.echo.2015.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Indexed: 11/24/2022]
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Liu J, Wang Y, An H, Liu J, Wei J, Wang H, Wang G. Correlation between arterial stiffness and coronary flow velocity reserve in subjects with pulse wave velocity >1400 cm/s. Clin Exp Hypertens 2015; 38:89-94. [PMID: 26362523 DOI: 10.3109/10641963.2015.1060988] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Brachial-ankle pulse wave velocity (ba-PWV) is an independent predictor for cardiovascular events. Coronary flow velocity reserve (CFVR) provides important information for coronary endothelial function. In the present study, we investigated the possible relationship between PWV and CFVR, especially in subjects with PWV > 1400 cm/s. Seventy five subjects were divided into two groups based on baPWV value (baPWV > 1400 cm/s versus baPWV < 1400 cm/s). PWV and CFVR were measured by Colin VP-1000 apparatus and non-invasive Doppler echocardiography, respectively. Our results showed that CFVR was significantly lower in patients with baPWV > 1400 cm/s than in patients with baPWV < 1400 cm/s (2.57 ± 0.68 versus 3.04 ± 0.73, p < 0.01). baPWV was negatively correlated with CFVR in the entire study group (r = -0.45, p < 0.0001) even adjusting for age, prevalence of diabetes mellitus and systolic blood pressure (r = -0.33, p = 0.044). Moreover, baPWV was markedly negatively correlated with CFVR in patients with baPWV > 1400 cm/s (r = -0.42, p < 0.01). Multiple linear regressions showed that baPWV was independently associated with CFVR in the entire study group (β = -0.702, p < 0.001). Our results showed that large arterial stiffness was negatively correlated with decreased CFVR especially in subjects with baPWV > 1400 cm/s, and baPWV was independently associated with CFVR.
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Affiliation(s)
- Jinbo Liu
- a Department of Vascular Medicine , Peking University Shougang Hospital , Beijing , P.R. of China
| | - Ying Wang
- b Physical Examination Center, Beijing Chao-yang Hospital, Capital Medical University , Beijing , China
| | - Huijie An
- c Department of Endocrinology , Beijing Chaoyang Hospital Affiliated to Capital Medical University , Beijing , P.R. of China , and
| | - Jia Liu
- c Department of Endocrinology , Beijing Chaoyang Hospital Affiliated to Capital Medical University , Beijing , P.R. of China , and
| | - Jinru Wei
- d The First People's Hospital of Nanning Affiliated to the Guangxi Medical University , Nanning , P.R. of China
| | - Hongyu Wang
- a Department of Vascular Medicine , Peking University Shougang Hospital , Beijing , P.R. of China
| | - Guang Wang
- c Department of Endocrinology , Beijing Chaoyang Hospital Affiliated to Capital Medical University , Beijing , P.R. of China , and
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YUFU KUNIO, SHINOHARA TETSUJI, EBATA YUKI, AYABE REIKA, FUKUI AKIRA, OKADA NORIHIRO, NAKAGAWA MIKIKO, TAKAHASHI NAOHIKO. Endothelial Function Predicts New Hospitalization due to Heart Failure Following Cardiac Resynchronization Therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:1260-6. [DOI: 10.1111/pace.12698] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 06/29/2015] [Accepted: 07/15/2015] [Indexed: 11/27/2022]
Affiliation(s)
- KUNIO YUFU
- From the Department of Cardiology and Clinical Examination; Faculty of Medicine, Oita University; Yufu Oita Japan
| | - TETSUJI SHINOHARA
- From the Department of Cardiology and Clinical Examination; Faculty of Medicine, Oita University; Yufu Oita Japan
| | - YUKI EBATA
- From the Department of Cardiology and Clinical Examination; Faculty of Medicine, Oita University; Yufu Oita Japan
| | - REIKA AYABE
- From the Department of Cardiology and Clinical Examination; Faculty of Medicine, Oita University; Yufu Oita Japan
| | - AKIRA FUKUI
- From the Department of Cardiology and Clinical Examination; Faculty of Medicine, Oita University; Yufu Oita Japan
| | - NORIHIRO OKADA
- From the Department of Cardiology and Clinical Examination; Faculty of Medicine, Oita University; Yufu Oita Japan
| | - MIKIKO NAKAGAWA
- From the Department of Cardiology and Clinical Examination; Faculty of Medicine, Oita University; Yufu Oita Japan
| | - NAOHIKO TAKAHASHI
- From the Department of Cardiology and Clinical Examination; Faculty of Medicine, Oita University; Yufu Oita Japan
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Abstract
The authors sought to evaluate coronary microvascular function and left ventricular diastolic dysfunction using transthoracic Doppler echocardiography in burn patients. In this study, 32 adult burn patients with partial or full-thickness scald burns that were hospitalized and treated were included. The control group was matched for age and sex and was composed of otherwise healthy volunteers. Transthoracic Doppler echocardiography examinations and simultaneous laboratory tests for cardiac evaluation were performed on the sixth month after burn injury as well as with the control group. High-sensitivity C-reactive protein levels were significantly higher in the burn patients than in controls (5.17 ± 3.86 vs 2.42 ± 1.78; P = .001). Lateral isovolumic relaxation time was significantly higher in the burn injury group than in the control group (92.7 ± 15.7 vs 85.5 ± 8.3; P = .03). Baseline coronary diastolic peak flow velocity of the left anterior descending artery was similar in both groups. However, hyperemic diastolic peak flow velocity and coronary flow velocity reserve (2.26 ± 0.48 vs 2.94 ± 0.47; P < .001) were significantly lower in the burn injury group than in the control group. Coronary flow velocity reserve was significantly and inversely correlated with high-sensitivity C-reactive protein, burn ratio, creatinine, and mitral A-wave max velocity. At the sixth month of treatment, burn patients had high-sensitivity C-reactive protein levels during this period, suggesting that inflammation still exists. In addition, subclinical coronary microvascular and left ventricular diastolic dysfunction can occur in burn patients without traditional cardiovascular risk factors. However, these results must be supported by additional studies.
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Abstract
OBJECTIVES Takotsubo stress cardiomyopathy (TSC) is an increasingly recognised and diagnosed disease, although the underlying pathophysiology is still unknown. Our aim was to investigate the effect of the catecholamine dobutamine on coronary flow reserve (CFR) measured non-invasively in patients with TSC and controls. Our hypothesis was that dobutamine stress can induce microvascular dysfunction in patients with a previous episode of TSC. SETTING This is a case-control study and a substudy of the Stockholm Myocardial Infarction with Normal Coronaries (SMINC) study. Elective dobutamine investigations were performed focusing on non-invasive measurements of CFR. The investigations were performed more than 6 months after the acute event. PARTICIPANTS 22 patients with a previous episode of TSC and 22 sex-matched and age-matched controls were recruited from the SMINC study. All patients with TSC had a previous normal cardiovascular MR investigation. RESULTS CFR at low-dose dobutamine was significantly lower in the TSC group compared with controls, 1.51 and 1.72, respectively (p=0.017). At high-dose dobutamine, CFR was 1.95 and 2.21 in the TSC group and controls, respectively (p=0.098). CONCLUSIONS We could not confirm that the catecholamine dobutamine induced microvascular dysfunction in patients with TSC. However, we found a small but significant difference in CFR at low-dose dobutamine, which implies that the role of microvascular function in TSC needs to be further explored.
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Affiliation(s)
- Olov Collste
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Mahbubul Alam
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mats Frick
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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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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Takemoto K, Hirata K, Tanimoto T, Matsuo Y, Ino Y, Kubo T, Tanaka A, Akasaka T. Combined Non-Invasive Doppler Echocardiography and Coronary Computed Tomography Lead to Diagnosis of Anomalous Left Coronary Artery From the Pulmonary Artery (ALCAPA) Syndrome. Circ J 2015; 79:1136-8. [PMID: 25739407 DOI: 10.1253/circj.cj-14-1374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kazushi Takemoto
- Division of Cardiology, Department of Medicine, Wakayama Medical University
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