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Rezaeian P, Shufelt C, Wei J, Pacheco C, Cook-Wiens G, Berman D, Tamarappoo B, Thomson L, Nelson M, Anderson R, Petersen J, Handberg E, Pepine C, Merz CB. Arterial stiffness assessment in coronary microvascular dysfunction and heart failure with preserved ejection fraction: An initial report from the WISE-CVD continuation study. Am Heart J Plus 2024; 41:100390. [PMID: 38600957 PMCID: PMC11004063 DOI: 10.1016/j.ahjo.2024.100390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/12/2024]
Abstract
Background Heart failure with preserved ejection fraction (HFpEF) is the most common cardiac complication in patients with coronary microvascular dysfunction (CMD), yet its underlying pathways remain unclear. Aortic pulse-wave velocity (aPWV) is an indicator of large artery stiffness and a predictor for cardiovascular disease. However, aPWV in CMD and HFpEF is not well characterized and may provide understanding of disease progression. Methods Among participants without obstructive coronary artery disease, we evaluated 51 women with suspected CMD and 20 women and men with evidence of HFpEF. All participants underwent aPWV measurement (SphygmoCor, Atcor Medical) with higher aPWV indicating greater vascular stiffness. Cardiac magnetic resonance imaging (CMRI) assessed left ventricular (LV) ejection fraction, CMD via myocardial perfusion reserve index (MPRI), and ventricular remodeling via LV mass-volume ratio. . Statistical analysis was performed using Wilcoxon rank sum tests, Pearson correlations and linear regression analysis. Results Compared to the suspected CMD group, the HFpEF participants were older (65 ± 12 vs 56 ± 11 yrs., p = 0.002) had higher BMI (31.0 ± 4.3 vs 27.8 ± 6.7 kg/m2, p = 0.013), higher aPWV (10.5 ± 2.0 vs 8.0 ± 1.6 m/s, p = 0.05) and lower MPRI (1.5 ± 0.3 vs1.8 ± 0.3, p = 0.02), but not remodeling. In a model adjusted for cardiovascular risk factors, the HFpEF group had a lower LVEF (estimate -4.78, p = 0.0437) than the suspected CMD group. Conclusions HFpEF participants exhibit greater arterial stiffness and lower myocardial perfusion reserve, with lower LVEF albeit not remodeling, compared to suspected CMD participants. These findings suggest arterial stiffness may contribute to progression from CMD to HFpEF. Prospective work is needed and ongoing.
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Affiliation(s)
- P. Rezaeian
- Torrance Memorial Medical Center-A Cedars-Sinai Affiliate, Torrance, CA, USA
| | - C.L. Shufelt
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - J. Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - C. Pacheco
- Hôspital Pierre-Boucher, Centre Hospitalier de l'Université de Montréal, Université de Montreal, QC, Canada
| | - G. Cook-Wiens
- Torrance Memorial Medical Center-A Cedars-Sinai Affiliate, Torrance, CA, USA
| | - D. Berman
- Taper Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - B. Tamarappoo
- Taper Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - L.E. Thomson
- Taper Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - M.D. Nelson
- The University of Texas at Arlington, Arlington, TX, USA
| | - R.D. Anderson
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - J. Petersen
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - E.M. Handberg
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - C.J. Pepine
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - C.N. Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
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Wei J, Barsky LL, Jalnapurkar S, Zarrini P, Cook-Wiens G, AlBadri A, Nelson MD, Shufelt C, Sharif B, Berman DS, Thomson L, Handberg EM, Petersen JW, Anderson RD, Pepine CJ, Bairey Merz CN, Mehta PK. Cold Pressor Testing and Sympathetic Nervous System Contribution to Ischemia with No Obstructive Coronary Artery Disease: Results from the Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction Project. Am Heart J Plus 2022; 13:100080. [PMID: 36262746 PMCID: PMC9578760 DOI: 10.1016/j.ahjo.2021.100080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Study Objective Cold Pressor Testing (CPT) is a known stimulus of the sympathetic nervous system (SNS). To better understand sympathetic contribution to coronary blood flow regulation in women with suspected ischemia and no obstructive coronary arteries (INOCA), we compared myocardial perfusion reserve during CPT stress cardiac magnetic resonance (CMR) imaging between women with suspected INOCA and reference subjects. Design Prospective cohort. Setting Academic hospital. Participants 107 women with suspected INOCA and 21-age-matched reference women. Interventions CPT stress CMR was performed with measurement of myocardial perfusion reserve index (MPRI), adjusted for rate pressure product (MPRIRPP). Invasive coronary function testing in a subset of INOCA women (n=42) evaluated for endothelial dysfunction in response to acetylcholine, including impaired coronary diameter response ≤0% and coronary blood flow response (ΔCBF) <50%. Main Outcome Measure MPRIRPP. Results Compared to reference women, the INOCA group demonstrated higher resting RPP (p=0.005) and CPT MPRIRPP (1.09±0.36 vs 0.83±0.18, p=0.002). Furthermore, INOCA women with impaired ΔCBF (n=23) had higher CPT MPRIRPP (p=0.044) compared to reference women despite lower left ventricular ejection fraction (64±7 % vs 69±2 %, p=0.005) and mass-to-volume ratio (0.79±0.15 vs 0.62±0.09, p<0.0001). These differences in CPT MPRIRPP did not persist after adjusting for age, body mass index, and history of hypertension. CPT MPRIRPP among INOCA women did not differ based on defined acetylcholine responses. Conclusions Myocardial perfusion reserve to CPT stress is greater among women with INOCA compared to reference subjects. CPT induced a higher MPRIRPP also in women with coronary endothelial dysfunction, suggesting a greater contribution of the SNS to coronary flow than endothelial dysfunction. Further investigation in a larger cohort is needed.
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Affiliation(s)
- J Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
| | - L L Barsky
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
| | - S Jalnapurkar
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
| | - P Zarrini
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
| | - G Cook-Wiens
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
| | | | | | - C Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
| | - B Sharif
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
| | - D S Berman
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
| | - Lej Thomson
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
| | - E M Handberg
- Division of Cardiology, University of Florida, Gainesville, FL
| | - J W Petersen
- Division of Cardiology, University of Florida, Gainesville, FL
| | - R D Anderson
- Division of Cardiology, University of Florida, Gainesville, FL
| | - C J Pepine
- Division of Cardiology, University of Florida, Gainesville, FL
| | - C N Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
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Zamani SK, Wei J, Kwan AC, Berman DS, Shufelt C, Bairey Merz CN, Nelson MD. Longitudinal changes in cardiac morphology and function in women with INOCA: results from repeat cardiac magnetic resonance imaging a median of 6 years apart. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Women with signs and symptoms of ischemia but no obstructive coronary arteries (INOCA) are at increased risk of developing heart failure with preserved ejection fraction. The exact mechanism(s) driving disease progression, however, remains incompletely understood.
Purpose
To evaluate longitudinal changes in cardiac morphology and function across all four chambers of the heart, in women with INOCA.
Methods
To accomplish our goal, we leveraged 13 cases of repeat cardiac magnetic resonance imaging (cMRI), performed a median of 6 years apart (range: 3–11 years), in women with INOCA. Cardiac morphology and function were retrospectively assessed from conventional cine images using commercially available software (V5.11.1, CVI42, Circle Cardiovascular Imaging). Left and right ventricular (LV, RV, respectively) mass, volume, and ejection fraction were assessed using a series of short axis images spanning the base to apex. Left atrial (LA) volume was assessed using three orthogonal long-axis images, while right atrial (RA) area was assessed using a single horizontal long axis image. Concentricity was defined as the mass-to-end-diastolic volume ratio. Lastly, strain and strain rate were assessed in all four chambers by feature tracking analysis.
Results
Upon follow-up, LV and RV end-diastolic volume index (Figure 1A), LA volume index (from 36±5 to 32±5 mL/m2, P=0.02) and RA area index (from 11.3±1.6 to 9.6±2.0 cm2/m2, P=0.003) were significantly reduced. LV mass was preserved (Figure 1B), resulting in a significant increase in LV concentricity (from 0.59±0.07 to 0.64±0.09, P=0.02), together with an increase in LV ejection fraction (Figure 1C), and reduction in both longitudinal (Figure 1D) and circumferential (from 1.3±0.2 to 1.1±0.3 s-1, P=0.05) LV early diastolic strain rate. In contrast, RV mass was significantly reduced (Figure 1B), while RV concentricity (from 0.19±0.02 to 0.20±0.04) and ejection fraction (from 58±4 to 59±6) were preserved.
Conclusions
To our knowledge, this is the first study to evaluate long-term changes in cardiac morphology and function in women with INOCA. That LV early diastolic strain rate was reduced at follow-up, is consistent with a growing body of cross-sectional observations from our group and others, highlighting diastolic dysfunction as an important contributor of disease progression in this patient population. That we observed a discordant pattern of change between LV and RV concentricity is unique and warrants further consideration.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National heart, lung, and blood institute (NIH)
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Affiliation(s)
- S K Zamani
- The University of Texas at Arlington, Applied Physiology and Advanced Imaging Lab, Arlington, United States of America
| | - J Wei
- Cedars-Sinai Smidt Heart Institute, Barbra Streisand Women's Heart Center, Los Angeles, United States of America
| | - A C Kwan
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, United States of America
| | - D S Berman
- Cedars-Sinai Medical Center, S. Mark Taper Foundation Imaging Center, Los Angeles, United States of America
| | - C Shufelt
- Cedars-Sinai Smidt Heart Institute, Barbra Streisand Women's Heart Center, Los Angeles, United States of America
| | - C N Bairey Merz
- Cedars-Sinai Smidt Heart Institute, Barbra Streisand Women's Heart Center, Los Angeles, United States of America
| | - M D Nelson
- The University of Texas at Arlington, Applied Physiology and Advanced Imaging Lab, Arlington, United States of America
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Sedlak T, Herscovici R, Cook-Wiens G, Handberg E, Wei J, Shufelt C, Bittner V, Reis S, Reichek N, Pepine C, Merz CB. Predicted Versus Observed Major Adverse Cardiac Event Risk in Women with Evidence of Ischemia and No Obstructive Coronary Artery Disease: A Report from Women’s Ischemia Syndrome Evaluation (WISE). Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.01.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Nelson M, Rezaeian P, Cook-Wiens G, Pacheco Claudio C, Wei J, Sharif B, Thomson L, Samuel B, Berman D, Shufelt C, Merz CB. Defining Mechanistic Links Between Ischemia and No Obstructive Coronary Artery Disease and Heart Failure with Preserved Ejection Fraction: Role of Peripheral Vascular Stiffness. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.01.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Rezaeian P, Shufelt C, Wei J, Pacheco C, Cook-Wiens G, Berman D, Tamarappoo B, Thomson L, Nelson M, Anderson R, Petersen J, Handberg E, Pepine C, Merz CB. Arterial Stiffness Ventricular Remodeling and Myocardial Perfusion in Coronary Microvascular Dysfunction: A Report from the WISE-CVD Continuation Study. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.01.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Haftbaradaran A, Zaya M, Mehta PK, Shufelt C, Lentz G, Dhawan S, Petersen J, Handberg E, Johnson BD, Pepine CJ, Leach D, Long S, Merz CNB. Five-year stroke rate in women with signs and symptoms of ischemia undergoing coronary angiography: a retrospective study from the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation (WISE). JRSM Open 2015; 6:2054270415577761. [PMID: 25893110 PMCID: PMC4372570 DOI: 10.1177/2054270415577761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- A Haftbaradaran
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA 90048, USA
| | - M Zaya
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA 90048, USA
| | - PK Mehta
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA 90048, USA
| | - C Shufelt
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA 90048, USA
| | - G Lentz
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA 90048, USA
| | - Shivani Dhawan
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA 90048, USA
| | - J Petersen
- University of Florida, Gainesville, FL, USA
| | - E Handberg
- University of Florida, Gainesville, FL, USA
| | - BD Johnson
- University of Pittsburgh, Pittsburgh, PA, USA
| | - CJ Pepine
- University of Florida, Gainesville, FL, USA
| | - D Leach
- University of Florida, Gainesville, FL, USA
| | - S Long
- University of Florida, Gainesville, FL, USA
| | - CN Bairey Merz
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA 90048, USA
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Thomson L, Shufelt C, Goykhman P, Agarwal M, Mehta P, Sedlak T, Li N, Gill E, Samuels B, Azabal B, Kar S, Kothawade K, Minissian M, Slomka P, Berman D, Merz NB. Myocardial Perfusion Reserve is Reduced in Symptomatic Women with Microvascular Coronary Dysfunction Compared to a Matched Reference Control Group. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Affiliation(s)
- R Hachamovitch
- Nuclear Cardiology Laboratory, St Francis Hospital, Roslyn, NY, USA
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10
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Affiliation(s)
- C Shufelt
- Department of Preventive Medicine, University of Southern California, Los Angeles, USA
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Affiliation(s)
- R Hachamovitch
- Department of Medicine, Weill Medical College of Cornell University, and Presbyterian Hospital, NY, USA
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McPherson EJ, Tontz W, Patzakis M, Woodsome C, Holtom P, Norris L, Shufelt C. Outcome of infected total knee utilizing a staging system for prosthetic joint infection. Am J Orthop (Belle Mead NJ) 1999; 28:161-5. [PMID: 10195839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
This study reviews, over a 5-year period, the records of 70 consecutive patients with prosthetic knee infection and evaluates outcomes as a function of a staging system for prosthetic joint infection. The staging system for prosthetic joint infection was divided into three main categories that include infection type, systemic host grade, and local extremity grade. Outcome indices analyzed included Knee Society Score (KSS), complication rate, amputation rate, and rate of permanent resection. We show that categorizing and stratifying data for patients with infected total knee arthroplasty are useful. A universally accepted staging system would allow for more objective comparisons of treatments and may eventually define particular treatment regimens for particular classes of patients.
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Affiliation(s)
- E J McPherson
- Department of Orthopaedic Surgery, University of Southern California School of Medicine, Los Angeles, USA
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