51
|
Unique Presentations and Etiologies of Myocardial Infarction in Women. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:66. [DOI: 10.1007/s11936-017-0571-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
52
|
Ahmed B, Creager MA. Alternative causes of myocardial ischemia in women: An update on spontaneous coronary artery dissection, vasospastic angina and coronary microvascular dysfunction. Vasc Med 2017; 22:146-160. [DOI: 10.1177/1358863x16686410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Bina Ahmed
- Dartmouth-Hitchcock Heart and Vascular Center, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Mark A Creager
- Dartmouth-Hitchcock Heart and Vascular Center, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| |
Collapse
|
53
|
Principals and clinical applications of magnetic resonance cardiac spectroscopy in heart failure. Heart Fail Rev 2017; 22:491-499. [DOI: 10.1007/s10741-017-9611-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
54
|
Singh A, Sharma RK, Chagtoo M, Agarwal G, George N, Sinha N, Godbole MM. 1H NMR Metabolomics Reveals Association of High Expression of Inositol 1, 4, 5 Trisphosphate Receptor and Metabolites in Breast Cancer Patients. PLoS One 2017; 12:e0169330. [PMID: 28072864 PMCID: PMC5225010 DOI: 10.1371/journal.pone.0169330] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 12/15/2016] [Indexed: 01/01/2023] Open
Abstract
1H NMR is used to detect alterations in metabolites and their linkage to metabolic processes in a number of pathological conditions including breast cancer. Inositol 1, 4, 5 trisphosphate (IP3R) receptor is an intracellular calcium channel known to regulate metabolism and cellular bioenergetics. Its expression is up regulated in a number of cancers. However, its linkage to metabolism in disease conditions has not been evaluated. This study was designed to determine the association if any, of these metabolites with altered expression of IP3R in breast cancer. We used 1H NMR to identify metabolites in the serum of breast cancer patients (n = 27) and performed Real-time Polymerase Chain Reaction analysis for quantifying the expression of IP3R type 3 and type 2 in tissues from breast cancer patients (n = 40). Principal Component Analysis (PCA) and Partial Least Square-Discriminant Analysis (PLS-DA) clearly distinguished patients with high/low IP3R expression from healthy subjects. The present study revealed high expression of IP3R type 2 and type 3 in human breast tumor tissue compared to adjacent non-tumorous tissue. Moreover, patients with ≥ 2-fold increase in IP3R (high IP3R group) had significantly higher concentration of metabolic intermediates compared to those with < 2-fold increase in IP3R (low IP3R group). We observed an increase in lipoprotein content and the levels of metabolites like lactate, lysine and alanine and a decrease in the levels of pyruvate and glucose in serum of high IP3R group patients when compared to those in healthy subjects. Receiver operating characteristic (ROC) curve analysis was performed to show the clinical utility of metabolites. In addition to the human studies, functional relevance of IP3Rs in causing metabolic disruption was observed in MCF-7 and MDA MB-231 cells. Results from our studies bring forth the importance of metabolic (or metabolomics) profiling of serum by 1H NMR in conjunction with tissue expression studies for characterizing breast cancer patients. The results from this study provide new insights into relationship of breast cancer metabolites with IP3R.
Collapse
Affiliation(s)
- Aru Singh
- Department of Molecular Medicine and Biotechnology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, India
| | | | - Megha Chagtoo
- Department of Molecular Medicine and Biotechnology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, India
| | - Gaurav Agarwal
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, India
| | - Nelson George
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, India
| | - Neeraj Sinha
- Centre of Biomedical Research, Raebareli Road, Lucknow, India
| | - Madan M. Godbole
- Department of Molecular Medicine and Biotechnology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, India
- * E-mail:
| |
Collapse
|
55
|
Gudmundsson A, Aspelund T, Sigurdsson G, Harris T, Launer LJ, Gudnason V, Jonsson H. Long-Term Hormone Replacement Therapy Is Associated with Low Coronary Artery Calcium Levels in a Cohort of Older Women: The Age, Gene/Environment Susceptibility-Reykjavik Study. J Am Geriatr Soc 2016; 65:200-206. [PMID: 27861721 DOI: 10.1111/jgs.14461] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To assess the relationship between hormone replacement therapy (HRT) and coronary artery calcium (CAC). DESIGN Cross-sectional. SETTING Established population-based cohort in Reykjavik, Iceland. PARTICIPANTS Women (mean age 76 ± 5) who had completed questionnaires on HRT use (N = 2,867). MEASUREMENTS Coronary artery calcium assessed using computed tomography was the outcome variable and was compared between women with history of HRT and those who had never used HRT and analyzed according to age, length of use, and time after menopause that HRT was initiated. RESULTS Eight hundred seventy-two (30.4%) participants had used HRT, and 312 (10.9%) were current users. After adjustment for age, other late-life variables, and a propensity score based on midlife data for HRT use as observed in late life, there were significant negative associations between CAC and history and length of HRT use. This association was evident in all age categories. When HRT had been used for longer than 15 years, median CAC level was less than 50% of that observed in never users. The lowest CAC was observed in those who started HRT within 5 years after menopause. The prevalence of coronary events was comparable in both groups. CONCLUSION A strong association was found between long-term HRT use and low CAC. The negative association between duration of HRT and CAC was evident in all age groups of older women.
Collapse
Affiliation(s)
- Adalsteinn Gudmundsson
- Landspitali University Hospital, Reykjavik, Iceland.,University of Iceland, Reykjavik, Iceland
| | - Thor Aspelund
- University of Iceland, Reykjavik, Iceland.,Icelandic Heart Association, Kopavogur, Iceland
| | - Gunnar Sigurdsson
- Landspitali University Hospital, Reykjavik, Iceland.,University of Iceland, Reykjavik, Iceland.,Icelandic Heart Association, Kopavogur, Iceland
| | - Tamara Harris
- Intramural Research Program, National Institute on Aging, Bethesda, Maryland
| | - Lenore J Launer
- Intramural Research Program, National Institute on Aging, Bethesda, Maryland
| | - Vilmundur Gudnason
- University of Iceland, Reykjavik, Iceland.,Icelandic Heart Association, Kopavogur, Iceland
| | - Helgi Jonsson
- Landspitali University Hospital, Reykjavik, Iceland.,University of Iceland, Reykjavik, Iceland
| |
Collapse
|
56
|
Vaccarino V, Wilmot K, Al Mheid I, Ramadan R, Pimple P, Shah AJ, Garcia EV, Nye J, Ward L, Hammadah M, Kutner M, Long Q, Bremner JD, Esteves F, Raggi P, Quyyumi AA. Sex Differences in Mental Stress-Induced Myocardial Ischemia in Patients With Coronary Heart Disease. J Am Heart Assoc 2016; 5:JAHA.116.003630. [PMID: 27559072 PMCID: PMC5079026 DOI: 10.1161/jaha.116.003630] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Emerging data suggest that young women with coronary heart disease (CHD) are disproportionally vulnerable to the adverse cardiovascular effects of psychological stress. We hypothesized that younger, but not older, women with stable CHD are more likely than their male peers to develop mental stress-induced myocardial ischemia (MSIMI). METHODS AND RESULTS We studied 686 patients (191 women) with stable coronary heart disease (CHD). Patients underwent (99m)Tc-sestamibi myocardial perfusion imaging at rest and with both mental (speech task) and conventional (exercise/pharmacological) stress testing. We compared quantitative (by automated software) and visual parameters of inducible ischemia between women and men and assessed age as an effect modifier. Women had a more-adverse psychosocial profile than men whereas there were few differences in medical history and CHD risk factors. Both quantitative and visual indicators of ischemia with mental stress were disproportionally larger in younger women. For each 10 years of decreasing age, the total reversibility severity score with mental stress was 9.6 incremental points higher (interaction, P<0.001) and the incidence of MSIMI was 82.6% higher (interaction, P=0.004) in women than in men. Incidence of MSIMI in women ≤50 years was almost 4-fold higher than in men of similar age and older patients. These results persisted when adjusting for sociodemographic and medical risk factors, psychosocial factors, and medications. There were no significant sex differences in inducible ischemia with conventional stress. CONCLUSIONS Young women with stable CHD are susceptible to MSIMI, which could play a role in the prognosis of this group.
Collapse
Affiliation(s)
- Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Kobina Wilmot
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Ibhar Al Mheid
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Ronnie Ramadan
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Pratik Pimple
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Amit J Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Ernest V Garcia
- Department of Radiology, Emory University School of Medicine, Atlanta, GA
| | - Jonathon Nye
- Department of Radiology, Emory University School of Medicine, Atlanta, GA
| | - Laura Ward
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Muhammad Hammadah
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Michael Kutner
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Qi Long
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Fabio Esteves
- Department of Radiology, Emory University School of Medicine, Atlanta, GA
| | - Paolo Raggi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA Department of Radiology, Emory University School of Medicine, Atlanta, GA Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Arshed A Quyyumi
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| |
Collapse
|
57
|
Behavioral, emotional and neurobiological determinants of coronary heart disease risk in women. Neurosci Biobehav Rev 2016; 74:297-309. [PMID: 27496672 DOI: 10.1016/j.neubiorev.2016.04.023] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/15/2016] [Accepted: 04/20/2016] [Indexed: 02/08/2023]
Abstract
Women have more of the stress-related behavioral profile that has been linked to cardiovascular disease than men. For example, women double the rates of stress-related mental disorders such as depression and posttraumatic stress disorder (PTSD) than men, and have higher rates of exposure to adversity early in life. This profile may increase women's long-term risk of cardiometabolic conditions linked to stress, especially coronary heart disease (CHD). In addition to having a higher prevalence of psychosocial stressors, women may be more vulnerable to the adverse effects of these stressors on CHD, perhaps through altered neurobiological physiology. Emerging data suggest that young women are disproportionally susceptible to the adverse effects of stress on the risk of cardiovascular disease, both in terms of initiating the disease as well as worsening the prognosis in women who have already exhibited symptoms of the disease. Women's potential vulnerability to psychosocial stress could also help explain their higher propensity toward abnormal coronary vasomotion and microvascular disease compared with men.
Collapse
|
58
|
Mauricio R, Srichai MB, Axel L, Hochman JS, Reynolds HR. Stress Cardiac MRI in Women With Myocardial Infarction and Nonobstructive Coronary Artery Disease. Clin Cardiol 2016; 39:596-602. [PMID: 27459149 DOI: 10.1002/clc.22571] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/05/2016] [Accepted: 06/06/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In a prospective study, cardiac MRI (CMR) and intravascular ultrasound were performed in women with myocardial infarction (MI) and nonobstructive coronary artery disease (MINOCA). Forty participants underwent adenosine-stress CMR (sCMR). HYPOTHESIS Abnormal perfusion may co-localize with ischemic late gadolinium enhancement (LGE) and T2-weighted signal hyperintensity (T2+), suggesting microvascular dysfunction contributed to MI. METHODS Qualitative perfusion analysis was performed by 2 independent readers. Abnormal myocardial perfusion reserve index (MPRI) was defined as global average ≤1.84. RESULTS Abnormal rest perfusion was present in 10 patients (25%) and stress perfusion abnormalities in 25 (63%). Abnormal stress perfusion was not associated with LGE but tended to occur with T2+. Among patients with abnormal perfusion and LGE, the LGE pattern was ischemic in half. The locations of abnormal perfusion and LGE matched in 75%, T2+ in 100%. Abnormal stress perfusion was not associated with plaque disruption and matched in location in 63%. MPRI was abnormal in 10 patients (25%) and was not associated with LGE, T2+ or plaque disruption. CONCLUSIONS Abnormal perfusion on sCMR is common among women with MINOCA. Abnormal perfusion usually co-localized with LGE and/or T2+ when present. Variability in LGE pattern leads to uncertainty about whether the finding of abnormal perfusion was cause or consequence of the tissue state leading to LGE. Low MPRI, possibly indicating diffuse microvascular disease, was observed with and without LGE and T2+. Multiple mechanisms may lead to abnormal perfusion on sCMR. Microvascular dysfunction may contribute to the pathogenesis of and coexist with other causes of MINOCA.
Collapse
Affiliation(s)
- Rina Mauricio
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Monvadi B Srichai
- Department of Medicine, Georgetown University School of Medicine, Washington, DC
| | - Leon Axel
- Department of Radiology, New York University School of Medicine, New York, New York
| | - Judith S Hochman
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Harmony R Reynolds
- Department of Medicine, New York University School of Medicine, New York, New York.
| |
Collapse
|
59
|
Sarapultsev PA, Sarapultsev AP. Stress cardiomyopathy: Is it limited to Takotsubo syndrome? Problems of definition. Int J Cardiol 2016; 221:698-718. [PMID: 27424315 DOI: 10.1016/j.ijcard.2016.07.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/04/2016] [Indexed: 02/09/2023]
Abstract
In 2006, Takotsubo syndrome (TTC) was described as a distinct type of stress-induced cardiomyopathy (stress cardiomyopathy). However, when thinking about Takotsubo cardiomyopathy from the viewpoints of the AHA and ESC classifications, 2 possible problems may arise. The first potential problem is that a forecast of disease outcome is lacking in the ESC classification, whereas the AHA only states that 'outcome is favorable with appropriate medical therapy'. However, based on the literature data, one can make a general conclusion that occurrence of myocardial lesions in TTC (i.e., myocardial fibrosis and contraction-band necrosis) causes the same effects as in other diseases with similar levels of myocardial damage and should not be considered to have a lesser impact on mortality. To summarise, TTC can cause not only severe complications such as pulmonary oedema, cardiogenic shock, and dangerous ventricular arrhythmias, but also damage to the myocardium, which can result in the development of potentially fatal conditions even after the disappearance of LV apical ballooning. The second potential problem arises from the definition of TTC as a stress cardiomyopathy in the AHA classification. In fact, the main factors leading to TTC are stress and microvascular anginas, since, as has been already discussed, coronary spasm can cause myocardium stunning, resulting in persistent apical ballooning. Thus, based on this review, 3 distinct types of stress cardiomyopathies exist (variant angina, microvascular angina, and TTC), with poor prognosis. Adding these diseases to the classification of cardiomyopathies will facilitate diagnosis and preventive prolonged treatment, which should include intensive anti-stress therapy.
Collapse
Affiliation(s)
- Petr A Sarapultsev
- Federal State Autonomous Educational Institution of Higher Professional Education, Ural Federal University named after the first President of Russia B. N. Yeltsin, Russia; Institute of Immunology and Physiology of the Ural Branch of the RAS, Russia
| | - Alexey P Sarapultsev
- Federal State Autonomous Educational Institution of Higher Professional Education, Ural Federal University named after the first President of Russia B. N. Yeltsin, Russia; Institute of Immunology and Physiology of the Ural Branch of the RAS, Russia.
| |
Collapse
|
60
|
Löring J, van der Kemp WJM, Almujayyaz S, van Oorschot JWM, Luijten PR, Klomp DWJ. Whole-body radiofrequency coil for (31) P MRSI at 7 T. NMR IN BIOMEDICINE 2016; 29:709-20. [PMID: 27037615 DOI: 10.1002/nbm.3517] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 02/05/2016] [Accepted: 02/19/2016] [Indexed: 05/12/2023]
Abstract
Widespread use of ultrahigh-field (31) P MRSI in clinical studies is hindered by the limited field of view and non-uniform radiofrequency (RF) field obtained from surface transceivers. The non-uniform RF field necessitates the use of high specific absorption rate (SAR)-demanding adiabatic RF pulses, limiting the signal-to-noise ratio (SNR) per unit of time. Here, we demonstrate the feasibility of using a body-sized volume RF coil at 7 T, which enables uniform excitation and ultrafast power calibration by pick-up probes. The performance of the body coil is examined by bench tests, and phantom and in vivo measurements in a 7-T MRI scanner. The accuracy of power calibration with pick-up probes is analyzed at a clinical 3-T MR system with a close to identical (1) H body coil integrated at the MR system. Finally, we demonstrate high-quality three-dimensional (31) P MRSI of the human body at 7 T within 5 min of data acquisition that includes RF power calibration. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- J Löring
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - W J M van der Kemp
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - J W M van Oorschot
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - P R Luijten
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - D W J Klomp
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
- MR Coils BV, Zaltbommel, the Netherlands
| |
Collapse
|
61
|
Abstract
The frequency, presentation, prognosis, and treatment of myocardial ischemia differ in men and women. A large proportion of women who have "normal" coronary arteries on angiography without any significant evidence of flow-limiting disease also have biochemical or imaging evidence of myocardial ischemia. In these women it is believed to be a dysfunction of coronary microcirculation and/or macrocirculation, or vasotonic angina (VA), that leads to abnormal vasoconstriction, and potentially to myocardial infarction, ventricular arrhythmias, and sudden death. Despite having a "normal" or near normal coronary angiography, these women should therefore undergo additional testing with acetylcholine to assess endothelial function. Long-term survival is believed to be relatively good. Predictors of poorer prognosis include documentation of severe endothelial dysfunction and presence of concurrent angiographycally visible coronary atherosclerosis. Because atherosclerosis is common in patients with VA, medical and lifestyle interventions for preventing or treating atherosclerosis should be implemented when appropriate. Angiotensin converting enzyme inhibitors are the mainstays of medical therapy for VA. Other agents have been tried with variable success, including beta-blockers. There are no available data on any specific treatment of VA in women (versus men).
Collapse
|
62
|
Baldassarre LA, Raman SV, Min JK, Mieres JH, Gulati M, Wenger NK, Marwick TH, Bucciarelli-Ducci C, Bairey Merz CN, Itchhaporia D, Ferdinand KC, Pepine CJ, Walsh MN, Narula J, Shaw LJ. Noninvasive Imaging to Evaluate Women With Stable Ischemic Heart Disease. JACC Cardiovasc Imaging 2016; 9:421-35. [PMID: 27056162 PMCID: PMC5486953 DOI: 10.1016/j.jcmg.2016.01.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 12/18/2022]
Abstract
Declines in cardiovascular deaths have been dramatic for men but occur significantly less in women. Among patients with symptomatic ischemic heart disease (IHD), women experience relatively worse outcomes compared with their male counterparts. Evidence to date has failed to adequately explore unique female imaging targets and their correlative signs and symptoms of IHD as major determinants of IHD risk. We highlight sex-specific anatomic and functional differences in contemporary imaging and introduce imaging approaches that leverage refined targets that may improve IHD risk prediction and identify potential therapeutic strategies for symptomatic women.
Collapse
Affiliation(s)
| | - Subha V Raman
- The Ohio State University College of Medicine, Columbus, Ohio
| | - James K Min
- Weill Cornell Medical College, New York, New York
| | | | - Martha Gulati
- The University of Arizona College of Medicine, Tucson, Arizona
| | | | | | | | | | - Dipti Itchhaporia
- Hoag Memorial Hospital Presbyterian Hospital, Newport Beach, California
| | | | - Carl J Pepine
- University of Florida College of Medicine, Gainesville, Florida
| | | | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Leslee J Shaw
- Emory University School of Medicine, Atlanta, Georgia.
| |
Collapse
|
63
|
Narimani S, Hosseinsabet A, Pourhosseini H. Effect of Coronary Slow Flow on the Longitudinal Left Ventricular Function Assessed by 2-Dimensional Speckle-Tracking Echocardiography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:723-729. [PMID: 26939598 DOI: 10.7863/ultra.15.05075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/13/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The coronary slow flow phenomenon is defined as the slow progression of an angiographic contrast agent to the distal part of the coronary arteries on selective coronary angiography in the absence of stenosis. There are some studies with different results about the effect of this phenomenon on left ventricular (LV) function. The aim of our study was to evaluate the longitudinal LV function in the coronary slow flow phenomenon using 2-dimensional (2D) speckle-tracking echocardiography. METHODS In a study with a patient-to-patient matched design, 36 patients with the coronary slow flow phenomenon and 36 individuals with normal coronary flow matched for age (±5 years), sex, hypertension, and diabetes mellitus were compared in terms of the longitudinal LV systolic and diastolic functions by pulsed wave tissue Doppler echocardiography and 2D speckle-tracking echocardiography-derived indices. RESULTS Lateral s' and e' waves were lower in the patients with the coronary slow flow phenomenon, but there were no statistically significant differences between the groups regarding the other tissue Doppler echocardiographic indices and longitudinal systolic strain and systolic and diastolic strain rates derived by 2D speckle-tracking echocardiography. CONCLUSIONS Our results showed that the coronary slow flow phenomenon could not impair the longitudinal LV systolic and diastolic functions.
Collapse
Affiliation(s)
- Sima Narimani
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Hosseinsabet
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hamidreza Pourhosseini
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
64
|
McSweeney JC, Rosenfeld AG, Abel WM, Braun LT, Burke LE, Daugherty SL, Fletcher GF, Gulati M, Mehta LS, Pettey C, Reckelhoff JF. Preventing and Experiencing Ischemic Heart Disease as a Woman: State of the Science: A Scientific Statement From the American Heart Association. Circulation 2016; 133:1302-31. [PMID: 26927362 PMCID: PMC5154387 DOI: 10.1161/cir.0000000000000381] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
65
|
Differences in coronary artery blood velocities in the setting of normal coronary angiography and normal stress echocardiography. Heart Int 2016; 10:e6-e11. [PMID: 27672435 PMCID: PMC4946382 DOI: 10.5301/heartint.5000221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2015] [Indexed: 12/13/2022] Open
Abstract
Background Normal left anterior descending (LAD) coronary artery as determined by coronary angiography is considered not only to reflect normal angiography but also to correlate with normal anatomy and function. However, subjects who undergo coronary angiography may differ from those who do not need to have invasive evaluation even if their functional noninvasive studies like dobutamine stress echocardiography (DSE) were normal. Aim LAD velocities in subjects with normal angiography and those with normal DSE are equal. Methods A total of 244 subjects were evaluated, 78 had normal LAD by angiography and 166 had normal LAD by DSE. All had Doppler sampling of LAD velocities by transthoracic echocardiography. Results Velocity was higher in the angiographic subgroup in diastole 41 ± 23 vs 33 ± 14 cm/s, p = 0.0078; systole 18 ± 14 vs 13 ± 7 cm/s, p = 0.012; diastolic integral 12.6 ± 5 vs 9.8 ± 3.8 cm, p = 3.15 × 10-5; systolic velocity integral 4 ± 2.9 vs 2.8 ± 1.9, p = 0.0014. While heart rate was similar in both groups, the product of diastolic velocity integral and heart rate of the LAD in the angiographic group was higher: 902 ± 450 vs 656 ± 394, p = 0.00599. Diastolic velocity deceleration time was similar in both groups. Coronary flow reserve defined as diastolic velocity ratio before and immediately after DSE correlated negatively with baseline velocity, r = -0.4. Conclusions Mode of defining normality of coronary artery affects velocity behavior of the vessel, reflecting functional differences possibly related to microvasculature and vasodilatation.
Collapse
|
66
|
Abstract
Cardiac Syndrome X (CSX), characterized by angina-like chest discomfort, ST segment depression during exercise, and normal epicardial coronary arteries at angiography, is highly prevalent in women. CSX is not benign, and linked to adverse cardiovascular outcomes and a poor quality of life. Coronary microvascular and endothelial dysfunction and abnormal cardiac nociception have been implicated in the pathogenesis of CSX. Treatment includes life-style modification, anti-anginal, anti-atherosclerotic, and anti-ischemic medications. Non-pharmacological options include cognitive behavioral therapy, enhanced external counterpulsation, neurostimulation, and stellate ganglionectomy. Studies have shown the efficacy of individual treatments but guidelines outlining the best course of therapy are lacking.
Collapse
Affiliation(s)
- Shilpa Agrawal
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Puja K Mehta
- Department of Medicine, Cedars-Sinai Medical Center, Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, 127 South San Vicente Boulevard, Los Angeles, CA 90048, USA.
| | - C Noel Bairey Merz
- Department of Medicine, Cedars-Sinai Medical Center, Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, 127 South San Vicente Boulevard, Los Angeles, CA 90048, USA
| |
Collapse
|
67
|
Lanza GA. Angina Pectoris and Myocardial Ischemia in the Absence of Obstructive Coronary Artery Disease: Role of Diagnostic Tests. Curr Cardiol Rep 2016; 18:15. [DOI: 10.1007/s11886-015-0688-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
68
|
Huqi A, Morrone D, Guarini G, Capozza P, Orsini E, Marzilli M. Stress Testing After Complete and Successful Coronary Revascularization. Can J Cardiol 2015; 32:986.e23-9. [PMID: 27038505 DOI: 10.1016/j.cjca.2015.12.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Noninvasive stress tests play a determinant role in the initial management of patients with chronic angina. Nonetheless, their use in the same patient population is considered inappropriate within 2 years after percutaneous coronary intervention (PCI). Indeed, early abnormal results correlate less well with angiographic control and are attributed to a number of confounding factors. We prospectively assessed prevalence and impact on the quality of life of abnormal stress test results in a highly selected patient population. METHODS Patients with no cardiac comorbidities who underwent successful and complete PCI with stenting for typical angina and had an abnormal exercise stress test (EST) under guideline-directed medical treatment were administered the Seattle Angina Questionnaire (SAQ). Clinical evaluation, EST, and the SAQ were repeated at 1, 6, and 12 months after the index PCI. RESULTS One hundred ninety-eight patients qualified and were included in the study (mean age, 64 years; 79% men). Although the majority had normal EST results or an increased threshold to angina, at 1 month after the index PCI, 29% of patients still had an abnormal result. At 6 and 12 months, 31% and 29% of patients had abnormal results, respectively. Quality-of-life assessment by the SAQ showed consistent results, with persistent angina in one third of patients. Control angiography documented a critical lesion, attributable to in-stent coronary restenosis, in only 8% of patients. CONCLUSIONS When stress testing is systematically performed after PCI, the prevalence of abnormal results is high and is associated with impaired quality of life. Prognostic significance along with the underlying pathophysiological mechanisms of such findings should be investigated.
Collapse
Affiliation(s)
- Alda Huqi
- Division of Cardiovascular Medicine, Cardio-Thoracic and Vascular Department, University of Pisa, Pisa, Italy.
| | - Doralisa Morrone
- Division of Cardiovascular Medicine, Cardio-Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Giacinta Guarini
- Division of Cardiovascular Medicine, Cardio-Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Paola Capozza
- Division of Cardiovascular Medicine, Cardio-Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Enrico Orsini
- Division of Cardiovascular Medicine, Cardio-Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Mario Marzilli
- Division of Cardiovascular Medicine, Cardio-Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| |
Collapse
|
69
|
Mittal SR. Diagnosis of coronary microvascular dysfunction - Present status. Indian Heart J 2015; 67:552-60. [PMID: 26702685 PMCID: PMC4699946 DOI: 10.1016/j.ihj.2015.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 07/28/2015] [Accepted: 08/10/2015] [Indexed: 12/14/2022] Open
Abstract
Definite clinical diagnosis of microvascular angina is not possible with the existing knowledge. Resting electrocardiogram may be normal, and exercise electrocardiogram may be unremarkable. Echocardiography usually does not show regional wall motion abnormalities. Transthoracic Doppler echocardiography can satisfactorily evaluate only left anterior descending coronary artery and that too in some patients. Radio-isotope imaging can detect only severe localized disease. Noninvasive diagnosis needs high index of suspicion. At present, definite diagnosis is based on documentation of normal epicardial coronaries, coronary flow reserve less than 2.5 on adenosine induced hyperemia, and absence of spasm of epicardial coronaries on acetylcholine provocation. Invasive evaluation is costly, needs sophisticated equipments and expertise. Therapeutic and prognostic implications of various parameters remains to be evaluated. At present invasive evaluation is recommended only for patients with intractable symptoms with unconfirmed diagnosis, requiring repeated hospitalization and evaluation with failure of empirical therapy.
Collapse
Affiliation(s)
- S R Mittal
- Department of Cardiology, Mittal Hospital & Research Centre, Pushkar Road, Ajmer 305001, Rajasthan, India.
| |
Collapse
|
70
|
Pepine CJ, Ferdinand KC, Shaw LJ, Light-McGroary KA, Shah RU, Gulati M, Duvernoy C, Walsh MN, Bairey Merz CN. Emergence of Nonobstructive Coronary Artery Disease: A Woman's Problem and Need for Change in Definition on Angiography. J Am Coll Cardiol 2015; 66:1918-33. [PMID: 26493665 PMCID: PMC4618799 DOI: 10.1016/j.jacc.2015.08.876] [Citation(s) in RCA: 220] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 08/28/2015] [Indexed: 01/12/2023]
Abstract
Recognition of ischemic heart disease (IHD) is often delayed or deferred in women. Thus, many at risk for adverse outcomes are not provided specific diagnostic, preventive, and/or treatment strategies. This lack of recognition is related to sex-specific IHD pathophysiology that differs from traditional models using data from men with flow-limiting coronary artery disease (CAD) obstructions. Symptomatic women are less likely to have obstructive CAD than men with similar symptoms, and tend to have coronary microvascular dysfunction, plaque erosion, and thrombus formation. Emerging data document that more extensive, nonobstructive CAD involvement, hypertension, and diabetes are associated with major adverse events similar to those with obstructive CAD. A central emerging paradigm is the concept of nonobstructive CAD as a cause of IHD and related adverse outcomes among women. This position paper summarizes currently available knowledge and gaps in that knowledge, and recommends management options that could be useful until additional evidence emerges.
Collapse
Affiliation(s)
- Carl J Pepine
- Division of Cardiology, University of Florida, Gainesville, Florida.
| | | | - Leslee J Shaw
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Rashmee U Shah
- Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Martha Gulati
- The College of Medicine and The College of Clinical Public Health, The Ohio State University, Columbus, Ohio
| | - Claire Duvernoy
- Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California
| |
Collapse
|
71
|
Lansky AJ, Pietras C. Coronary Microvascular Dysfunction. JACC Cardiovasc Interv 2015; 8:1442-1444. [DOI: 10.1016/j.jcin.2015.04.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 04/09/2015] [Indexed: 01/27/2023]
|
72
|
Crystal GJ, Klein LW. Fractional flow reserve: physiological basis, advantages and limitations, and potential gender differences. Curr Cardiol Rev 2015; 11:209-19. [PMID: 25329922 PMCID: PMC4558352 DOI: 10.2174/1573403x10666141020113318] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/04/2014] [Accepted: 10/15/2014] [Indexed: 01/31/2023] Open
Abstract
Fractional flow reserve (FFR) is a physiological index of the severity of a stenosis in an epicardial coronary artery, based on the pressure differential across the stenosis. Clinicians are increasingly relying on this method because it is independent of baseline flow, relatively simple, and cost effective. The accurate measurement of FFR is predicated on maximal hyperemia being achieved by pharmacological dilation of the downstream resistance vessels (arterioles). When the stenosis causes FFR to be impaired by > 20%, it is considered to be significant and to justify revascularization. A diminished hyperemic response due to microvascular dysfunction can lead to a false normal FFR value, and a misguided clinical decision. The blunted vasodilation could be the result of defects in the signaling pathways modulated (activated or inhibited) by the drug. This might involve a downregulation or reduced number of vascular receptors, endothelial impairment, or an increased activity of an opposing vasoconstricting mechanism, such as the coronary sympathetic nerves or endothelin. There are data to suggest that microvascular dysfunction is more prevalent in post-menopausal women, perhaps due to reduced estrogen levels. The current review discusses the historical background and physiological basis for FFR, its advantages and limitations, and the phenomenon of microvascular dysfunction and its impact on FFR measurements. The question of whether it is warranted to apply gender-specific guidelines in interpreting FFR measurements is addressed.
Collapse
Affiliation(s)
- George J Crystal
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Chicago, IL 60657, USA.
| | | |
Collapse
|
73
|
Chronotropic response to vasodilator-stress in patients submitted to myocardial perfusion imaging: impact on the accuracy in detecting coronary stenosis. Eur J Nucl Med Mol Imaging 2015; 42:1903-11. [PMID: 26194718 DOI: 10.1007/s00259-015-3129-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/02/2015] [Indexed: 10/23/2022]
Abstract
AIMS A lower heart rate response (HRR) during vasodilator MPI has been shown to have a relevant adverse prognostic impact. We sought to evaluate the interaction among individual HRR to vasodilator stress and myocardial perfusion imaging (MPI) accuracy in patients with suspected ischemic heart disease (IHD). METHODS AND RESULTS One hundred and sixty-five consecutive patients were submitted to vasodilator-stress MPI on a cardiac camera equipped with cadmium-zinc-thelluride detectors and coronary angiography. A coronary stenosis >70 % was considered significant. In every patient, the summed difference score (SDS) was computed from MPI images. Patients were categorized according to the tertiles of the distribution of individual HRR during dipyridamole: "Group 1" (HRR < 8 bpm; lowest tertile); "Group 2" (8 ≤ HRR ≤ 12 bpm; middle tertile); "Group 3" (HRR >12 bpm; highest tertile). Significant coronary artery disease (CAD) was present in 102 (62 %) patients. In the overall population, MPI showed a significant accuracy (AUC: 0.81, 95 % CI 0.74-0.86; p < 0.001) in unmasking the presence of significant coronary stenosis. Interestingly, in patients with a blunted HRR during dipyridamole ("Group 1") MPI showed a significantly lower sensitivity (68 %) in detecting CAD than in those with a higher HRR ("Group 3") (91 %, p = 0.007), despite a preserved specificity (76 % vs 77 %, P=NS). Similarly, the correlation among CAD extent and post-stress LV functional stunning was limited to "Group 3" patients, while it disappeared in those with blunted HRR. CONCLUSIONS In patients with suspected IHD, MPI sensitivity is strongly influenced by the magnitude of patient heart rate increase to the pharmacologic stressor, suggesting an interaction among blunted HRR and lower accuracy in unmasking CAD.
Collapse
|
74
|
|
75
|
Dass S, Cochlin LE, Suttie JJ, Holloway CJ, Rider OJ, Carden L, Tyler DJ, Karamitsos TD, Clarke K, Neubauer S, Watkins H. Exacerbation of cardiac energetic impairment during exercise in hypertrophic cardiomyopathy: a potential mechanism for diastolic dysfunction. Eur Heart J 2015; 36:1547-54. [PMID: 25990345 DOI: 10.1093/eurheartj/ehv120] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 03/24/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS Hypertrophic cardiomyopathy (HCM) is the commonest cause of sudden cardiac death in the young, with an excess of exercise-related deaths. The HCM sarcomere mutations increase the energy cost of contraction and impaired resting cardiac energetics has been documented by measurement of phosphocreatine/ATP (PCr/ATP) using (31)Phosphorus MR Spectroscopy ((31)P MRS). We hypothesized that cardiac energetics are further impaired acutely during exercise in HCM and that this would have important functional consequences. METHODS AND RESULTS (31)P MRS was performed in 35 HCM patients and 20 age- and gender-matched normal volunteers at rest and during leg exercise with 2.5 kg ankle weights. Peak left-ventricular filling rates (PFRs) and myocardial perfusion reserve (MPRI) were calculated during adenosine stress. Resting PCr/ATP was significantly reduced in HCM (HCM: 1.71 ± 0.35, normal 2.14 ± 0.35 P < 0.0001). During exercise, there was a further reduction in PCr/ATP in HCM (1.56 ± 0.29, P = 0.02 compared with rest) but not in normals (2.16 ± 0.26, P = 0.98 compared with rest). There was no correlation between PCr/ATP reduction and cardiac mass, wall thickness, MPRI, or late-gadolinium enhancement. PFR and PCr/ATP were significantly correlated at rest (r = 0.48, P = 0.02) and stress (r = 0.53, P = 0.01). CONCLUSION During exercise, the pre-existing energetic deficit in HCM is further exacerbated independent of hypertrophy, perfusion reserve, or degree of fibrosis. This is in keeping with the change at the myofilament level. We offer a potential explanation for exercise-related diastolic dysfunction in HCM.
Collapse
Affiliation(s)
- Sairia Dass
- Division of Cardiovascular Medicine, Anatomy and Genetics, Oxford University, Oxford, UK
| | - Lowri E Cochlin
- Department of Physiology, Anatomy and Genetics, Oxford University, Oxford, UK
| | - Joseph J Suttie
- Division of Cardiovascular Medicine, Anatomy and Genetics, Oxford University, Oxford, UK
| | - Cameron J Holloway
- Division of Cardiovascular Medicine, Anatomy and Genetics, Oxford University, Oxford, UK
| | - Oliver J Rider
- Division of Cardiovascular Medicine, Anatomy and Genetics, Oxford University, Oxford, UK
| | - Leah Carden
- Division of Cardiovascular Medicine, Anatomy and Genetics, Oxford University, Oxford, UK
| | - Damian J Tyler
- Department of Physiology, Anatomy and Genetics, Oxford University, Oxford, UK
| | - Theodoros D Karamitsos
- Division of Cardiovascular Medicine, Anatomy and Genetics, Oxford University, Oxford, UK
| | - Kieran Clarke
- Department of Physiology, Anatomy and Genetics, Oxford University, Oxford, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Anatomy and Genetics, Oxford University, Oxford, UK
| | - Hugh Watkins
- Division of Cardiovascular Medicine, Anatomy and Genetics, Oxford University, Oxford, UK
| |
Collapse
|
76
|
Kadermuneer P, Vinod GV, Haridasan V, Rajesh G, Sajeev CG, Bastion C, Vinayakumar D, Mathew D, George B, Krishnan MN. Prognostic significance of coronary sinus filling time in patients with angina and normal coronaries at one year follow up. Indian Heart J 2015; 67:245-9. [PMID: 26138182 PMCID: PMC4495673 DOI: 10.1016/j.ihj.2015.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 03/10/2015] [Accepted: 03/11/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Coronary sinus filling time (CSFT) has been proposed as a simple method for assessment of coronary microvascular function in patients with angina and normal coronaries. But its correlation with inducible ischemia and prognostic significance in predicting future cardiovascular events has not been studied. The present study assessed the prognostic significance of CSFT during one year of follow up. METHODS We compared coronary sinus filling time of patients with angina and normal coronaries with that of control population. Control group was formed by those patients with supraventricular arrhythmia undergoing radiofrequency ablation and having normal coronaries. Baseline treadmill test (TMT) parameters like workload, duration and Duke Score were assessed. Patients were followed up for one year and a composite of cardiovascular mortality and non-fatal myocardial infarction was analyzed. Number of patients presenting to emergency or outpatient department with recurrent chest pain symptoms during one year follow up was considered for secondary outcome analysis. Coronary sinus filling time was analyzed with respect to cardiovascular events, repeat hospitalization for recurrent angina and TMT parameters. RESULTS Total 72 patients and 16 controls were studied. Mean CSFT value in the study group was 5.31 ± 1.03 sec and in the control group was 4.16 ± 0.72 sec and the difference was significant (p value = 0.0001). No correlation was found between baseline and repeat TMT parameters with CSFT. There was no cardiovascular mortality or hospitalization for non-fatal MI during one year follow up. But patients with frequent emergency or outpatient department visits with chest pain had a high CSFT compared with asymptomatic patients (p value = 0.005). CONCLUSION Coronary sinus filling time may be used as a simple marker of microvascular dysfunction in patients with angina and normal coronaries. Patients with recurrent chest pain symptoms after one year follow up were found to have high CSFT compared to asymptomatic patients.
Collapse
Affiliation(s)
- P Kadermuneer
- Additional Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala, India.
| | - G V Vinod
- Senior Resident, Department of Cardiology, Government Medical College, Kozhikode, Kerala, India
| | - V Haridasan
- Assistant Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala, India
| | - G Rajesh
- Additional Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala, India
| | - C G Sajeev
- Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala, India
| | - Cicy Bastion
- Additional Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala, India
| | - D Vinayakumar
- Additional Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala, India
| | - Dolly Mathew
- Assistant Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala, India
| | - Biju George
- Assistant Professor, Department of Community Medicine, Government Medical College, Kozhikode, Kerala, India
| | - M N Krishnan
- Professor and Head, Department of Cardiology, Government Medical College, Kozhikode, Kerala, India
| |
Collapse
|
77
|
Gopalakrishnan P, Ragland MM, Tak T. Gender Differences in Coronary Artery Disease: Review of Diagnostic Challenges and Current Treatment. Postgrad Med 2015; 121:60-8. [DOI: 10.3810/pgm.2009.03.1977] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
78
|
de Carvalho EEV, Santi GL, Crescêncio JC, de Oliveira LFL, dos Reis DCC, Figueiredo AB, Pintya AO, Lima-Filho MO, Gallo-Júnior L, Marin-Neto JA, Simões MV. Pilot study testing the effect of physical training over the myocardial perfusion and quality of life in patients with primary microvascular angina. J Nucl Cardiol 2015; 22:130-7. [PMID: 25080872 DOI: 10.1007/s12350-014-9949-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/12/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Primary microvascular angina (PMA) is a common clinical condition associated to negative impact on quality of life (QOL) and reduced physical capacity. This study aimed at evaluating the effects of aerobic physical training (APT) on myocardial perfusion, physical capacity, and QOL in patients with PMA. METHODS We investigated 12 patients (53.8 ± 9.7 years old; 7 women) with PMA, characterized by angina, angiographycally normal coronary arteries, and reversible perfusion defects (RPDs) detected on (99m)Tc-sestamibi-SPECT myocardial perfusion scintigraphy (MPS). At baseline and after 4 month of APT, the patients underwent MPS, cardiopulmonary test, and QOL questionnaire. Stress-rest MPS images were visually analyzed by attributing semi-quantitative scores (0 = normal; 4 = absent uptake), using a 17-segment left ventricular model. Summed stress, rest, and difference scores (SDS) were calculated. RESULTS In comparison to the baseline, in the post-training we observed a significant increase in peak-VO2 (19.4 ± 4.8 and 22.1 ± 6.2 mL·kg(-1)·minute(-1), respectively, P = .01), reduction of SDS (10.1 ± 8.8 and 2.8 ± 4.9, P = .008), and improvement in QOL scores. CONCLUSIONS Physical training in patients with PMA is associated with reduction of myocardial perfusion abnormalities, increasing of physical capacity, and improvement in QOL. The findings of this hypothesis-generating study suggest that APT can be a valid therapeutic option for patients with PMA.
Collapse
Affiliation(s)
- Eduardo Elias Vieira de Carvalho
- Cardiology Division, Internal Medicine Department, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
79
|
Abed Y, Jamee A. Characteristics and Risk Factors Attributed to Coronary Artery Disease in Women Attended Health Services in Gaza-Palestine Observational Study. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/wjcd.2015.51002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
80
|
Duncker DJ, Koller A, Merkus D, Canty JM. Regulation of coronary blood flow in health and ischemic heart disease. Prog Cardiovasc Dis 2014; 57:409-22. [PMID: 25475073 DOI: 10.1016/j.pcad.2014.12.002] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The major factors determining myocardial perfusion and oxygen delivery have been elucidated over the past several decades, and this knowledge has been incorporated into the management of patients with ischemic heart disease (IHD). The basic understanding of the fluid mechanical behavior of coronary stenoses has also been translated to the cardiac catheterization laboratory where measurements of coronary pressure distal to a stenosis and coronary flow are routinely obtained. However, the role of perturbations in coronary microvascular structure and function, due to myocardial hypertrophy or coronary microvascular dysfunction, in IHD is becoming increasingly recognized. Future studies should therefore be aimed at further improving our understanding of the integrated coronary microvascular mechanisms that control coronary blood flow, and of the underlying causes and mechanisms of coronary microvascular dysfunction. This knowledge will be essential to further improve the treatment of patients with IHD.
Collapse
Affiliation(s)
- Dirk J Duncker
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Cardiovascular Research Institute COEUR, Erasmus MC, University Medical School, Rotterdam, The Netherlands.
| | - Akos Koller
- Department of Pathophysiology and Gerontology, Medical School, University of Pécs, Hungary; Department of Physiology, New York Medical College, Valhalla, NY, USA
| | - Daphne Merkus
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Cardiovascular Research Institute COEUR, Erasmus MC, University Medical School, Rotterdam, The Netherlands
| | - John M Canty
- Division of Cardiovascular Medicine, University at Buffalo and the Western New York Department of Veterans Affairs Health System, Buffalo, NY, USA
| |
Collapse
|
81
|
Microvascular coronary dysfunction and ischemic heart disease: where are we in 2014? Trends Cardiovasc Med 2014; 25:98-103. [PMID: 25454903 DOI: 10.1016/j.tcm.2014.09.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 09/30/2014] [Indexed: 12/21/2022]
Abstract
Many patients with angina and signs of myocardial ischemia on stress testing have no significant obstructive epicardial coronary disease. There are many potential coronary and non-coronary mechanisms for ischemia without obstructive epicardial coronary disease, and prominent among these is coronary microvascular and/or endothelial dysfunction. Patients with coronary microvascular and/or endothelial dysfunction are often at increased risk of adverse cardiovascular events, including ischemic events and heart failure despite preserved ventricular systolic function. In this article, we will review the diagnosis and treatment of coronary microvascular and endothelial dysfunction, discuss their potential contribution to heart failure with preserved ejection fraction, and highlight recent advances in the evaluation of atherosclerotic morphology in these patients, many of whom have non-obstructive epicardial disease.
Collapse
|
82
|
Abstract
Cardiac Syndrome X (CSX), characterized by angina-like chest discomfort, ST segment depression during exercise, and normal epicardial coronary arteries at angiography, is highly prevalent in women. CSX is not benign, and linked to adverse cardiovascular outcomes and a poor quality of life. Coronary microvascular and endothelial dysfunction and abnormal cardiac nociception have been implicated in the pathogenesis of CSX. Treatment includes life-style modification, anti-anginal, anti-atherosclerotic, and anti-ischemic medications. Non-pharmacological options include cognitive behavioral therapy, enhanced external counterpulsation, neurostimulation, and stellate ganglionectomy. Studies have shown the efficacy of individual treatments but guidelines outlining the best course of therapy are lacking.
Collapse
Affiliation(s)
- Shilpa Agrawal
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Puja K Mehta
- Department of Medicine, Cedars-Sinai Medical Center, Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, 127 South San Vicente Boulevard, Los Angeles, CA 90048, USA.
| | - C Noel Bairey Merz
- Department of Medicine, Cedars-Sinai Medical Center, Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, 127 South San Vicente Boulevard, Los Angeles, CA 90048, USA
| |
Collapse
|
83
|
Kuruvilla S, Kramer CM. Coronary microvascular dysfunction in women: an overview of diagnostic strategies. Expert Rev Cardiovasc Ther 2014; 11:1515-25. [PMID: 24160578 DOI: 10.1586/14779072.2013.833854] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Coronary microvascular dysfunction (CMD) also known as syndrome X, is characterized by typical anginal symptoms, evidence of myocardial ischemia on non-invasive testing and normal to minimal coronary disease on coronary angiography. It has a female preponderance and has been detected in up to 50% of women presenting with chest pain symptoms. Definitive diagnosis of CMD is critical as recent evidence suggests that women with this condition are at increased risk of cardiovascular events in the future. Invasive coronary reactivity testing on coronary angiography is considered to be the 'gold standard' for diagnosis of CMD. Non-invasive imaging techniques such as PET and cardiac magnetic resonance hold promise for detection of CMD in the future.
Collapse
Affiliation(s)
- Sujith Kuruvilla
- Department of Medicine (Cardiology), University of Virginia Health System, Charlottesville, VA, USA and
| | | |
Collapse
|
84
|
Prognostic role of stress/rest myocardial perfusion scintigraphy in patients with cardiac syndrome x. Int J Cardiol 2014; 173:467-71. [DOI: 10.1016/j.ijcard.2014.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 03/03/2014] [Accepted: 03/09/2014] [Indexed: 01/21/2023]
|
85
|
Nelson MD, Szczepaniak LS, Wei J, Haftabaradaren A, Bharadwaj M, Sharif B, Mehta P, Zhang X, Thomson LE, Berman DS, Li D, Bairey Merz CN. Diastolic dysfunction in women with signs and symptoms of ischemia in the absence of obstructive coronary artery disease: a hypothesis-generating study. Circ Cardiovasc Imaging 2014; 7:510-6. [PMID: 24633782 PMCID: PMC4031259 DOI: 10.1161/circimaging.114.001714] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 03/10/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Angina, in the absence of obstructive coronary artery disease, is more common in women, is associated with adverse cardiovascular morbidity and mortality, and is a major burden to the healthcare system. Although advancements have been made to understand the mechanistic underpinning of this disease, the functional consequence remains unclear. METHODS AND RESULTS Cardiac magnetic resonance imaging was performed to assess left ventricular function in 20 women with signs and symptoms of ischemia, but no obstructive coronary artery disease (cases), and 15 age- and body mass index-matched reference controls. Functional imaging included standard cinematic imaging to assess left ventricular morphology and global function, along with tissue tagging to assess left ventricular tissue deformation. Systolic function was preserved in both cases and controls, with no differences in ejection fraction (mean±SE: 63.1±8% versus 65±2%), circumferential strain (-20.7±0.6% versus -21.9±0.5%), or systolic circumferential strain rate (-105.9±6.1% versus -109.0±3.8% per second). In contrast, we observed significant differences between cases and controls in diastolic function, as demonstrated by reductions in both diastolic circumferential strain rate (153.8±8.9% versus 191.4±8.9% per second; P<0.05) and peak rate of left ventricular untwisting (-99.4±8.0° versus -129.4±12.8° per second; P<0.05). CONCLUSIONS Diastolic function is impaired in women with signs and symptoms of ischemia in the absence of coronary artery disease, as assessed by cardiac magnetic resonance tissue tagging. These results are hypothesis-generating. Larger studies are needed to define the exact mechanism(s) responsible and to establish viable treatment strategies.
Collapse
Affiliation(s)
- Michael D Nelson
- From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Lidia S Szczepaniak
- From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Janet Wei
- From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Afsaneh Haftabaradaren
- From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Meghan Bharadwaj
- From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Behzad Sharif
- From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Puja Mehta
- From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Xiao Zhang
- From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Louise E Thomson
- From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Daniel S Berman
- From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Debiao Li
- From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - C Noel Bairey Merz
- From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA
| |
Collapse
|
86
|
Microvascular dysfunction: genetic polymorphisms suggest sex-specific differences in disease phenotype. Coron Artery Dis 2014; 25:275-6. [PMID: 24762819 DOI: 10.1097/mca.0000000000000122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
87
|
Jespersen L, Abildstrom SZ, Hvelplund A, Madsen JK, Galatius S, Pedersen F, Hojberg S, Prescott E. Burden of hospital admission and repeat angiography in angina pectoris patients with and without coronary artery disease: a registry-based cohort study. PLoS One 2014; 9:e93170. [PMID: 24705387 PMCID: PMC3976412 DOI: 10.1371/journal.pone.0093170] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 03/03/2014] [Indexed: 12/11/2022] Open
Abstract
AIMS To evaluate risk of hospitalization due to cardiovascular disease (CVD) and repeat coronary angiography (CAG) in stable angina pectoris (SAP) with no obstructive coronary artery disease (CAD) versus obstructive CAD, and asymptomatic reference individuals. METHODS AND RESULTS We followed 11,223 patients with no prior CVD having a first-time CAG in 1998-2009 due to SAP symptoms and 5,695 asymptomatic reference individuals from the Copenhagen City Heart Study through registry linkage for 7.8 years (median). In recurrent event survival analysis, patients with SAP had 3-4-fold higher risk of hospitalization for CVD irrespective of CAG findings and cardiovascular comorbidity. Multivariable adjusted hazard ratios(95%CI) for patients with angiographically normal coronary arteries was 3.0(2.5-3.5), for angiographically diffuse non-obstructive CAD 3.9(3.3-4.6) and for 1-3-vessel disease 3.6-4.1(range)(all P<0.001). Mean accumulated hospitalization time was 3.5(3.0-4.0)(days/10 years follow-up) in reference individuals and 4.5(3.8-5.2)/7.0(5.4-8.6)/6.7(5.2-8.1)/6.1(5.2-7.4)/8.6(6.6-10.7) in patients with angiographically normal coronary arteries/angiographically diffuse non-obstructive CAD/1-, 2-, and 3-vessel disease, respectively (all P<0.05, age-adjusted). SAP symptoms predicted repeat CAG with multivariable adjusted hazard ratios for patients with angiographically normal coronary arteries being 2.3(1.9-2.9), for angiographically diffuse non-obstructive CAD 5.5(4.4-6.8) and for obstructive CAD 6.6-9.4(range)(all P<0.001). CONCLUSIONS Patients with SAP symptoms and angiographically normal coronary arteries or angiographically diffuse non-obstructive CAD suffer from considerably greater CVD burdens in terms of hospitalization for CVD and repeat CAG compared with asymptomatic reference individuals even after adjustment for cardiac risk factors and exclusion of cardiovascular comorbidity as cause. Contrary to common perception, excluding obstructive CAD by CAG in such patients does not ensure a benign cardiovascular prognosis.
Collapse
Affiliation(s)
- Lasse Jespersen
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
- * E-mail:
| | - Steen Z. Abildstrom
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Anders Hvelplund
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
| | - Jan K. Madsen
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
| | - Soren Galatius
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
| | - Frants Pedersen
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Soren Hojberg
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
- Copenhagen City Heart Study, Bispebjerg University Hospital, Copenhagen, Denmark
| |
Collapse
|
88
|
Sex differences in mental stress-induced myocardial ischemia in young survivors of an acute myocardial infarction. Psychosom Med 2014; 76:171-80. [PMID: 24608039 PMCID: PMC4008686 DOI: 10.1097/psy.0000000000000045] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Emotional stress may disproportionally affect young women with ischemic heart disease. We sought to examine whether mental stress-induced myocardial ischemia (MSIMI), but not exercise-induced ischemia, is more common in young women with previous myocardial infarction (MI) than in men. METHODS We studied 98 post-MI patients (49 women and 49 men) aged 38 to 60 years. Women and men were matched for age, MI type, and months since MI. Patients underwent technetium-99m sestamibi perfusion imaging at rest, after mental stress, and after exercise/pharmacological stress. Perfusion defect scores were obtained with observer-independent software. A summed difference score (SDS), the difference between stress and rest scores, was used to quantify ischemia under both stress conditions. RESULTS Women 50 years or younger, but not older women, showed a more adverse psychosocial profile than did age-matched men but did not differ for conventional risk factors and tended to have less angiographic coronary artery disease. Compared with age-matched men, women 50 years or younger exhibited a higher SDS with mental stress (3.1 versus 1.5, p = .029) and had twice the rate of MSIMI (SDS ≥ 3; 52% versus 25%), whereas ischemia with physical stress did not differ (36% versus 25%). In older patients, there were no sex differences in MSIMI. The higher prevalence of MSIMI in young women persisted when adjusting for sociodemographic and life-style factors, coronary artery disease severity, and depression. CONCLUSIONS MSIMI post-MI is more common in women 50 years or younger compared with age-matched men. These sex differences are not observed in post-MI patients who are older than 50 years.
Collapse
|
89
|
GOMES V, GOMES MB, TIBIRICA E, LESSA MA. Post-operative endothelial dysfunction assessment using laser Doppler perfusion measurement in cardiac surgery patients. Acta Anaesthesiol Scand 2014; 58:468-77. [PMID: 24617621 DOI: 10.1111/aas.12286] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) is associated with systemic inflammatory response and endothelial dysfunction. Our hypothesis is that CPB-induced post-operative endothelial dysfunction may be detected using laser Doppler perfusion monitoring (LDPM) in the skin microcirculation. METHODS We used LDPM to investigate the subacute effects of the CPB on systemic microvascular reactivity among patients undergoing CABG surgery with CPB. Thirty patients were submitted to the study of skin microcirculation and blood sample collection at baseline (pre-surgery) and at 7 days post-surgical procedure. The skin microcirculation was evaluated by acetylcholine (ACh) and sodium nitroprusside (SNP) iontophoresis, and thermal hyperemia (TH). Plasma levels of nitrite/nitrate were also analyzed, and cytokine profiles were determined using a multiplex system. RESULTS On-pump CABG surgery induced a significant reduction of the increased microvascular dermal flux observed after cumulative doses of ACh iontophoresis and after TH. On-pump CABG surgery did not induce any significant changes in the microvascular flux after cumulative doses of SNP. Patients still presented high levels of interleukin (IL)-6, IL-8, and C-reactive protein, and low bioavailability of nitric oxide 7 days after the CABG surgery with CPB. CONCLUSION We observed a significant impairment of systemic microvascular endothelial function and well-preserved endothelium-independent vasodilatation in the skin microcirculation of patients 1 week after CABG surgery with CPB. Our results suggest that LDPM is a useful tool for the assessment of on-pump CABG-induced subacute post-operative endothelial dysfunctions.
Collapse
Affiliation(s)
- V. GOMES
- Laboratory of Cardiovascular Investigation; Oswaldo Cruz Institute/FIOCRUZ; Rio de Janeiro Brazil
| | - M. B. GOMES
- Department of Internal Medicine; Diabetes Unit; State University of Rio de Janeiro; Rio de Janeiro Brazil
| | - E. TIBIRICA
- Laboratory of Cardiovascular Investigation; Oswaldo Cruz Institute/FIOCRUZ; Rio de Janeiro Brazil
| | - M. A. LESSA
- Laboratory of Cardiovascular Investigation; Oswaldo Cruz Institute/FIOCRUZ; Rio de Janeiro Brazil
| |
Collapse
|
90
|
Moran AE, Forouzanfar MH, Roth GA, Mensah GA, Ezzati M, Flaxman A, Murray CJL, Naghavi M. The global burden of ischemic heart disease in 1990 and 2010: the Global Burden of Disease 2010 study. Circulation 2014; 129:1493-501. [PMID: 24573351 DOI: 10.1161/circulationaha.113.004046] [Citation(s) in RCA: 460] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ischemic heart disease (IHD) burden consists of years of life lost from IHD deaths and years of disability lived with 3 nonfatal IHD sequelae: nonfatal acute myocardial infarction, angina pectoris, and ischemic heart failure. Our aim was to estimate the global and regional burden of IHD in 1990 and 2010. METHODS AND RESULTS Global and regional estimates of acute myocardial infarction incidence and angina and heart failure prevalence by age, sex, and world region in 1990 and 2010 were estimated based on data from a systematic review and nonlinear mixed-effects meta-regression methods. Age-standardized acute myocardial infarction incidence and angina prevalence decreased globally between 1990 and 2010; ischemic heart failure prevalence increased slightly. The global burden of IHD increased by 29 million disability-adjusted life-years (29% increase) between 1990 and 2010. About 32.4% of the growth in global IHD disability-adjusted life-years between 1990 and 2010 was attributable to aging of the world population, 22.1% was attributable to population growth, and total disability-adjusted life-years were attenuated by a 25.3% decrease in per capita IHD burden (decreased rate). The number of people living with nonfatal IHD increased more than the number of IHD deaths since 1990, but >90% of IHD disability-adjusted life-years in 2010 were attributable to IHD deaths. CONCLUSIONS Globally, age-standardized acute myocardial infarction incidence and angina prevalence have decreased, and ischemic heart failure prevalence has increased since 1990. Despite decreased age-standardized fatal and nonfatal IHD in most regions since 1990, population growth and aging led to a higher global burden of IHD in 2010.
Collapse
Affiliation(s)
- Andrew E Moran
- Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (A.E.M.); Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA (M.H.F., G.R., A.F., C.J.L.M., M.N.); Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA (G.R.); Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and MRC-HPA Centre for Environment and Health and Department of Epidemiology and Biostatistics, Imperial College London, London, UK (M.E.)
| | | | | | | | | | | | | | | |
Collapse
|
91
|
Betim Paes Leme AM, Salemi VMC, Weiss RG, Parga JR, Ianni BM, Mady C, Kalil-Filho R. Exercise-induced decrease in myocardial high-energy phosphate metabolites in patients with Chagas heart disease. J Card Fail 2014; 19:454-60. [PMID: 23834921 DOI: 10.1016/j.cardfail.2013.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 05/12/2013] [Accepted: 05/16/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The influence of exercise on cardiac metabolic response in patients with Chagas disease is incompletely understood. METHODS AND RESULTS Changes in cardiac energetic metabolism were investigated in Chagas disease patients before and during isometric handgrip exercise with (31)P magnetic resonance spectroscopy (MRS). Twenty-eight patients (10 with systolic dysfunction: group I; 10 with normal systolic function and electrocardiogram (ECG) abnormalities: group II; and 8 asymptomatic without ECG abnormalities: group III) and 8 healthy control subjects (group C) were evaluated by electrocardiogram, echocardiogram, functional tests for coronary artery disease, and image-selected localized cardiac (31)P-MRS. The myocardial phosphocreatine to [β-phosphate]adenosine triphosphate ratio (PCr/β-ATP) was measured at rest and during isometric handgrip exercise. Exercise testing or 99mTc-sestamibi scintigraphy were negative for myocardial ischemia in all individuals. At rest, cardiac PCr/β-ATP was decreased in all Chagas groups (1.23 ± 0.37) versus group C (1.88 ± 0.08; P < .001) and was lower in group I (0.89 ± 0.24) versus groups II (1.44 ± 0.23) and III (1.40 ± 0.37; P < .001). There was no stress-induced change in cardiac PCr/β-ATP (1.88 ± 0.08 at rest vs 1.89 ± 0.08 during exercise; P = NS) in group C. Mean cardiac PCr/β-ATP was 0.89 ± 0.24 and 0.56 ± 0.21 at rest and during exercise, respectively, in group I (37% decrease; P < .001). In group II, PCr/β-ATP was 1.44 ± 0.23 at rest and 0.97 ± 0.37 during exercise (33% decrease; P < .001). In group III, PCr/β-ATP was 1.40 ± 0.37 at rest and 0.60 ± 0.19 during exercise (57% decrease; P < .001). CONCLUSIONS Myocardial high-energy phosphates are reduced at rest in Chagas heart disease patients, and the reduction is greater in patients with left ventricular dysfunction. Regardless of left ventricular function, Chagas patients exhibit an exercise-induced decline in cardiac high-energy phosphates consistent with myocardial ischemia, suggesting the possibility that this metabolic approach may offer a tool to probe new interventions in Chagas disease patients.
Collapse
Affiliation(s)
- Ana Maria Betim Paes Leme
- Faculdade de Medicina, Heart Institute, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | |
Collapse
|
92
|
Predictive value of the corrected TIMI frame count in patients with suspected angina pectoris but no obstructive coronary artery disease at angiography. Clin Res Cardiol 2014; 103:381-7. [DOI: 10.1007/s00392-014-0665-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
|
93
|
Park KE, Pepine CJ. Microvascular dysfunction: what have we learned from WISE? Expert Rev Cardiovasc Ther 2014; 9:1491-4. [DOI: 10.1586/erc.11.165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
94
|
Abstract
Many patients undergoing coronary angiography because of chest pain syndromes, believed to be indicative of obstructive atherosclerosis of the epicardial coronary arteries, are found to have normal angiograms. In the past two decades, a number of studies have reported that abnormalities in the function and structure of the coronary microcirculation may occur in patients without obstructive atherosclerosis, but with risk factors or with myocardial diseases as well as in patients with obstructive atherosclerosis; furthermore, coronary microvascular dysfunction (CMD) can be iatrogenic. In some instances, CMD represents an epiphenomenon, whereas in others it is an important marker of risk or may even contribute to the pathogenesis of cardiovascular and myocardial diseases, thus becoming a therapeutic target. This review article provides an update on the clinical relevance of CMD in different clinical settings and also the implications for therapy.
Collapse
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Sciences, Institute of Cardiology, Catholic University of the Sacred Heart, 00187 L.go Vito 1, Roma, Italy
| | | | | |
Collapse
|
95
|
Jespersen L, Abildstrom SZ, Hvelplund A, Galatius S, Madsen JK, Pedersen F, Hojberg S, Prescott E. Symptoms of angina pectoris increase the probability of disability pension and premature exit from the workforce even in the absence of obstructive coronary artery disease. Eur Heart J 2013; 34:3294-303. [DOI: 10.1093/eurheartj/eht395] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
|
96
|
Agarwal M, Shufelt C, Mehta PK, Gill E, Berman DS, Li D, Sharif B, Li N, Bairey Merz CN, Thomson LEJ. Cardiac risk factors and myocardial perfusion reserve in women with microvascular coronary dysfunction. Cardiovasc Diagn Ther 2013; 3:146-52. [PMID: 24282763 PMCID: PMC3839214 DOI: 10.3978/j.issn.2223-3652.2013.08.01] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 07/15/2013] [Indexed: 11/14/2022]
Abstract
UNLABELLED Women with myocardial ischemia without obstructive coronary artery disease (CAD) often have microvascular coronary dysfunction (MCD). Traditional cardiac risk factors (RFs) contribute modestly to MCD detected by invasive coronary reactivity testing (CRT). Cardiac magnetic resonance imaging (CMRI) is an emerging noninvasive technique used to evaluate MCD. We evaluated RFs related to CMRI myocardial perfusion in women with MCD. 53 women with CRT confirmed MCD underwent adenosine stress and rest CMRI (1.5 Tesla). The myocardial perfusion reserve index (MPRI) was calculated (Pie Medical) with lower MPRI meaning less perfusion reserve. Relationships between RFs and MPRI were examined. The mean age was 54±10 years with a mean body mass index (BMI) of 26.2±4.2. The mean MPRI was 1.63±0.39. Hypertension, dyslipidemia, elevated BMI, and post-menopausal status were inversely related to MPRI, while ever smoking, age, family history of CAD, history of irregular menses, and history of menopausal hormone therapy (MHT) or oral contraceptive (OC) use were not. Dyslipidemia and BMI remained significant independent predictors of MPRI. Regression modeling demonstrated that the RFs of dyslipidemia, obesity, hypertension, family history of CAD, and history of irregular menses explained 27% of the observed MCD variance. CONCLUSIONS In conclusion, impaired MPRI measured by CMRI is related to dyslipidemia and elevated BMI in women with MCD. These results suggest traditional RFs contribute modestly to MCD; a larger cohort of women with MCD should be examined to confirm and extend these observations. The impact of traditional CAD RF modification strategies, including optimal medical therapy, should be explored as MCD treatment targets.
Collapse
Affiliation(s)
- Megha Agarwal
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
97
|
Ng VG, Meller S, Shetty S, Lansky AJ. Diagnosing and characterizing coronary artery disease in women: developments in noninvasive and invasive imaging techniques. J Cardiovasc Transl Res 2013; 6:740-51. [PMID: 23918630 DOI: 10.1007/s12265-013-9500-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/08/2013] [Indexed: 01/07/2023]
Abstract
Cardiovascular disease is the leading cause of death in men and women in the USA; yet, coronary artery disease (CAD) continues to be underrecognized and underdiagnosed in women. Noninvasive and invasive imaging techniques are constantly being developed in order to more accurately assess CAD. At the same time, the impact of gender on the interpretation and accuracy of these studies is still being elucidated. Furthermore, new imaging techniques have improved our understanding of CAD pathophysiology and progression and have begun to reveal gender differences in the development of CAD. This article will review current imaging techniques and their application to diagnosing and understanding CAD in women.
Collapse
Affiliation(s)
- Vivian G Ng
- Yale University School of Medicine, P.O. Box 208017, New Haven, CT, 06520-8017, USA
| | | | | | | |
Collapse
|
98
|
Bizino MB, Hammer S, Lamb HJ. Metabolic imaging of the human heart: clinical application of magnetic resonance spectroscopy. Heart 2013; 100:881-90. [PMID: 23904358 DOI: 10.1136/heartjnl-2012-302546] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Maurice B Bizino
- Department of Radiology, Leiden University Medical Center, , Leiden, The Netherlands
| | | | | |
Collapse
|
99
|
Lin T, Rechenmacher S, Rasool S, Varadarajan P, Pai RG. Reduced survival in patients with "coronary microvascular disease". Int J Angiol 2013; 21:89-94. [PMID: 23730136 DOI: 10.1055/s-0032-1315799] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The syndrome of chest pain, abnormal stress test, and nonflow limiting coronary artery disease (CAD) is common and is attributed to coronary microvascular disease (µVD). It is associated with increased hospital admissions and health care costs. But its impact on long-term survival is not known. Of the 9941 consecutive patients who had an exercise stress test for evaluation of chest pain between May 1991 and July 2007, 935 had both a positive stress test and a coronary angiogram within 1 year of their stress test forming the study cohort. Significant angiographic CAD defined as ≥70% stenosis of an epicardial coronary artery or ≥50% stenosis of the left main coronary artery was present in 324 patients. Rest (n = 611) were considered to have coronary µVD. Compared with patients with significant epicardial CAD, patients with coronary µVD were younger (63 ± 11 vs. 65 ± 10 years, p = 0.002), and had lower left ventricular wall thickness (p < 0.02), systolic blood pressure (BP; p = 0.002), pulse pressure (0.0008), systolic BP with exercise (p = 0.0001), and pulse pressure with exercise (p < 0.0001). Those with coronary µVD had a better survival compared with those with significant epicardial CAD, but worse than that expected for age- and gender-matched population (p < 0.0001). Coronary µVD as a cause of chest pain and positive stress test is common. All-cause mortality in patients with coronary µVD is worse than in an age- and gender-matched population control, but better than those with significant epicardial CAD.
Collapse
Affiliation(s)
- Terence Lin
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California
| | | | | | | | | |
Collapse
|
100
|
Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Zoghbi WA, Arend TE, Oetgen WJ, May C, Bradfield L, Keller S, Ramadhan E, Tomaselli GF, Brown N, Robertson RM, Whitman GR, Bezanson JL, Hundley J. 2012 ACCF/AHA Focused Update Incorporated Into the ACCF/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction. Circulation 2013; 127:e663-828. [DOI: 10.1161/cir.0b013e31828478ac] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|