Predictors of inpatient outcomes in hospitalized patients after left heart catheterization

Oxidative Stress Is Associated With Diastolic Dysfunction in Women With Ischemia With No Obstructive Coronary Artery Disease

Background Women with signs and symptoms of ischemia and no obstructive coronary artery disease often have evidence of diastolic dysfunction. Oxidative stress (OS) is associated with cardiovascular risk factors and adverse outcomes. The relationship between systemic OS and diastolic dysfunction is unknown. Methods and Results A subgroup of women (n=75) with suspected ischemia and no obstructive coronary artery disease who had both cardiac magnetic resonance imaging and OS measurements were enrolled in the WISE-CVD (Women Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction) study. Left ventricular end-diastolic pressure was measured invasively. Left ventricular end-diastolic volume and peak filling rate were assessed using cardiac magnetic resonance imaging. Aminothiol levels of plasma cystine and glutathione were measured as markers of OS. Spearman correlation and linear regression analyses were conducted. The group mean age was 54±11 years, and 61% had a resting left ventricular end-diastolic pressure >12 mm Hg. Cystine levels correlated negatively with the peak filling rate (r=-0.31, P=0.007) and positively with left ventricular end-diastolic pressure (r=0.25; P=0.038), indicating that increased OS was associated with diastolic dysfunction. After multivariate adjustment including multiple known risk factors for diastolic dysfunction and cardiovascular medications, cystine levels continued to be associated with peak filling rate (β=-0.27, P=0.049) and left ventricular end-diastolic pressure (β=0.25; P=0.035). Glutathione levels were not associated with indices of diastolic function. Conclusions OS, measured by elevated levels of cystine, is associated with diastolic dysfunction in women with evidence of ischemia and no obstructive coronary artery disease, indicating the role of OS in patients with ischemia and no obstructive coronary artery disease. Its role in the progression of heart failure with preserved ejection fraction should be explored further.

Diastolic dysfunction measured by cardiac magnetic resonance imaging in women with signs and symptoms of ischemia but no obstructive coronary artery disease

BACKGROUND

Women with chest pain and no obstructive coronary artery disease often have coronary microvascular dysfunction (CMD), diagnosed by invasive coronary reactivity testing (CRT). The relationship between CMD and diastolic function measured by cardiac magnetic resonance imaging (CMR) is not well described.

METHODS

41 women with suspected CMD underwent CRT and CMR. Left ventricular end-diastolic pressure (LVEDP), coronary flow reserve (CFR) and coronary blood flow (CBF) were measured invasively. Resting CMR of these women and 20 reference controls was assessed for LV mass, septal wall thickness, ejection fraction (LVEF), end-diastolic volume (EDV), peak filling rate (PFR) and time-to-peak-filling rate (tPFR). Pearson correlations and linear regression models were made.

RESULTS

Mean age was 55±9, all had LVEF≥50%, and 16/41 (40%) had LVEDP>15mmHg. CMD (CFR<2.5 or CBF<50%) was present in 34/41 (83%) women. tPFR (mean 178±110ms) and PFR (mean 3.2±0.64 EDV/s) were not significantly different in women with or without CMD. tPFR increased with age (r=0.37, p=0.017) and septal wall thickness (r=0.47, p=0.002), while PFR decreased with age (r=-0.45, p=0.003). There was an inverse relationship between CFR and tPFR (r=-0.3, p=0.058). Increasing mass was associated with decreasing CBF (p=0.02). Compared to controls, cases had lower LVEF (p=0.049) and lower EDV (p=0.0002).

CONCLUSION

In women with signs and symptoms of ischemia but no obstructive coronary artery disease, CMD and elevated LVEDP are prevalent. While non-endothelial dependent CMD may be related to diastolic dysfunction, further investigation is needed regarding links between CMD, diastolic dysfunction and the development of heart failure with preserved LVEF.

Diagnostic value of automated quantification of nuclear cardiology in Japanese patients with single vessel coronary artery disease: comparison between Japanese and American normal databases

BACKGROUND

The Japanese diagnostic assessment of nuclear cardiology has usually been based on semi-quantitative visual analyses but not on automated quantification with a total perfusion deficit (TPD). We, therefore, aimed to determine whether automated TPD quantification is useful to detect coronary artery disease (CAD) in Japanese patients in comparison with conventional visual segmental analysis, and to compare results from the automated assessment between the Japanese and American normal databases (NDBs).

METHODS

Patients with suspected CAD underwent rest (201)Tl and stress (99m)Tc-tetrofosmin myocardial perfusion single photon emission computed tomography (SPECT) and coronary angiography within three months. The TPD was automatically derived from the SPECT image through quantitative perfusion SPECT software with the Japanese and American NDBs. The visual summed stress scores (SSS) were estimated with the 5-point visual scoring model for 20 segments of SPECT images. An abnormal criteria for the stress TPD and SSS were defined as ≥ 5% and ≥ 4, respectively.

RESULTS

Detection sensitivity of CAD was 87% with the stress TPD score derived from the Japanese NDB and 85% with the SSS in visual analysis. In contrast, the detection sensitivity with the stress TPD score derived from the American NDB was 75%, which was significantly lower than that with the Japanese TPD (p=0.0004). Specificity of the automated Japanese TPD assessment was similar to that of the visual SSS assessment (87% vs. 80%). Thus, sensitivity and specificity of the automated quantitative assessment based on the TPD scores derived from the Japanese NDB were consistent with that of visual quantification based on the segmental defect scores.

CONCLUSION

The automated quantitative assessment with the Japanese NDB is useful for the detection of CAD when experts in visual interpretation of a myocardial perfusion SPECT image were absent in a clinical setting.