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Aldujeli A, Tsai TY, Haq A, Tatarunas V, Knokneris A, Briedis K, Unikas R, Onuma Y, Brilakis ES, Serruys PW. Impact of Coronary Microvascular Dysfunction on Functional Left Ventricular Remodeling and Diastolic Dysfunction. J Am Heart Assoc 2024; 13:e033596. [PMID: 38686863 PMCID: PMC11179865 DOI: 10.1161/jaha.123.033596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/21/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) is a common complication of ST-segment-elevation myocardial infarction (STEMI) and can lead to adverse cardiovascular events. Whether CMD after STEMI is associated with functional left ventricular remodeling (FLVR) and diastolic dysfunction, has not been investigated. METHODS AND RESULTS This is a nonrandomized, observational, prospective study of patients with STEMI with multivessel disease. Coronary flow reserve and index of microcirculatory resistance of the culprit vessel were measured at 3 months post-STEMI. CMD was defined as index of microcirculatory resistance ≥25 or coronary flow reserve <2.0 with a normal fractional flow reserve. We examined the association between CMD, LV diastolic dysfunction, FLVR, and major adverse cardiac events at 12-month follow-up. A total of 210 patients were enrolled; 59.5% were men, with a median age of 65 (interquartile range, 58-76) years. At 3-month follow-up, 57 patients (27.14%) exhibited CMD. After 12 months, when compared with patients without CMD, patients with CMD had poorer LV systolic function recovery (-10.00% versus 8.00%; P<0.001), higher prevalence of grade 2 LV diastolic dysfunction (73.08% versus 1.32%; P<0.001), higher prevalence of group 3 or 4 FLVR (11.32% versus 7.28% and 22.64% versus 1.99%, respectively; P<0.001), and higher incidence of major adverse cardiac events (50.9% versus 9.8%; P<0.001). Index of microcirculatory resistance was independently associated with LV diastolic dysfunction and adverse FLVR. CONCLUSIONS CMD is present in ≈1 of 4 patients with STEMI during follow-up. Patients with CMD have a higher prevalence of LV diastolic dysfunction, adverse FLVR, and major adverse cardiac events at 12 months compared with those without CMD. REGISTRATION URL: https://www.clinicaltrials.gov; Unique Identifier: NCT05406297.
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Affiliation(s)
- Ali Aldujeli
- Lithuanian University of Health Sciences Kaunas Lithuania
| | - Tsung-Ying Tsai
- CORRIB Research Centre for Advanced Imaging and Core Lab University of Galway Galway Ireland
- Cardiovascular center Taichung Veterans General Hospital Taichung Taiwan
| | - Ayman Haq
- Abbott Northwestern Hospital/Minneapolis Heart Institute Foundation Minneapolis MN
| | | | | | | | - Ramunas Unikas
- Lithuanian University of Health Sciences Kaunas Lithuania
| | - Yoshinobu Onuma
- CORRIB Research Centre for Advanced Imaging and Core Lab University of Galway Galway Ireland
- University Hospital Galway Galway Ireland
| | - Emmanouil S Brilakis
- Abbott Northwestern Hospital/Minneapolis Heart Institute Foundation Minneapolis MN
| | - Patrick W Serruys
- CORRIB Research Centre for Advanced Imaging and Core Lab University of Galway Galway Ireland
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Dang W, Cao N, Zhang Y, Li W, Li H. Association among β2-adrenergic receptor autoantibodies and proximal left anterior descending artery lesions in patients with initial ST-segment elevation myocardial infarction. Clin Cardiol 2023; 46:1371-1379. [PMID: 37587904 PMCID: PMC10642316 DOI: 10.1002/clc.24129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/24/2023] [Accepted: 08/08/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND β2 -adrenergic receptor autoantibody (β2 -AA) are widely present in patients with many different types of cardiovascular diseases. Proximal left anterior descending (LAD) artery lesions are associated with adverse prognostic events in patients with ST-segment elevation myocardial infarction (STEMI). HYPOTHESIS β2 -AA is associated with the presence of proximal LAD lesions in patients with STEMI. METHODS A cohort of 153 patients with STEMI who underwent primary percutaneous coronary intervention (PPCI) was enrolled in the study. Baseline characteristics were compared between the proximal LAD group (n = 62) and the nonproximal LAD group (n = 91). Admission serum of patients was collected to detect the level of β2 -AA. Data for echocardiogram within 24 hours after PPCI and at the 6-month follow-up were recorded. RESULTS The optical density values and positive rates of β2 -AA in the proximal LAD group were higher than those in the nonproximal LAD group (p < 0.05). β2 -AA positively correlated with high sensitivity C-reactive protein and peak N-terminal pro-B type natriuretic peptide levels in the proximal LAD group, but those were not relevant in the nonproximal LAD group. Multivariate logistic regression analysis revealed that high β2 -AA levels was independently associated with the presence of proximal LAD lesions in patients with STEMI. Furthermore, a receiver operating characteristic curve was used to show the efficiency of β2 -AA levels to detect proximal LAD lesions, and the AUC of the β2-AA OD value was 0.658 (95% confidence interval 0.568-0.749; p = 0.001). CONCLUSIONS The STEMI patients with high β2 -AA levels had a greater possibility having proximal LAD lesions.
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Affiliation(s)
- Wenxi Dang
- Department of Cardiology, Cardiovascular Center, Beijing Friendship HospitalCapital Medical UniversityBeijingChina
- Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular DiseaseBeijingChina
| | - Ning Cao
- Department of Cardiology, Cardiovascular Center, Beijing Friendship HospitalCapital Medical UniversityBeijingChina
- Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular DiseaseBeijingChina
- Laboratory of Clinical MedicineCapital Medical UniversityBeijingChina
| | - Yue Zhang
- Department of Cardiology, Cardiovascular Center, Beijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Weiping Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship HospitalCapital Medical UniversityBeijingChina
- Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular DiseaseBeijingChina
- Laboratory of Clinical MedicineCapital Medical UniversityBeijingChina
| | - Hongwei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship HospitalCapital Medical UniversityBeijingChina
- Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular DiseaseBeijingChina
- Laboratory of Clinical MedicineCapital Medical UniversityBeijingChina
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3
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Maslov LN, Naryzhnaya NV, Popov SV, Mukhomedzyanov AV, Derkachev IA, Kurbatov BK, Krylatov AV, Fu F, Pei J, Ryabov VV, Vyshlov EV, Gusakova SV, Boshchenko AA, Sarybaev A. A historical literature review of coronary microvascular obstruction and intra-myocardial hemorrhage as functional/structural phenomena. J Biomed Res 2023; 37:281-302. [PMID: 37503711 PMCID: PMC10387746 DOI: 10.7555/jbr.37.20230021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
The analysis of experimental data demonstrates that platelets and neutrophils are involved in the no-reflow phenomenon, also known as microvascular obstruction (MVO). However, studies performed in the isolated perfused hearts subjected to ischemia/reperfusion (I/R) do not suggest the involvement of microembolization and microthrombi in this phenomenon. The intracoronary administration of alteplase has been found to have no effect on the occurrence of MVO in patients with acute myocardial infarction. Consequently, the major events preceding the appearance of MVO in coronary arteries are independent of microthrombi, platelets, and neutrophils. Endothelial cells appear to be the target where ischemia can disrupt the endothelium-dependent vasodilation of coronary arteries. However, reperfusion triggers more pronounced damage, possibly mediated by pyroptosis. MVO and intra-myocardial hemorrhage contribute to the adverse post-infarction myocardial remodeling. Therefore, pharmacological agents used to treat MVO should prevent endothelial injury and induce relaxation of smooth muscles. Ischemic conditioning protocols have been shown to prevent MVO, with L-type Ca 2+ channel blockers appearing the most effective in treating MVO.
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Affiliation(s)
- Leonid N Maslov
- Laboratory of Experimental Cardiology, Cardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Tomsk Region 634012, Russia
| | - Natalia V Naryzhnaya
- Laboratory of Experimental Cardiology, Cardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Tomsk Region 634012, Russia
| | - Sergey V Popov
- Laboratory of Experimental Cardiology, Cardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Tomsk Region 634012, Russia
| | - Alexandr V Mukhomedzyanov
- Laboratory of Experimental Cardiology, Cardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Tomsk Region 634012, Russia
| | - Ivan A Derkachev
- Laboratory of Experimental Cardiology, Cardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Tomsk Region 634012, Russia
| | - Boris K Kurbatov
- Laboratory of Experimental Cardiology, Cardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Tomsk Region 634012, Russia
| | - Andrey V Krylatov
- Laboratory of Experimental Cardiology, Cardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Tomsk Region 634012, Russia
| | - Feng Fu
- Department of Physiology and Pathophysiology, National Key Discipline of Cell Biology, School of Basic Medicine, the Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Jianming Pei
- Department of Physiology and Pathophysiology, National Key Discipline of Cell Biology, School of Basic Medicine, the Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Vyacheslav V Ryabov
- Laboratory of Experimental Cardiology, Cardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Tomsk Region 634012, Russia
| | - Evgenii V Vyshlov
- Laboratory of Experimental Cardiology, Cardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Tomsk Region 634012, Russia
| | | | - Alla A Boshchenko
- Laboratory of Experimental Cardiology, Cardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Tomsk Region 634012, Russia
| | - Akpay Sarybaev
- National Center of Cardiology and Internal Medicine, Bishkek 720040, Kyrgyzstan
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Endothelial-cell-mediated mechanism of coronary microvascular dysfunction leading to heart failure with preserved ejection fraction. Heart Fail Rev 2023; 28:169-178. [PMID: 35266091 PMCID: PMC9902427 DOI: 10.1007/s10741-022-10224-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 02/07/2023]
Abstract
Although the prevalence of heart failure with preserved ejection fraction (HFpEF) is growing worldwide, its complex pathophysiology has yet to be fully elucidated, and multiple hypotheses have all failed to produce a viable target for therapeutic action or provide effective treatment. Cardiac remodeling has long been considered an important mechanism of HFpEF. Strong evidence has been reported over the past years that coronary microvascular dysfunction (CMD), manifesting as structural and functional abnormalities of coronary microvasculature, also contributes to the evolution of HFpEF. However, the mechanisms of CMD are still not well understood and need to be studied further. Coronary microvascular endothelial cells (CMECs) are one of the most abundant cell types in the heart by number and active players in cardiac physiology and pathology. CMECs are not only important cellular mediators of cardiac vascularization but also play an important role in disease pathophysiology by participating in the inception and progression of cardiac remodeling. CMECs are also actively involved in the pathogenesis of CMD. Numerous studies have confirmed that CMD is closely related to cardiac remodeling. ECs may serve a critical function in mediating the connection between CMD and HFpEF. It follows that CMECs participate in the mechanism of CMD leading to HFpEF. In this review article, we focus on the role of CMD in the pathogenesis of HFpEF resulting from cardiac remodeling and highlight the subsequent complexity of the EC-mediated correlation between CMD and HFpEF.
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Evaluation of the Advantages of Myocardial Blood Flow Index in the Diagnosis of Chronic Obstructive Coronary Artery Disease Versus Coronary Computed Tomography Angiography: A Feasibility Study. IRANIAN JOURNAL OF RADIOLOGY 2022. [DOI: 10.5812/iranjradiol-123693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: There is a hidden relationship between the degree of coronary artery stenosis and downstream myocardial remodeling. The mutual influence in myocardial ischemia and myocardial remodeling provides an index for quantifying the myocardial blood flow based on the principles of physics. Objectives: This study aimed to evaluate the advantages of myocardial blood flow index (MBFI) in the diagnosis of chronic obstructive coronary artery disease (CAD). Patients and Methods: The data of 68 patients (39 males; mean age: 57.0 ± 10.20 years) with suspected CAD were analyzed retrospectively, including the imaging findings of coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) within one week. The MBFI was also calculated for the patients. After determining the optimal cut-off value based on ICA (stenosis ≥ 70%) as the gold standard test, the diagnostic performance of MBFI and CCTA was compared. The diagnostic accuracy was examined by the receiver operating characteristic (ROC) curve. For statistical analysis, chi-square test was performed to analyze influence data, and a P-value less than 0.05 was considered statistically significant. Results: In 68 cases evaluated in this study, the average scan dose of CCTA was 3.02 ± 1.15 mSv. There were 28 cases with stenosis ≥ 70%. The optimal cutoff value of MBFI and CCTA was 0.111 and 70%, respectively. Also, the area under the curve (AUC) for MBFI and CCTA was 0.857 and 0.621 (Z = 2.091, P = 0.0365), respectively. The sensitivity, specificity, positive predictive value, and negative predictive value were 92.31%, 92.86%, 88.89%, and 95.12% for MBFI and 61.54%, 78.57%, 64.00%, and 76.74% for CCTA, respectively. The diagnostic accuracy was also estimated at 92.65% for MBFI and 72.06% for CCTA (χ2 = 9.844, P = 0.0017). Conclusion: In this study, MBFI performed better than CCTA in identifying lesions with stenosis ≥ 70%. A lower MBFI indicated the need for an upcoming active intervention, while a higher MBFI suggested avoiding unnecessary invasive testing.
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Zhou J, Onuma Y, Garg S, Kotoku N, Kageyama S, Masuda S, Ninomiya K, Huo Y, Reiber JHC, Tu S, Piek JJ, Escaned J, Perera D, Bourantas C, Yan H, Serruys PW. Angiography derived assessment of the coronary microcirculation: is it ready for prime time? Expert Rev Cardiovasc Ther 2022; 20:549-566. [PMID: 35899781 DOI: 10.1080/14779072.2022.2098117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Non-obstructive coronary arteries (NOCA) are present in 39.7% to 62.4% of patients who undergo elective angiography. Coronary microcirculation (<400 µm) is not visible on angiography therefore functional assessment, invasive or non-invasive plays a prior role to help provide a more personalized diagnosis of angina. AREA COVERED In this review, we revise the pathophysiology, clinical importance and invasive assessment of the coronary microcirculation, and discuss angiography-derived indices of microvascular resistance. A comprehensive literature review over four decades is also undertaken. EXPERT OPINION The coronary microvasculature plays an important role in flow autoregulation and metabolic regulation. Invasive assessment of microvascular resistance is a validated modality with independent prognostic value, nevertheless, its routine application is hampered by the requirement of intravascular instrumentation and hyperaemic agents. The angiography-derived index of microvascular resistance has emerged as a promising surrogate in pilot studies, however, more data are needed to validate and compare the diagnostic and prognostic accuracy of different equations as well as to illustrate the relationship between angiography-derived parameters for epicardial coronary arteries and those for the microvasculature.
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Affiliation(s)
- Jinying Zhou
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China.,Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Scot Garg
- Department of CardiologyRoyal Blackburn Hospital, Blackburn, United Kingdom
| | - Nozomi Kotoku
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Shigetaka Kageyama
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Shinichiro Masuda
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Kai Ninomiya
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Yunlong Huo
- PKU-HKUST Shenzhen-Hong Kong Institution, Shenzhen, China; Department of Cardiology, Peking University First Hospital, Beijing, China; Institute of Mechanobiology & Medical Engineering, School of Life Sciences & Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Johan H C Reiber
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Shengxian Tu
- School of Biomedical Engineering,Biomedical Instrument Institute Shanghai Jiao Tong University, Shanghai, China
| | - Jan J Piek
- Department of Cardiology, Academic Medical Center of Amsterdam, Amsterdam, The Netherlands
| | - Javier Escaned
- Complutense University of Madrid Hospital Clinico San Carlos IDISCC, Madrid, Spain
| | - Divaka Perera
- Cardiovascular Division, King's College London, London, UK
| | - Christos Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK; Institute of Cardiovascular Sciences, University College London, London, UK
| | - Hongbing Yan
- Chinese Academy of Medical Sciences, Shenzhen, China; Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital,, Beijing, China
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Rocco E, Grimaldi MC, Maino A, Cappannoli L, Pedicino D, Liuzzo G, Biasucci LM. Advances and Challenges in Biomarkers Use for Coronary Microvascular Dysfunction: From Bench to Clinical Practice. J Clin Med 2022; 11:jcm11072055. [PMID: 35407662 PMCID: PMC8999821 DOI: 10.3390/jcm11072055] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/27/2022] [Accepted: 04/02/2022] [Indexed: 02/01/2023] Open
Abstract
Coronary microvascular dysfunction (CMD) is related to a broad variety of clinical scenarios in which cardiac microvasculature is morphologically and functionally affected, and it is associated with impaired responses to vasoactive stimuli. Although the prevalence of CMD involves about half of all patients with chronic coronary syndromes and more than 20% of those with acute coronary syndrome, the diagnosis of CMD is often missed, leading to the underestimation of its clinical importance. The established and validated techniques for the measurement of coronary microvascular function are invasive and expensive. An ideal method to assess endothelial dysfunction should be accurate, non-invasive, cost-effective and accessible. There are varieties of biomarkers available, potentially involved in microvascular disease, but none have been extensively validated in this heterogeneous clinical population. The investigation of potential biomarkers linked to microvascular dysfunction might improve the assessment of the diagnosis, risk stratification, disease progression and therapy response. This review article offers an update about traditional and novel potential biomarkers linked to CMD.
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Affiliation(s)
- Erica Rocco
- Department of Medical-Surgical Sciences and Biotechnologies, Cardiology Unit, ICOT Hospital, Sapienza University of Rome, 04110 Latina, Italy;
| | - Maria Chiara Grimaldi
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy; (A.M.); (L.C.); (D.P.); (G.L.); (L.M.B.)
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence:
| | - Alessandro Maino
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy; (A.M.); (L.C.); (D.P.); (G.L.); (L.M.B.)
| | - Luigi Cappannoli
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy; (A.M.); (L.C.); (D.P.); (G.L.); (L.M.B.)
| | - Daniela Pedicino
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy; (A.M.); (L.C.); (D.P.); (G.L.); (L.M.B.)
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Giovanna Liuzzo
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy; (A.M.); (L.C.); (D.P.); (G.L.); (L.M.B.)
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Luigi Marzio Biasucci
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy; (A.M.); (L.C.); (D.P.); (G.L.); (L.M.B.)
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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8
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Geng Y, Wu X, Liu H, Zheng D, Xia L. Index of microcirculatory resistance: state-of-the-art and potential applications in computational simulation of coronary artery disease. J Zhejiang Univ Sci B 2022; 23:123-140. [PMID: 35187886 DOI: 10.1631/jzus.b2100425] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The dysfunction of coronary microcirculation is an important cause of coronary artery disease (CAD). The index of microcirculatory resistance (IMR) is a quantitative evaluation of coronary microcirculatory function, which provides a significant reference for the prediction, diagnosis, treatment, and prognosis of CAD. IMR also plays a key role in investigating the interaction between epicardial and microcirculatory dysfunctions, and is closely associated with coronary hemodynamic parameters such as flow rate, distal coronary pressure, and aortic pressure, which have been widely applied in computational studies of CAD. However, there is currently a lack of consensus across studies on the normal and pathological ranges of IMR. The relationships between IMR and coronary hemodynamic parameters have not been accurately quantified, which limits the application of IMR in computational CAD studies. In this paper, we discuss the research gaps between IMR and its potential applications in the computational simulation of CAD. Computational simulation based on the combination of IMR and other hemodynamic parameters is a promising technology to improve the diagnosis and guide clinical trials of CAD.
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Affiliation(s)
- Yingyi Geng
- Key Laboratory for Biomedical Engineering of Ministry of Education, Institute of Biomedical Engineering, Zhejiang University, Hangzhou 310027, China
| | - Xintong Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, Institute of Biomedical Engineering, Zhejiang University, Hangzhou 310027, China
| | - Haipeng Liu
- Research Centre of Intelligent Healthcare, Faculty of Health and Life Science, Coventry University, Coventry CV1 5FB, UK
| | - Dingchang Zheng
- Research Centre of Intelligent Healthcare, Faculty of Health and Life Science, Coventry University, Coventry CV1 5FB, UK.
| | - Ling Xia
- Key Laboratory for Biomedical Engineering of Ministry of Education, Institute of Biomedical Engineering, Zhejiang University, Hangzhou 310027, China.
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Marin F, Scarsini R, Terentes-Printzios D, Kotronias RA, Ribichini F, Banning AP, De Maria GL. The Role of Coronary Physiology in Contemporary Percutaneous Coronary Interventions. Curr Cardiol Rev 2022; 18:e080921196264. [PMID: 34521331 PMCID: PMC9241117 DOI: 10.2174/1573403x17666210908114154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/21/2021] [Accepted: 03/02/2021] [Indexed: 01/10/2023] Open
Abstract
Invasive assessment of coronary physiology has radically changed the paradigm of myocardial revascularization in patients with coronary artery disease. Despite the prognostic improvement associated with ischemia-driven revascularization strategy, functional assessment of angiographic intermediate epicardial stenosis remains largely underused in clinical practice. Multiple tools have been developed or are under development in order to reduce the invasiveness, cost, and extra procedural time associated with the invasive assessment of coronary physiology. Besides epicardial stenosis, a growing body of evidence highlights the role of coronary microcirculation in regulating coronary flow with consequent pathophysiological and clinical and prognostic implications. Adequate assessment of coronary microcirculation function and integrity has then become another component of the decision-making algorithm for optimal diagnosis and treatment of coronary syndromes. This review aims at providing a comprehensive description of tools and techniques currently available in the catheterization laboratory to obtain a thorough and complete functional assessment of the entire coronary tree (both for the epicardial and microvascular compartments).
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Affiliation(s)
- Federico Marin
- Division of Cardiology, University of Verona, Verona, Italy.,Oxford Heart Centre, Oxford University Hospitals, Oxford, United Kingdom
| | | | | | - Rafail A Kotronias
- Oxford Heart Centre, Oxford University Hospitals, Oxford, United Kingdom
| | | | - Adrian P Banning
- Oxford Heart Centre, Oxford University Hospitals, Oxford, United Kingdom
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10
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van Lavieren MA, Stegehuis VE, Bax M, Echavarría-Pinto M, Wijntjens GWM, de Winter RJ, Koch KT, Henriques JP, Escaned J, Meuwissen M, van de Hoef TP, Piek JJ. Time course of coronary flow capacity impairment in ST-segment elevation myocardial infarction. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2021; 10:516–522. [PMID: 32450714 PMCID: PMC8248849 DOI: 10.1177/2048872620918706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/23/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Microvascular dysfunction in the setting of ST-elevated myocardial infarction (STEMI) plays an important role in long-term poor clinical outcome. Coronary flow reserve (CFR) is a well-established physiological parameter to interrogate the coronary microcirculation. Together with hyperaemic average peak flow velocity, CFR constitutes the coronary flow capacity (CFC), a validated risk stratification tool in ischaemic heart disease with significant prognostic value. This mechanistic study aims to elucidate the time course of the microcirculation as reflected by alterations in microcirculatory physiological parameters in the acute phase and during follow-up in STEMI patients. METHODS We assessed CFR and CFC in the culprit and non-culprit vessel in consecutive STEMI patients at baseline (n = 98) and after one-week (n = 64) and six-month follow-up (n = 65). RESULTS A significant trend for culprit CFC in infarct size as determined by peak troponin T (p = 0.004), time to reperfusion (p = 0.038), the incidence of final Thrombolysis In Myocardial Infarction 3 flow (p = 0.019) and systolic retrograde flow (p = 0.043) was observed. Non-culprit CFC linear contrast analysis revealed a significant trend in C-reactive protein (p = 0.027), peak troponin T (p < 0.001) and heart rate (p = 0.049). CFC improved both in the culprit and the non-culprit vessel at one-week (both p < 0.001) and six-month follow-up (p = 0.0013 and p < 0.001) compared with baseline. CONCLUSION This study demonstrates the importance of microcirculatory disturbances in the setting of STEMI, which is relevant for the interpretation of intracoronary diagnostic techniques which are influenced by both culprit and non-culprit vascular territories. Assessment of non-culprit vessel CFC in the setting of STEMI might improve risk stratification of these patients following coronary reperfusion of the culprit vessel.
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Affiliation(s)
- Martijn A van Lavieren
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
| | - Valérie E Stegehuis
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
| | - Matthijs Bax
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Mauro Echavarría-Pinto
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
- Cardiovascular institute, Hospital Clínico San Carlos, Madrid, Spain
- Faculty of Medicine, Autonomous University of Queretaro, Mexico
| | - Gilbert W M Wijntjens
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
| | - Robbert J de Winter
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
| | - Karel T Koch
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
| | - José P Henriques
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
| | - Javier Escaned
- Cardiovascular institute, Hospital Clínico San Carlos, Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- Faculty of Medicine, Complutense University of Madrid, Spain
| | | | - Tim P van de Hoef
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
| | - Jan J Piek
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
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11
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Noirclerc N, Marliere S, Bakhti A, Mangin L, Cassar E, Vautrin E, Piliero N, Ormezzano O, Bouvaist H, Riou L, Vanzetto G, Belle L, Barone-Rochette G. Impact of a micro-net mesh technology covering stent on coronary microvascular dysfunction in patients with high thrombus burden. Catheter Cardiovasc Interv 2021; 99:397-404. [PMID: 34057279 DOI: 10.1002/ccd.29782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/26/2021] [Accepted: 05/10/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Highly thrombotic coronary lesions continue to be a serious and clinically significant problem that is not effectively and completely addressed by current technology. OBJECTIVES We aimed to investigate whether a micro-net mesh (MNM) technology covering stent could preserve the index of microcirculatory resistance (IMR) after percutaneous coronary intervention (PCI) in patients with high thrombus burden. METHODS AND RESULTS Fifty-two patients with non-ST elevation myocardial infarction or ST Elevation Myocardial Infarction and high thrombus burden (TIMI thrombus grade ≥ 3) were randomized into two groups, PCI with a MNM covering stent (MNM group, n = 25) and PCI with any commercially available stent (DES group, n = 27). As the primary endpoint, IMR was measured immediately after PCI using a pressure-temperature sensor-tipped coronary wire. The secondary endpoint was left ventricular ejection fraction (LVEF) at 6 months of follow-up. The IMR in the MNM group was significantly lower in comparison to the DES group (33.2 [21.3, 48.9] vs. 57.2 [39.9, 98.0], p = 0.005). No significant differences were observed in baseline LVEF (54.5 ± 10.2% vs. 53.1 ± 6.87%, p = .57), while LVEF was significantly improved at follow-up in the MNM group (61.1 ± 7.1% vs. 53.9 ± 6.35%, p = .0001). CONCLUSION MNM technology significantly improved coronary microvascular dysfunction after PCI in patient with acute coronary syndrome and appears as a useful technological option for thrombus management.
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Affiliation(s)
| | | | - Akader Bakhti
- Department of Cardiology, Hospital Center, Annecy-Genevois, France
| | - Lionel Mangin
- Department of Cardiology, Hospital Center, Annecy-Genevois, France
| | - Emmanuel Cassar
- Department of Cardiology, Hospital Center, Annecy-Genevois, France
| | - Estelle Vautrin
- Department of Cardiology, University Hospital, Grenoble-Alpes, France
| | - Nicolas Piliero
- Department of Cardiology, University Hospital, Grenoble-Alpes, France
| | - Olivier Ormezzano
- Department of Cardiology, University Hospital, Grenoble-Alpes, France.,University Grenoble alpes, INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France
| | - Helene Bouvaist
- Department of Cardiology, University Hospital, Grenoble-Alpes, France
| | - Laurent Riou
- University Grenoble alpes, INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France
| | - Gerald Vanzetto
- Department of Cardiology, University Hospital, Grenoble-Alpes, France.,University Grenoble alpes, INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France.,French Alliance Clinical Trial, French Clinical Research Infrastructure Network, Paris, France
| | - Loic Belle
- Department of Cardiology, Hospital Center, Annecy-Genevois, France
| | - Gilles Barone-Rochette
- Department of Cardiology, University Hospital, Grenoble-Alpes, France.,University Grenoble alpes, INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France.,French Alliance Clinical Trial, French Clinical Research Infrastructure Network, Paris, France
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12
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Maznyczka AM, Oldroyd KG, McCartney P, McEntegart M, Berry C. The Potential Use of the Index of Microcirculatory Resistance to Guide Stratification of Patients for Adjunctive Therapy in Acute Myocardial Infarction. JACC Cardiovasc Interv 2020; 12:951-966. [PMID: 31122353 DOI: 10.1016/j.jcin.2019.01.246] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/20/2018] [Accepted: 01/03/2019] [Indexed: 12/31/2022]
Abstract
The goal of reperfusion therapies in ST-segment elevation myocardial infarction has evolved to include effective reperfusion of the microcirculation subtended by the culprit epicardial coronary artery. The index of microcirculatory resistance is measured using a pressure- and temperature-sensing coronary guidewire and quantifies microvascular dysfunction. The index of microcirculatory resistance is an independent predictor of microvascular obstruction, infarct size, and adverse clinical outcomes. It has the advantage of being immediately measurable in the catheterization laboratory, before the results of blood biomarkers or noninvasive imaging become available. This provides an opportunity for additional intervention that may alter outcomes. In this review, the authors provide a critical appraisal of the published research on the emerging role of the index of microcirculatory resistance as a tool to guide the stratification of patients for adjunctive therapeutic strategies in acute ST-segment elevation myocardial infarction.
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Affiliation(s)
- Annette M Maznyczka
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Keith G Oldroyd
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Peter McCartney
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Margaret McEntegart
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom.
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13
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Cirillo P, Izzo R, Mancusi C, Buono F, Ziviello F, Spinelli L, Esposito G, DI Gioia G, Barbato E, Strisciuglio T, Trimarco B, Morisco C. Impact of drug-eluting stents on left ventricular wall motion after successful reperfusion of first anterior ST elevation myocardial infarction. Minerva Cardiol Angiol 2020; 69:144-153. [PMID: 32515176 DOI: 10.23736/s2724-5683.20.05176-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Timely myocardial reperfusion by primary percutaneous coronary intervention (pPCI) prevents the development of left ventricular (LV) dysfunction after myocardial infarction (MI). We aimed to investigate whether bare-metal stents (BMS) and drug eluting stents (DES) differently affect the recovery of LV function in patients with ST-elevation MI (STEMI). METHODS Overall 103anterior STEMI patients were retrospectively analyzed. All patients had single vessel disease with culprit lesion at the left anterior descending coronary artery. Patients were categorized in DES group (N.=67) and BMS group (N.=36). Changes in LV contractility were assessed by trans-thoracic echocardiogram as Left Ventricular Wall Motion Score Index (LVWMSI). Follow-up visits were performed between 6 and 12 months after hospital discharge. RESULTS Compared to baseline, LV ejection fraction (EF) remained unchanged between the two groups at the follow-up; LVWMSI significantly improved in patients treated with DES (1.95±0.25 vs. 1.78±0.38, P<0.05), whereas did not change in those treated with BMS (2.09±0.21 vs. 1.98±0.33, P: not significant). At follow-up the LVWMSI was significantly higher in patients with DES than with BMS (P=0.048). LV end-systolic and end-diastolic volumes (LVESV, LVEDV) significantly increased in patients receiving a BMS, whereas it did not change in those receiving a DES (P<0.05). Multivariate analysis adjusted for age, gender, type of stent (DES or BMS), and type of revascularization (primary PCI or rescue PCI or thrombolysis + PCI) showed that DES implantation was an independent predictor of LVWMSI improvement (OR: 3.8 [1.143-12.969] P=0.03). CONCLUSIONS DES implantation is associated with a favorable impact on LV remodeling and regional contractility.
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Affiliation(s)
- Plinio Cirillo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Francesco Buono
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Francesca Ziviello
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Letizia Spinelli
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Giuseppe DI Gioia
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Emanuele Barbato
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Teresa Strisciuglio
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy -
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14
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Bobi J, Solanes N, Dantas AP, Ishida K, Regueiro A, Castillo N, Sabaté M, Rigol M, Freixa X. Moderate Hypothermia Modifies Coronary Hemodynamics and Endothelium-Dependent Vasodilation in a Porcine Model of Temperature Management. J Am Heart Assoc 2020; 9:e014035. [PMID: 32009525 PMCID: PMC7033898 DOI: 10.1161/jaha.119.014035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/04/2019] [Indexed: 01/03/2023]
Abstract
Background Hypothermia has been associated with therapeutic benefits including reduced mortality and better neurologic outcomes in survivors of cardiac arrest. However, undesirable side effects have been reported in patients undergoing coronary interventions. Using a large animal model of temperature management, we aimed to describe how temperature interferes with the coronary vasculature. Methods and Results Coronary hemodynamics and endothelial function were studied in 12 pigs at various core temperatures. Left circumflex coronary artery was challenged with intracoronary nitroglycerin, bradykinin, and adenosine at normothermia (38°C) and mild hypothermia (34°C), followed by either rewarming (38°C; n=6) or moderate hypothermia (MoHT; 32°C, n=6). Invasive coronary hemodynamics by Doppler wire revealed a slower coronary blood velocity at 32°C in the MoHT protocol (normothermia 20.2±11.2 cm/s versus mild hypothermia 18.7±4.3 cm/s versus MoHT 11.3±5.3 cm/s, P=0.007). MoHT time point was also associated with high values of hyperemic microvascular resistance (>3 mm Hg/cm per second) (normothermia 2.0±0.6 mm Hg/cm per second versus mild hypothermia 2.0±0.8 mm Hg/cm per second versus MoHT 3.4±1.6 mm Hg/cm per second, P=0.273). Assessment of coronary vasodilation by quantitative coronary analysis showed increased endothelium-dependent (bradykinin) vasodilation at 32°C when compared with normothermia (normothermia 6.96% change versus mild hypothermia 9.01% change versus MoHT 25.42% change, P=0.044). Results from coronary reactivity in vitro were in agreement with angiography data and established that endothelium-dependent relaxation in MoHT completely relies on NO production. Conclusions In this porcine model of temperature management, 34°C hypothermia and rewarming (38°C) did not affect coronary hemodynamics or endothelial function. However, 32°C hypothermia altered coronary vasculature physiology by slowing coronary blood flow, increasing microvascular resistance, and exacerbating endothelium-dependent vasodilatory response.
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Affiliation(s)
- Joaquim Bobi
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)Cardiology DepartmentInstitut Clínic CardiovascularHospital Clínic de BarcelonaUniversity of BarcelonaSpain
| | - Núria Solanes
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)Cardiology DepartmentInstitut Clínic CardiovascularHospital Clínic de BarcelonaUniversity of BarcelonaSpain
| | - Ana Paula Dantas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)Cardiology DepartmentInstitut Clínic CardiovascularHospital Clínic de BarcelonaUniversity of BarcelonaSpain
| | - Kohki Ishida
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)Cardiology DepartmentInstitut Clínic CardiovascularHospital Clínic de BarcelonaUniversity of BarcelonaSpain
- Department of Internal Medicine and CardiologyKitasato University School of MedicineSagamiharaJapan
| | - Ander Regueiro
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)Cardiology DepartmentInstitut Clínic CardiovascularHospital Clínic de BarcelonaUniversity of BarcelonaSpain
| | - Nadia Castillo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)Cardiology DepartmentInstitut Clínic CardiovascularHospital Clínic de BarcelonaUniversity of BarcelonaSpain
| | - Manel Sabaté
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)Cardiology DepartmentInstitut Clínic CardiovascularHospital Clínic de BarcelonaUniversity of BarcelonaSpain
| | - Montserrat Rigol
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)Cardiology DepartmentInstitut Clínic CardiovascularHospital Clínic de BarcelonaUniversity of BarcelonaSpain
| | - Xavier Freixa
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)Cardiology DepartmentInstitut Clínic CardiovascularHospital Clínic de BarcelonaUniversity of BarcelonaSpain
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15
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Xu J, Lo S, Juergens CP, Leung DY. Assessing Coronary Microvascular Dysfunction in Ischaemic Heart Disease: Little Things Can Make a Big Difference. Heart Lung Circ 2019; 29:118-127. [PMID: 31255478 DOI: 10.1016/j.hlc.2019.05.187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 04/10/2019] [Accepted: 05/29/2019] [Indexed: 01/01/2023]
Abstract
The role of coronary microvascular dysfunction (CMD) in the pathogenesis of ischaemic heart disease and in determining long-term prognosis is increasingly recognised. In selected patients, a comprehensive coronary assessment including an assessment of microvascular function may help refine risk stratification and improve patient outcomes. Various non-invasive and invasive techniques have been developed to assess the coronary microcirculation. Many of these tests utilise the indicator-dilution principle to determine coronary or myocardial blood flow. However, these techniques are often limited by their variability and lack of specificity for the coronary microvasculature. Consequently, there is still paucity of data on targeted therapies for CMD and their implications on long-term clinical outcomes, particularly in the setting of non-ST elevation acute coronary syndromes. Recent technical advancements, such as the index of microcirculatory resistance, have largely overcome these limitations and are able to provide novel insights into the assessment and treatment of CMD. This review summarises the currently available techniques for the assessment of CMD and provides an overview of its clinical implications.
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Affiliation(s)
- James Xu
- Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of NSW, Sydney, NSW, Australia.
| | - Sidney Lo
- Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of NSW, Sydney, NSW, Australia
| | - Craig P Juergens
- Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of NSW, Sydney, NSW, Australia
| | - Dominic Y Leung
- Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of NSW, Sydney, NSW, Australia
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16
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Li QW, Liu XJ, Li JH, Zhang GQ, Chen SM, Huang CL, Qiu M, Li YL, Duan P, Weng YJ, Zhang XY, Huang CY. Applying WCACG modified process is beneficial on reduced door-to-balloon time of acute STEMI patients. Biomedicine (Taipei) 2019; 9:10. [PMID: 31124456 PMCID: PMC6533935 DOI: 10.1051/bmdcn/2019090210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 02/18/2019] [Indexed: 11/17/2022] Open
Abstract
Background: Various systems have employed with the objective to reduce the time from emergency medical services contact to balloon inflammation for ST-elevation myocardial infraction (STEMI) patients. The WCACG message system was used to an alternative communication platform to improve confirmation of the diagnosis and movement to treatment, resulted in shorten the door-to-balloon (D-to-B) time for STEMI patients. Methods: We collected 366 STEMI patients admitted at the Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People’s Hospital, Department of Cardiology, during the period from June 2013 to October 2015. The patients were divided into two groups one underwent the current GC processes and the other group was handled using WCACG system. We compared between two groups with several indicators including D-to-B time, duration of hospitalization, associated costs, and incidence of adverse cardiovascular events. Results: The results show that the new method with WCACG system significantly reduced the average D-to-B time (from 100.42 ± 25.14 mins to 79.81 ± 20.51 mins, P < 0.05) compared to the GC processes, and also reduced the duration, costs and undesirable cardiac incidence during hospitalization. Conclusions: The modified WCACG process is an applicable system to save pieces of time and efficiently integrate the opinions of experts in emergency.
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Affiliation(s)
- Qiao-Wen Li
- Department of Cardiology, Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Guangdong, China
| | - Xiao-Jian Liu
- Department of Cardiology, Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Guangdong, China
| | - Jin-Hua Li
- Department of Cardiology, Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Guangdong, China
| | - Guo-Qi Zhang
- Department of Cardiology, Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Guangdong, China
| | - Su-Min Chen
- Department of Cardiology, Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Guangdong, China
| | - Chao-Long Huang
- Department of Cardiology, Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Guangdong, China
| | - Min Qiu
- Department of Cardiology, Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Guangdong, China
| | - Yue-Liang Li
- Department of Cardiology, Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Guangdong, China
| | - Peng Duan
- Department of Cardiology, Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Guangdong, China
| | - Yi-Jiun Weng
- Department of Cardiology, Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Guangdong, China - Graduate Institute of Basic Medical Science, China Medical University, Taichung 404, Taiwan
| | - Xiao-Yong Zhang
- Department of Cardiology, Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Guangdong, China
| | - Chih-Yang Huang
- Graduate Institute of Basic Medical Science, China Medical University, Taichung 404, Taiwan - Graduate Institute of Chinese Medical Science, China Medical University, Taichung 404, Taiwan - Department of Health and Nutrition Biotechnology, Asia University, Taichung 413, Taiwan
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17
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Bulluck H, Foin N, Tan JW, Low AF, Sezer M, Hausenloy DJ. Invasive Assessment of the Coronary Microcirculation in Reperfused ST-Segment-Elevation Myocardial Infarction Patients: Where Do We Stand? Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004373. [PMID: 28242607 DOI: 10.1161/circinterventions.116.004373] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
For patients presenting with an acute ST-segment-elevation myocardial infarction, the most effective therapy for reducing myocardial infarct size and preserving left ventricular systolic function is primary percutaneous coronary intervention (PPCI). However, mortality and morbidity remain significant. This is partly attributed to the development of microvascular obstruction, which occurs in around 50% of ST-segment-elevation myocardial infarction patients post-PPCI, and it is associated with adverse left ventricular remodeling and worse clinical outcomes. Although microvascular obstruction can be detected by cardiac imaging techniques several hours post-PPCI, it may be too late to intervene at that time. Therefore, being able to predict the development of microvascular obstruction at the time of PPCI may identify high-risk patients who might benefit from further adjuvant intracoronary therapies, such as thrombolysis, vasodilators, glycoprotein IIb/IIIa inhibitors, and anti-inflammatory agents that may reduce microvascular obstruction. Recent studies have shown that invasive coronary physiology measurements performed during PPCI can be used to assess the coronary microcirculation. In this article, we provide an overview of the various invasive methods currently available to assess the coronary microcirculation in the setting of ST-segment-elevation myocardial infarction, and how they could potentially be used in the future for tailoring therapies to those most at risk.
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Affiliation(s)
- Heerajnarain Bulluck
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.); The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (H.B., D.J.H.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (H.B., N.F., D.J.H.); National Heart Research Institute Singapore, National Heart Centre Singapore (H.B., N.F., J.W.T., D.J.H.); National University Heart Centre, Singapore (A.F.L.); Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Çapa, Turkey (M.S.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (D.J.H.); and Yong Loo Lin School of Medicine, National University Singapore (D.J.H.)
| | - Nicolas Foin
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.); The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (H.B., D.J.H.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (H.B., N.F., D.J.H.); National Heart Research Institute Singapore, National Heart Centre Singapore (H.B., N.F., J.W.T., D.J.H.); National University Heart Centre, Singapore (A.F.L.); Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Çapa, Turkey (M.S.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (D.J.H.); and Yong Loo Lin School of Medicine, National University Singapore (D.J.H.)
| | - Jack W Tan
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.); The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (H.B., D.J.H.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (H.B., N.F., D.J.H.); National Heart Research Institute Singapore, National Heart Centre Singapore (H.B., N.F., J.W.T., D.J.H.); National University Heart Centre, Singapore (A.F.L.); Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Çapa, Turkey (M.S.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (D.J.H.); and Yong Loo Lin School of Medicine, National University Singapore (D.J.H.)
| | - Adrian F Low
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.); The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (H.B., D.J.H.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (H.B., N.F., D.J.H.); National Heart Research Institute Singapore, National Heart Centre Singapore (H.B., N.F., J.W.T., D.J.H.); National University Heart Centre, Singapore (A.F.L.); Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Çapa, Turkey (M.S.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (D.J.H.); and Yong Loo Lin School of Medicine, National University Singapore (D.J.H.)
| | - Murat Sezer
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.); The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (H.B., D.J.H.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (H.B., N.F., D.J.H.); National Heart Research Institute Singapore, National Heart Centre Singapore (H.B., N.F., J.W.T., D.J.H.); National University Heart Centre, Singapore (A.F.L.); Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Çapa, Turkey (M.S.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (D.J.H.); and Yong Loo Lin School of Medicine, National University Singapore (D.J.H.)
| | - Derek J Hausenloy
- From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.); The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (H.B., D.J.H.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (H.B., N.F., D.J.H.); National Heart Research Institute Singapore, National Heart Centre Singapore (H.B., N.F., J.W.T., D.J.H.); National University Heart Centre, Singapore (A.F.L.); Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Çapa, Turkey (M.S.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (D.J.H.); and Yong Loo Lin School of Medicine, National University Singapore (D.J.H.).
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18
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de Waard GA, Fahrni G, de Wit D, Kitabata H, Williams R, Patel N, Teunissen PF, van de Ven PM, Umman S, Knaapen P, Perera D, Akasaka T, Sezer M, Kharbanda RK, van Royen N. Hyperaemic microvascular resistance predicts clinical outcome and microvascular injury after myocardial infarction. Heart 2017; 104:127-134. [PMID: 28663361 DOI: 10.1136/heartjnl-2017-311431] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Early detection of microvascular dysfunction after acute myocardial infarction (AMI) could identify patients at high risk of adverse clinical outcome, who may benefit from adjunctive treatment. Our objective was to compare invasively measured coronary flow reserve (CFR) and hyperaemic microvascular resistance (HMR) for their predictive power of long-term clinical outcome and cardiac magnetic resonance (CMR)-defined microvascular injury (MVI). METHODS Simultaneous intracoronary Doppler flow velocity and pressure measurements acquired immediately after revascularisation for AMI from five centres were pooled. Clinical follow-up was completed for 176 patients (mean age 60±10 years; 140(80%) male; ST-elevation myocardial infarction (STEMI) 130(74%) and non-ST-segment elevation myocardial infarction 46(26%)) with median follow-up time of 3.2 years. In 110 patients with STEMI, additional CMR was performed. RESULTS The composite end point of death and hospitalisation for heart failure occurred in 17 patients (10%). Optimal cut-off values to predict the composite end point were 1.5 for CFR and 3.0 mm Hg cm-1•s for HMR. CFR <1.5 was predictive for the composite end point (HR 3.5;95% CI 1.1 to 10.8), but not for its individual components. HMR ≥3.0 mm Hg cm-1 s was predictive for the composite end point (HR 7.0;95% CI 1.5 to 33.7) as well as both individual components. HMR had significantly greater area under the receiver operating characteristic curve for MVI than CFR. HMR remained an independent predictor of adverse clinical outcome and MVI, whereas CFR did not. CONCLUSIONS HMR measured immediately following percutaneous coronary intervention for AMI with a cut-off value of 3.0 mm Hg cm-1 s, identifies patients with MVI who are at high risk of adverse clinical outcome. For this purpose, HMR is superior to CFR.
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Affiliation(s)
- Guus A de Waard
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Gregor Fahrni
- Oxford Heart Centre, Oxford University Hospitals, Oxford, UK
| | - Douwe de Wit
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Hironori Kitabata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Rupert Williams
- Cardiovascular Division, British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King's College London, London, UK
| | - Niket Patel
- Oxford Heart Centre, Oxford University Hospitals, Oxford, UK
| | - Paul F Teunissen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Sabahattin Umman
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Divaka Perera
- Cardiovascular Division, British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King's College London, London, UK
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Murat Sezer
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Niels van Royen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
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19
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Johnson NP, Gould KL, Di Carli MF, Taqueti VR. Invasive FFR and Noninvasive CFR in the Evaluation of Ischemia: What Is the Future? J Am Coll Cardiol 2017; 67:2772-2788. [PMID: 27282899 DOI: 10.1016/j.jacc.2016.03.584] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/07/2016] [Accepted: 03/15/2016] [Indexed: 12/14/2022]
Abstract
This review provides an integrative and forward-looking perspective on the gamut of coronary physiology for the diagnosis and management of atherosclerosis. Because clinical events serve as the ultimate gold standard, the future of all diagnostic tests, including invasive fractional flow reserve and noninvasive coronary flow reserve, depends on their ability to improve patient outcomes. Given the prominent role of acute coronary syndromes and invasive procedures in cardiology, we practically consider 2 broad categories of patients with coronary disease: acute and stable. For patients with acute coronary disease, coronary physiology may potentially refine treatment of the culprit lesion. For both patients with stable and acute nonculprit disease, reducing hard endpoints with revascularization potentially occurs at the severe end of the focal physiological spectrum, an area under-represented in existing trials. Nonepicardial disease and diffuse atherosclerosis remain underexplored aspects of coronary physiology for testing of novel treatments.
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Affiliation(s)
- Nils P Johnson
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas.
| | - K Lance Gould
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas
| | - Marcelo F Di Carli
- Departments of Medicine and Radiology, Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, and the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Viviany R Taqueti
- Departments of Medicine and Radiology, Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, and the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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20
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Fineschi M, Verna E, Mezzapelle G, Bartolini D, Turiano G, Manari A, Lucarelli K, Uguccioni L, Repetto A, Tarantini G. Assessing MICRO-vascular resistances via IMR to predict outcome in STEMI patients with multivessel disease undergoing primary PCI (AMICRO): Rationale and design of a prospective multicenter clinical trial. Am Heart J 2017; 187:37-44. [PMID: 28454806 DOI: 10.1016/j.ahj.2017.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/05/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND In STEMI patients treated with primary percutaneous coronary angioplasty (PPCI) the evaluation of coronary microcirculatory resistance index (IMR) predict the extent of microvascular damage and left ventricular (LV) remodeling. However, the impact of IMR on the clinical outcome after PPCI in patients with multivessel disease (MVD) remains unsettled. AIM We designed a prospective multicenter controlled clinical trial to evaluate the prognostic value of IMR in terms of clinical outcome and left ventricular remodeling in STEMI patients with MVD undergoing PPCI. METHODS AND DESIGN The study will involve 242 patients with MVD defines as the presence of at least a non-culprit lesion of >50% stenosis at index coronary angiography. Both fractional flow reserve (FFR) and IMR will be measured in the infarct-related artery (IRA) after successful PPCI. Measurements of FFR and IMR will be repeated in the IRA and performed in the non-culprit vessels at staged angiography. The non-culprit vessel lesions will be treated only in the presence of a FFR<0.75. A 2D echocardiographic evaluation of the left ventricular (LV) volumes and ejection fraction will be performed before hospital discharge and at 1-year follow-up. The primary end-point of the study will be the composite of cardiovascular death, re-hospitalization for heart failure and resuscitation or appropriate ICD shock during 1-year of follow-up. Secondary end-points will be the impact of IMR in predicting LV remodeling during follow-up and correlations between IMR and ST-segment resolution. Other secondary endpoints will be need for new revascularization, stent thrombosis and re-infarction of the non-culprit vessels territory. IMPLICATIONS If IMR significantly correlates with differences in outcome and LV remodeling, it will emerge as a potential prognostic index after PPCI in patients with MVD.
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Affiliation(s)
| | - Edoardo Verna
- Ospedale di Circolo e Fondazione Macchi, Università dell'Insubria, Varese (VA).
| | | | | | | | | | - Katia Lucarelli
- Ospedale Generale Regionale F. Miulli, Acquaviva delle Fonti (BA)
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21
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Hung OY, Lee SK, Eshtehardi P, Samady H. Novel biomarkers of coronary microvascular disease. Future Cardiol 2016; 12:497-509. [PMID: 27291585 PMCID: PMC5941701 DOI: 10.2217/fca-2016-0012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 05/06/2016] [Indexed: 01/20/2023] Open
Abstract
Coronary microvascular disease in the absence of myocardial diseases has traditionally been diagnosed through coronary reactivity testing in the cardiac catheterization laboratory. Compared with invasive procedures, blood-based biomarkers may have reduced cost, less risk of physical harm and greater accessibility, making them ideal for an outpatient management strategy. There are a variety of biomarkers available with potential utility in the management of microvascular disease; however, none have yet been extensively validated or established in this clinical patient population.
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Affiliation(s)
- Olivia Y Hung
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Suegene K Lee
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Parham Eshtehardi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Habib Samady
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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22
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The index of microcirculatory resistance in the physiologic assessment of the coronary microcirculation. Coron Artery Dis 2016; 26 Suppl 1:e15-26. [PMID: 26247265 DOI: 10.1097/mca.0000000000000213] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The coronary microcirculation plays a critical role in normal cardiac physiology as well as in many disease states. However, methods to evaluate the function of the coronary microvessels have been limited by technical and theoretical issues. Recently, the index of microcirculatory resistance (IMR) has been proposed and validated as a simple and specific invasive method of assessing the coronary microcirculation. By relying on the thermodilution theory and using a pressure-temperature sensor guidewire, IMR provides a measurement of the minimum achievable microcirculatory resistance in a target coronary artery territory, enabling a quantitative assessment of the microvascular integrity. Unlike indices such as coronary flow reserve, IMR is highly reproducible and independent of hemodynamic changes. In ST-elevation myocardial infarction, IMR predicts myocardial recovery and long-term mortality, whereas in patients with stable coronary artery disease, preintervention IMR predicts the occurrence of periprocedural myocardial infarction. Increasingly, research has focused on IMR-guided interventions of the microcirculation, with the aim of preventing and/or treating the microcirculatory dysfunction that commonly accompanies the epicardial coronary disease. In the present review, we will discuss the theoretical and practical basis for IMR, the clinical studies supporting it, and the future lines of research using this novel tool.
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23
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Ahn SG, Hung OY, Lee JW, Lee JH, Youn YJ, Ahn MS, Kim JY, Yoo BS, Lee SH, Yoon J, Kwon W, Samady H. Combination of the Thermodilution-Derived Index of Microcirculatory Resistance and Coronary Flow Reserve Is Highly Predictive of Microvascular Obstruction on Cardiac Magnetic Resonance Imaging After ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Interv 2016; 9:793-801. [PMID: 27017370 DOI: 10.1016/j.jcin.2015.12.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/17/2015] [Accepted: 12/17/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the predictive accuracy of invasive coronary microvascular indexes for identifying microvascular obstruction (MVO) on cardiac magnetic resonance imaging (CMR) in patients treated with primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). BACKGROUND We hypothesized that a combination of the index of microcirculatory resistance (IMR) and the thermodilution-derived coronary flow reserve (CFRthermo) will enhance the predictive accuracy of detecting MVO compared with either index alone. METHODS The IMR and CFRthermo were measured using a single pressure sensor/thermistor-tipped guidewire in 40 STEMI patients immediately after PCI and related to MVO assessed by CMR day 7. The primary endpoint was the predictive accuracy of the IMR for detecting MVO. RESULTS Patients with an IMR >36 (upper tertile) had a higher rate of MVO compared with those with an IMR ≤36 (93% vs. 39%; p = 0.001). MVO occurred in all patients with an IMR >36 and a CFRthermo ≤1.7 and in no patients with an IMR ≤36 and a CFRthermo >1.7. The IMR remained an independent predictor of MVO (odds ratio: 1.212, 95% confidence interval [CI]: 1.004 to 1.464; p = 0.045) after adjustment for age, creatine kinase-myocardial band, myocardial blush grade, thrombus burden, and CFRthermo. Both the IMR (area under the curve, 0.868, 95% CI: 0.719 to 0.956; p = 0.001) and the CFRthermo (area under the curve, 0.706, 95% CI: 0.536 to 0.842; p = 0.03) were predictive of MVO. Combined IMR and CFRthermo increased the area under the curve for MVO to 0.941. CONCLUSIONS In patients who underwent primary PCI for STEMI, an increased IMR has an independent predictive value for MVO detection, and combined high IMR and low CFRthermo are highly predictive of MVO. These indexes could be used to further risk-stratify patients and guide regional and systemic therapies.
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Affiliation(s)
- Sung Gyun Ahn
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Olivia Y Hung
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jun-Won Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Ji Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Young Jin Youn
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Min-Soo Ahn
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Jang-Young Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Byung-Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Seung-Hwan Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Junghan Yoon
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Woocheol Kwon
- Department of Radiology, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea.
| | - Habib Samady
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea.
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24
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Faustino M, Baptista SB, Freitas A, Monteiro C, Leal P, Nédio M, Antunes C, Farto e Abreu P, Gil V, Morais C. The Index of Microcirculatory Resistance as a Predictor of Echocardiographic Left Ventricular Performance Recovery in Patients With ST-Elevation Acute Myocardial Infarction Undergoing Successful Primary Angioplasty. J Interv Cardiol 2016; 29:137-45. [PMID: 26927606 DOI: 10.1111/joic.12278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This study aims to evaluate the relationship between IMR (Index of Microcirculatory Resistance) and the echocardiographic evolution of left ventricular (LV) systolic and diastolic performance after ST-elevation acute myocardial infarction (STEMI), undergoing primary angioplasty (P-PCI). METHODS IMR was evaluated immediately after P-PCI. Echocardiograms were performed within the first 24 hours (Echo1) and at 3 months (Echo2): LV volumes, ejection fraction (LVEF), wall motion score index (WMSI), E/é ratio, global longitudinal strain (GLS), and left atrial volume were measured. RESULTS Forty STEMI patients were divided in 2 groups according to median IMR: Group 1 (IMR < 26), with less microvascular dysfunction, and Group 2 (IMR > = 26), with more microvascular dysfunction. In Echo1 GLS was significantly better in Group 1 (-14.9 vs. -12.9 in Group 2, P = 0.005). However, there were no significant differences between the two groups in LV systolic volume, LVEF and WMS. Between Echo1 and Echo2, there were significant improvements in LVEF (0.48 ± 0.06 vs. 0.55 ± 0.06, P < 0.0001), GLS (-14.9 ± 1.3 vs. -17.3 ± 7.6, P = 0.001), and E/é ratio (9.3 ± 3.4 vs. 8.2 ± 2.0, P = 0.037) in Group 1, but not in Group 2: LVEF (0.49 ± 0.06 vs. 0.50 ± 0.05, P = 0.47), GLS (-12.9 ± 2.4 vs. -14.4 ± 3.2, P = 0.052), and E/é ratio (8.8 ± 2.4 vs. 10.0 ± 4.7, P = 0.18). WMSI improved significantly more in Group 1 (reduction of -17.1% vs. -6.8% in Group 2, P = 0.015). CONCLUSION Lower IMR was associated with better myocardial GLS acutely after STEMI, and with a significantly higher recovery of the LVEF, WMSI, E/E' ratio and GLS, suggesting that IMR is an early marker of cardiac recovery, after acute myocardial infarction.
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Affiliation(s)
- Mariana Faustino
- Department of Cardiology, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Sérgio Bravo Baptista
- Department of Cardiology, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - António Freitas
- Department of Cardiology, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Célia Monteiro
- Department of Cardiology, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Paulo Leal
- Department of Cardiology, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Maura Nédio
- Department of Cardiology, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Claudia Antunes
- Department of Cardiology, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Pedro Farto e Abreu
- Department of Cardiology, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Victor Gil
- Department of Cardiology, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Carlos Morais
- Department of Cardiology, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
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25
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Abstract
Objective proof of focal lesions is mandatory, and the best invasive method of physiological testing is fractional flow r eserve (FFR). The increased trans-stenotic gradient is measured via the guiding catheter and pressure transducer on a 0.014" coronary wire at maximal hyperaemia induced by adenosine. Patients with a FFR of less than 0.8 should undergo myocardial revascularisation by percutaneous coronary intervention or coronary artery bypass graft, particularly if the proximal and middle segments of the main coronary arteries and large side-branches are affected; there is no prognostic revascularisation benefit in patients with moderate stenoses and FFR greater than 0.80. FFR assessment of coronary lesions is superior to other invasive morphological studies, such as intracoronary ultrasound or optical coherence tomography. Its use in non-culprit vessels in acute coronary syndromes is currently under scrutiny. Recent advances in computed tomographic technique allow non-invasive assessment of FFR, but clinical validation has yet to be obtained.
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Affiliation(s)
- Serban Balanescu
- Cardiology Department, Elias University Hospital, Bucharest, Romania
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26
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Teunissen PFA, de Waard GA, Hollander MR, Robbers LFHJ, Danad I, Biesbroek PS, Amier RP, Echavarría-Pinto M, Quirós A, Broyd C, Heymans MW, Nijveldt R, Lammertsma AA, Raijmakers PG, Allaart CP, Lemkes JS, Appelman YE, Marques KM, Bronzwaer JGF, Horrevoets AJG, van Rossum AC, Escaned J, Beek AM, Knaapen P, van Royen N. Doppler-derived intracoronary physiology indices predict the occurrence of microvascular injury and microvascular perfusion deficits after angiographically successful primary percutaneous coronary intervention. Circ Cardiovasc Interv 2015; 8:e001786. [PMID: 25717044 DOI: 10.1161/circinterventions.114.001786] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND A total of 40% to 50% of patients with ST-segment-elevation myocardial infarction develop microvascular injury (MVI) despite angiographically successful primary percutaneous coronary intervention (PCI). We investigated whether hyperemic microvascular resistance (HMR) immediately after angiographically successful PCI predicts MVI at cardiovascular magnetic resonance and reduced myocardial blood flow at positron emission tomography (PET). METHODS AND RESULTS Sixty patients with ST-segment-elevation myocardial infarction were included in this prospective study. Immediately after successful PCI, intracoronary pressure-flow measurements were performed and analyzed off-line to calculate HMR and indices derived from the pressure-velocity loops, including pressure at zero flow. Cardiovascular magnetic resonance and H2 (15)O PET imaging were performed 4 to 6 days after PCI. Using cardiovascular magnetic resonance, MVI was defined as a subendocardial recess of myocardium with low signal intensity within a gadolinium-enhanced area. Myocardial perfusion was quantified using H2 (15)O PET. Reference HMR values were obtained in 16 stable patients undergoing coronary angiography. Complete data sets were available in 48 patients of which 24 developed MVI. Adequate pressure-velocity loops were obtained in 29 patients. HMR in the culprit artery in patients with MVI was significantly higher than in patients without MVI (MVI, 3.33±1.50 mm Hg/cm per second versus no MVI, 2.41±1.26 mm Hg/cm per second; P=0.03). MVI was associated with higher pressure at zero flow (45.68±13.16 versus 32.01±14.98 mm Hg; P=0.015). Multivariable analysis showed HMR to independently predict MVI (P=0.04). The optimal cutoff value for HMR was 2.5 mm Hg/cm per second. High HMR was associated with decreased myocardial blood flow on PET (myocardial perfusion reserve <2.0, 3.18±1.42 mm Hg/cm per second versus myocardial perfusion reserve ≥2.0, 2.24±1.19 mm Hg/cm per second; P=0.04). CONCLUSIONS Doppler-flow-derived physiological indices of coronary resistance (HMR) and extravascular compression (pressure at zero flow) obtained immediately after successful primary PCI predict MVI and decreased PET myocardial blood flow. CLINICAL TRIAL REGISTRATION URL http://www.trialregister.nl. Unique identifier: NTR3164.
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Affiliation(s)
- Paul F A Teunissen
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Guus A de Waard
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Maurits R Hollander
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Lourens F H J Robbers
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Ibrahim Danad
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - P Stefan Biesbroek
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Raquel P Amier
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Mauro Echavarría-Pinto
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Alicia Quirós
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Christopher Broyd
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Martijn W Heymans
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Robin Nijveldt
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Adriaan A Lammertsma
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Pieter G Raijmakers
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Cornelis P Allaart
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Jorrit S Lemkes
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Yolande E Appelman
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Koen M Marques
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Jean G F Bronzwaer
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Anton J G Horrevoets
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Albert C van Rossum
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Javier Escaned
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Aernout M Beek
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Paul Knaapen
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Niels van Royen
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.).
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Echavarría-Pinto M, Serruys PW, Garcia-Garcia HM, Broyd C, Cerrato E, Macaya C, Escaned J. Use of intracoronary physiology indices in acute coronary syndromes. Interv Cardiol 2015. [DOI: 10.2217/ica.15.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Broyd CJ, Echavarria-Pinto M, Cerrato E, Escaned J. Evaluation of Microvascular Disease and Clinical Outcomes. Interv Cardiol Clin 2015; 4:443-457. [PMID: 28581931 DOI: 10.1016/j.iccl.2015.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Although coronary microcirculatory dysfunction occurs in numerous cardiac conditions and influences prognosis, it has been largely ignored in clinical practice due to the lack of adequate methods for its assessment. Microcirculatory dysfuntion may result from a variety of causes, including structural remodelling (arterioles or capillaries), dysregulation (paradoxical arteriolar vasoconstriction), hypersensitivity to vasoactive factors or adrenergic drive, and extravascular compression of collapsable elements. Thus, the selection of a method to interrogate coronary microcirculation should be based on the suspected cause of dysfunction. This article reviews such assessment tools and their prognostic information.
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Affiliation(s)
| | | | - Enrico Cerrato
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid 28040, Spain
| | - Javier Escaned
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid 28040, Spain.
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Gohbara M, Iwahashi N, Kataoka S, Hayakawa Y, Sakamaki K, Akiyama E, Maejima N, Tsukahara K, Hibi K, Kosuge M, Ebina T, Umemura S, Kimura K. Glycemic Variability Determined by Continuous Glucose Monitoring System Predicts Left Ventricular Remodeling in Patients With a First ST-Segment Elevation Myocardial Infarction. Circ J 2015; 79:1092-9. [PMID: 25739857 DOI: 10.1253/circj.cj-14-1226] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Impaired glucose metabolism plays an important role in patients with acute myocardial infarction, but the clinical significance of glycemic variability (GV) early after the onset of ST-segment elevation myocardial infarction (STEMI) remains to be fully elucidated. METHODS AND RESULTS We prospectively investigated the clinical impact of GV, as determined by a continuous glucose monitoring system (CGMS), on left ventricular remodeling (LVR) assessed by cardiac magnetic resonance imaging (CMR) in 69 patients (63±13 years, 59 men) with a first reperfused STEMI within 12 h of onset. All patients were equipped with a CGMS when in a stable phase after admission and underwent repeat CMR at baseline and 7 months follow-up. Patients were divided into 2 groups according to the mean amplitude of glycemic excursions (MAGE). Patients in the upper tertile of MAGE were categorized as group High (H) and the other two-thirds as group Low (L). LVR was defined as an absolute increase in left ventricular end-diastolic volume index of ≥20%. LVR more frequently occurred in group H than in group L (56% vs. 11%, P<0.001). Multivariate analysis showed the higher MAGE group was an independent predictor of LVR in the chronic phase (odds ratio, 13.999; 95% confidence interval, 3.059 to 64.056; P=0.001). CONCLUSIONS MAGE early after the onset of STEMI identified patients with LVR in the chronic phase.
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Affiliation(s)
- Masaomi Gohbara
- Division of Cardiology, Yokohama City University Medical Center
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Diletti R, Yetgin T, Manintveld OC, Ligthart JM, Zivelonghi C, Zijlstra F, Ribichini F. Percutaneous coronary interventions during ST-segment elevation myocardial infarction: current status and future perspectives. EUROINTERVENTION 2014; 10 Suppl T:T13-22. [DOI: 10.4244/eijv10sta4] [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: 11/23/2022]
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