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Zhang J, Ma M, Li H, Pu Z, Liu H, Huang T, Cheng H, Gong Y, Chu Y, Wang Z, Jiang J, Xia L. Early diagnosis of coronary microvascular dysfunction by myocardial contrast stress echocardiography. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:7845-7858. [PMID: 37161175 DOI: 10.3934/mbe.2023339] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Coronary microvascular dysfunction (CMD) is one of the basic mechanisms of myocardial ischemia. Myocardial contrast echocardiography (MCE) is a bedside technique that utilises microbubbles which remain entirely within the intravascular space and denotes the status of microvascular perfusion within that region. Some pilot studies suggested that MCE may be used to diagnose CMD, but without further validation. This study is aimed to investigate the diagnostic performance of MCE for the evaluation of CMD. MCE was performed at rest and during adenosine triphosphate stress. ECG triggered real-time frames were acquired in the apical 4-chamber, 3-chamber, 2-chamber, and long-axis imaging planes. These images were imported into Narnar for further processing. Eighty-two participants with suspicion of coronary disease and absence of significant epicardial lesions were prospectively investigated. Thermodilution was used as the gold standard to diagnose CMD. CMD was present in 23 (28%) patients. Myocardial blood flow reserve (MBF) was assessed using MCE. CMD was defined as MBF reserve < 2. The MCE method had a high sensitivity (88.1%) and specificity (95.7%) in the diagnosis of CMD. There was strong agreement with thermodilution (Kappa coefficient was 0.727; 95% CI: 0.57-0.88, p < 0.001). However, the correlation coefficient (r = 0.376; p < 0.001) was not high.
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Affiliation(s)
- Jucheng Zhang
- Department of Clinical Engineering, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou 310009, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou 310009, China
| | - Minwen Ma
- Department of Clinical Engineering, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou 310009, China
| | - Huajun Li
- Department of Cardiology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou 310009, China
| | - Zhaoxia Pu
- Department of Cardiology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou 310009, China
| | - Haipeng Liu
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Tianhai Huang
- Department of Clinical Engineering, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou 310009, China
| | - Huan Cheng
- Key Laboratory for Biomedical Engineering of Ministry of Education, Institute of Biomedical Engineering, Zhejiang University, Hangzhou 310027, China
| | - Yinglan Gong
- Institute of Wenzhou, Zhejiang University, Wenzhou 325036, China
| | - Yonghua Chu
- Department of Clinical Engineering, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou 310009, China
| | - Zhikang Wang
- Department of Clinical Engineering, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou 310009, China
| | - Jun Jiang
- Department of Cardiology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou 310009, China
| | - Ling Xia
- Key Laboratory for Biomedical Engineering of Ministry of Education, Institute of Biomedical Engineering, Zhejiang University, Hangzhou 310027, China
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Zhang J, Li X, Liu J, Shang Y, Tan L, Guo Y. Early and dynamic detection of doxorubicin induced cardiotoxicity by myocardial contrast echocardiography combined with two-dimensional speckle tracking echocardiography in rats. Front Cardiovasc Med 2023; 9:1063499. [PMID: 36712239 PMCID: PMC9880177 DOI: 10.3389/fcvm.2022.1063499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/27/2022] [Indexed: 01/15/2023] Open
Abstract
Background Anthracycline-induced cardiotoxicity is well-known as a side effect of chemotherapy. Currently, clinical imaging techniques are not capable to detect doxorubicin (DOX)-induced cardiotoxicity before a functional decline. The purpose of this study was to evaluate whether myocardial contrast echocardiography (MCE) can dynamically monitor the cardiac changes in the early stage in the DOX-induced rat model of cardiotoxicity. Methods A weekly injection of 2.5 mg/kg of DOX was used to generate a rat model of cardiotoxicity. All groups underwent ultrasonic examinations including standard echocardiography, 2D speckle tracking echocardiography (2D-STE), and MCE. Then all rats were sacrificed immediately for histopathological evaluation. Results A total of eight control rats and 32 DOX-treated rats were included in the study and grouped according to their treatment period. Decreased quantitative parameters of myocardial blood flow (MBF) (control vs. group 1: 133.31 ± 20.23 dB/s vs. 103.35 ± 21.60 dB/s, P = 0.048) and β (control vs. group 2: 11.17 ± 1.48/s vs. 7.15 ± 1.23/s, P < 0.001) were observed after 2 and 4 weeks of treatment, respectively, while left ventricular global strain (control vs. group 3: -23.67 ± 3.92% vs. -16.01 ± 3.40%, P = 0.002) decreased after 6 weeks of treatment and left ventricular ejection fraction (LVEF) (control vs. group 4: 82.41 ± 3.20% vs. 70.89 ± 9.30%, P = 0.008) decreased after 8 weeks of treatment. The main histopathological features are increased myocardial vacuolization and interstitial fibrosis and decreased myocardial microvessel density. Conclusion Compared with standard echocardiography and 2D-STE, MCE can accurately and non-invasively detect changes in early myocardial perfusion, demonstrating the clinical potential of continuous and dynamic monitoring of DOX-induced cardiotoxicity.
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Zhou YX, Hu YG, Cao S, Xiong Y, Lei JR, Yuan WY, Chen JL, Zhou Q. Prognostic value of myocardial contrast echocardiography in acute anterior wall ST-segment elevation myocardial infarction with successful epicardial recanalization. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1487-1497. [PMID: 35284974 DOI: 10.1007/s10554-022-02545-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/27/2022] [Indexed: 11/28/2022]
Abstract
Although myocardial contrast echocardiography (MCE) can evaluate microvascular perfusion abnormalities, its prognostic value is uncertain in acute anterior wall ST-Segment elevation myocardial infarction (STEMI) with successful epicardial recanalization. Therefore, the study aims to investigate the prognostic role of qualitative and quantitative MCE in acute anterior wall STEMI with successful epicardial recanalization. 153 STEMI patients were assessed by MCE within 7 days after successful epicardial recanalization. Qualitative perfusion parameters (microvascular perfusion score index, MPSI) and quantitative perfusion parameters (A, β, and Aβ) were acquired using a 17-segment model. And corrected A and Aβ were calculated. Patients were all followed for major adverse cardiovascular events (MACEs). During median follow-up of 27 (4) months, 39 (25.49%) patients experienced MACEs, while 114 (74.51%) were free from MACEs. Patients with MACEs had higher MPSI (1.65 ± 0.13 vs. No-MACEs 1.35 ± 0.20, P < 0.001), lower β (1.09 ± 0.19 s-1 vs. No-MACEs 1.34 ± 0.30 s-1, P < 0.001), corrected A (0.17 ± 0.03 dB vs. No-MACEs 0.19 ± 0.04 dB, P = 0.039) and lower corrected Aβ (0.19 ± 0.06 dB/s vs. No-MACEs 0.25 ± 0.08 dB/s, P < 0.001). MPSI of 1.44 provided an area under the curve (AUC) of 0.872, while β of 1.18 s-1 and corrected Aβ of 0.22 dB/s provided AUCs of 0.759 and 0.724, respectively. The combination of MPSI, β and corrected Aβ provided an increased AUC of 0.964 (all P < 0.05). Time-dependent ROC analysis showed that the AUCs of the MPSI, β, corrected Aβ and the combination at 1, 1.5 and 2 years indicated a strong predictive power for MACEs (AUC = 0.900/0.894/0.881 for MPSI, 0.648/0.704/0.732 for β, 0.674/0.686/0.722 for corrected Aβ, and 0.947/0.962/0.967 for the combination, respectively). Patients with MPSI < 1.44, β > 1.18 s-1, or corrected Aβ > 0.22 dB/s had lower event rate (all Log Rank P ≤ 0.001). MPSI, β, corrected Aβ, GLS and WBC were independent predictors of MACEs with adjusted hazard ratio of 34.41 (8.18-144.87), P < 0.001 for MPSI; 39.29 (27.46-65.44), P < 0.001 for β; 8.93 (1.46-54.55), P = 0.018 for corrected Aβ; 10.88 (2.83-41.86), P = 0.001 for GLS; and 1.43 (1.16-1.75), P = 0.001 for WBC. Qualitative and quantitative MCE can accurately predict MACEs in acute anterior wall STEMI with successful epicardial recanalization, and their combined predictive value is higher.
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Affiliation(s)
- Yan-Xiang Zhou
- Department of Ultrasonography, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei, People's Republic of China
| | - Yu-Gang Hu
- Department of Ultrasonography, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei, People's Republic of China
| | - Sheng Cao
- Department of Ultrasonography, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei, People's Republic of China
| | - Ye Xiong
- Department of Ultrasonography, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei, People's Republic of China
| | - Jia-Rui Lei
- Department of Ultrasonography, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei, People's Republic of China
| | - Wen-Yue Yuan
- Department of Ultrasonography, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei, People's Republic of China
| | - Jin-Ling Chen
- Department of Ultrasonography, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei, People's Republic of China.
| | - Qing Zhou
- Department of Ultrasonography, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei, People's Republic of China.
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Li M, Zeng D, Xie Q, Xu R, Wang Y, Ma D, Shi Y, Xu X, Huang M, Fei H. A deep learning approach with temporal consistency for automatic myocardial segmentation of quantitative myocardial contrast echocardiography. Int J Cardiovasc Imaging 2021; 37:1967-1978. [PMID: 33595760 DOI: 10.1007/s10554-021-02181-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 01/30/2021] [Indexed: 02/05/2023]
Abstract
Quantitative myocardial contrast echocardiography (MCE) has been proved to be valuable in detecting myocardial ischemia. During quantitative MCE analysis, myocardial segmentation is a critical step in determining accurate region of interests (ROIs). However, traditional myocardial segmentation mainly relies on manual tracing of myocardial contours, which is time-consuming and laborious. To solve this problem, we propose a fully automatic myocardial segmentation framework that can segment myocardial regions in MCE accurately without human intervention. A total of 100 patients' MCE sequences were divided into a training set and a test set according to a 7: 3 proportion for analysis. We proposed a bi-directional training schema, which incorporated temporal information of forward and backward direction among frames in MCE sequences to ensure temporal consistency by combining convolutional neural network with recurrent neural network. Experiment results demonstrated that compared with a traditional segmentation model (U-net) and the model considering only forward temporal information (U-net + forward), our framework achieved the highest segmentation precision in Dice coefficient (U-net vs U-net + forward vs our framework: 0.78 ± 0.07 vs 0.79 ± 0.07 vs 0.81 ± 0.07, p < 0.01), Intersection over Union (0.65 ± 0.09 vs 0.66 ± 0.09 vs 0.68 ± 0.09, p < 0.01), and lowest Hausdorff Distance (32.68 ± 14.6 vs 28.69 ± 13.18 vs 27.59 ± 12.82 pixel point, p < 0.01). In the visual grading study, the performance of our framework was the best among these three models (52.47 ± 4.29 vs 54.53 ± 5.10 vs 57.30 ± 4.73, p < 0.01). A case report on a randomly selected subject for perfusion analysis showed that the perfusion parameters generated by using myocardial segmentation of our proposed framework were similar to that of the expert annotation. The proposed framework could generate more precise myocardial segmentation when compared with traditional methods. The perfusion parameters generated by these myocardial segmentations have a good similarity to that of manual annotation, suggesting that it has the potential to be utilized in routine clinical practice.
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Affiliation(s)
- Mingqi Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Dewen Zeng
- Department of Computer Science and Engineering, University of Notre Dame, South Bend, IN, USA
| | - Qiu Xie
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ruixue Xu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Dunliang Ma
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yiyu Shi
- Department of Computer Science and Engineering, University of Notre Dame, South Bend, IN, USA
| | - Xiaowei Xu
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Meiping Huang
- Department of Catheterization Lab, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Hongwen Fei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
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Umnov IN, Bobrov AL, Alekhin MN. [Contrast Echocardiography with a Quantitative Assessment of Myocardial Perfusion in Patients with Previous Q-Wave Myocardial Infarction]. KARDIOLOGIIA 2020; 60:17-23. [PMID: 32345194 DOI: 10.18087/cardio.2020.2.n817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess possibilities of contrast echocardiography with quantitative evaluation of myocardial perfusion in patients with previous Q-wave myocardial infarction. MATERIALS AND METHODS We examined 15 men (42-72 years) with coronary artery disease and previous myocardial infarction, and pathological Q-wave in 2 or more ECG leads. Quantification of left ventricular (LV) myocardial perfusion was performed by calculating of the ultrasound signal tissue intensity from the LV myocardial segments during intravenous administration of the ultrasound contrast agent (SonoVue). The Tissue intensive curve (TIC) analysis was done in the end-diastolic period before and on the fourth cardiac cycle after applying the "flash". Changes in the intensity of myocardial perfusion (A4, dB) was estimated as the difference between the intensity values of the ultrasound signal in the myocardial segment during the period of filling the contrast bubbles on 4-th cardiac cycle and before applying the «flash». Measurements were performed in 16 segments of the LV. A contrast cardiac magnetic resonance imaging (contrast MRI) was performed in order to verify the LV scar. Fibrotic changes of 50% of myocardial wall or more were considered as signs of post-infarction scar. RESULTS The dynamics of perfusion and scar presence in 240 myocardial segments were evaluated. The median A4 was 1 dB (range, -20 to 10 dB). MRI revealed 82 of 240 segments with the large-focal scar. The effectiveness of the diagnostic test (quantitative contrast perfusion echocardiography with A4 assessment) to detect myocardial scar was investigated. ROC curve analysis showed good model quality, AUC=0,787 (0,730-0,837); sensitivity 82.9%; specificity 75.3%; p<0.01. The cut-off point for A4 was -1. CONCLUSION A new approach to quantitative contrast assessment of perfusion allows to identify perfusion disorders with high efficiency in patients with previous Q-wave myocardial infarction.
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Affiliation(s)
- I N Umnov
- Limited liability company «European Institute for Family Health», Saint Petersburg
| | - A L Bobrov
- Federal state budget military educational institution of higher education «S.M. Kirov Military Medical Academy» Ministry of Defense of the Russian Federation, Saint Petersburg
| | - M N Alekhin
- Federal state budgetary institution of continuing education «Central Medical Academy» Office of the President of the Russian Federation, Moscow
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Platts DG, Bartnikowski N, Gregory SD, Scalia GM, Fraser JF. Contrast Microsphere Destruction by a Continuous Flow Ventricular Assist Device: An In Vitro Evaluation Using a Mock Circulation Loop. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4907898. [PMID: 28884121 PMCID: PMC5572588 DOI: 10.1155/2017/4907898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/22/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Transthoracic echocardiography (TTE) is fundamental in managing patients supported with ventricular assist devices (VAD). However imaging can be difficult in these patients. Contrast improves image quality but they are hydrodynamically fragile agents. The aim was to assess contrast concentration following passage through a VAD utilising a mock circulation loop (MCL). METHODS Heartware continuous flow (CF) VAD was incorporated into a MCL. Definity® contrast was infused into the MCL with imaging before and after CF-VAD. 5 mm2 regions of interest were used to obtain signal intensity (decibels), as a surrogate of contrast concentration. RESULTS Four pump speeds revealed significant reduction in contrast signal intensity after CF-VAD compared to before CF-VAD (all p < 0.0001). Combined pre- and postpump data at all speeds showed a 22.2% absolute reduction in contrast signal intensity across the CF-VAD (14.8 ± 0.8 dB prepump versus 11.6 ± 1.4 dB postpump; p < 0.0001). Mean signal intensity reduction at each speed showed an inverse relationship between speed and relative reduction in signal intensity. CONCLUSION Contrast microsphere transit through a CF-VAD within a MCL resulted in significant reduction in signal intensity, consistent with destruction within the pump. This was evident at all CF-VAD pump speeds but relative signal drop was inversely proportional to pump speed.
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Affiliation(s)
- David G. Platts
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Nicole Bartnikowski
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Shaun D. Gregory
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- School of Engineering, Griffith University, Brisbane, QLD, Australia
| | - Gregory M. Scalia
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
- Heart Care Partners, Wesley Hospital, Brisbane, QLD, Australia
| | - John F. Fraser
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, QLD, Australia
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Jiang L, Yao H, Liang ZG. Postoperative Assessment of Myocardial Function and Microcirculation in Patients with Acute Coronary Syndrome by Myocardial Contrast Echocardiography. Med Sci Monit 2017; 23:2324-2332. [PMID: 28514327 PMCID: PMC5443357 DOI: 10.12659/msm.901233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Postoperative myocardial function and microcirculation of acute coronary syndrome (ACS) was assessed by myocardial contrast echocardiography (MCE). MATERIAL AND METHODS Eighty-nine ACS patients treated with percutaneous coronary intervention (PCI) were detected by MCE and two-dimensional ultrasonography before and a month later after PCI respectively. Their myocardial perfusion was evaluated by myocardial contrast score (MSC) and contrast score index (CSI); cross-sectional area of microvessel (A), average myocardial microvascular impairment (β), and myocardial blood flow (MBF) were analyzed by cardiac ultrasound quantitative analysis (CUSQ), and fractional flow reserve (FFR) change was observed. Left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD), and left ventricular end-systolic dimension (LVESD) were observed; the index of microcirculatory resistance (IMR), FFR, and coronary flow reserve (CFR) were detected to evaluate coronary microcirculation. RESULTS None of the 89 patients experienced no-reflow. Patients with normal myocardial perfusion mostly had normal or slightly decreased ventricular wall motion after PCI. A month after the operation, there was an increase in A, β, MBF, LVEF, E/A, IMR, FFR, and CFR (all P<0.05), while LVEDD, LVESD, diastolic gallop A peak, E/Ea, E/Ea×S, and Tei decreased (all P<0.05). LVEF and IMR were in positive correlations with A. LVEF, IMR, FFR and CFR were positively correlated with b and MBF (both r>0, P<0.05), while E/Ea×Sa and Tei were negatively correlated with b and MBF (r<0, P<0.05). CONCLUSIONS MCE can safely assess post-PCI myocardial function and microcirculation of ASC.
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Affiliation(s)
- Li Jiang
- Department of Hematology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China (mainland)
| | - Hong Yao
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Zhao-Guang Liang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
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Prognostic Value of Myocardial Perfusion Analysis in Patients with Coronary Artery Disease: A Meta-Analysis. J Am Soc Echocardiogr 2017; 30:270-281. [DOI: 10.1016/j.echo.2016.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Indexed: 01/28/2023]
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Mattoso AAA, Tsutsui JM, Kowatsch I, Cruz VYL, Sbano JCN, Ribeiro HB, Kalil Filho R, Porter TR, Mathias W. Prognostic value of dobutamine stress myocardial perfusion echocardiography in patients with known or suspected coronary artery disease and normal left ventricular function. PLoS One 2017; 12:e0172280. [PMID: 28234978 PMCID: PMC5325237 DOI: 10.1371/journal.pone.0172280] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 02/02/2017] [Indexed: 01/13/2023] Open
Abstract
Objective We sought to determine the prognostic value of qualitative and quantitative analysis obtained by real-time myocardial perfusion echocardiography (RTMPE) in patients with known or suspected coronary artery disease (CAD). Background Quantification of myocardial blood flow reserve (MBFR) in patients with CAD using RTMPE has been demonstrated to further improve accuracy over the analysis of wall motion (WM) and qualitative analysis of myocardial perfusion (QMP). Methods From March 2003 to December 2008, we prospectively studied 168 patients with normal left ventricular function (LVF) who underwent dobutamine stress RTMPE. The replenishment velocity reserve (β) and MBFR were derived from RTMPE. Acute coronary events were: cardiac death, myocardial infarction and unstable angina with need for urgent coronary revascularization. Results During a median follow-up of 34 months (5 days to 6.9 years), 17 acute coronary events occurred. Abnormal β reserve in ≥2 coronary territories was the only independent predictor of events hazard ratio (HR) = 21, 95% CI = 4.5–99; p<0.001). Both, abnormal β reserve and MBFR added significant incremental value in predicting events over qualitative analysis of WM and MP (χ2 = 6.6 and χ2 = 24.6, respectively; p = 0.001 and χ2 = 6.6 and χ2 = 15.5, respectively; p = 0.012, respectively). When coronary angiographic data was added to the multivariate analysis model, β reserve remained the only predictor of events with HR of 21.0 (95% CI = 4.5–99); p<0.001. Conclusion Quantitative dobutamine stress RTMPE provides incremental prognostic information over clinical variables, qualitative analysis of WM and MP, and coronary angiography in predicting acute coronary events.
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Affiliation(s)
- Angele A. A. Mattoso
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Jeane M. Tsutsui
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
- * E-mail:
| | - Ingrid Kowatsch
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Vitória Y. L. Cruz
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - João C. N. Sbano
- University of Nebraska Medical Center, Omaha, United States of America
| | - Henrique B. Ribeiro
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Roberto Kalil Filho
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Thomas R. Porter
- University of Nebraska Medical Center, Omaha, United States of America
| | - Wilson Mathias
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
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Bulte CS, Boer C, Hartemink KJ, Kamp O, Heymans MW, Loer SA, de Marchi SF, Vogel R, Bouwman RA. Myocardial Microvascular Responsiveness During Acute Cardiac Sympathectomy Induced by Thoracic Epidural Anesthesia. J Cardiothorac Vasc Anesth 2017; 31:134-141. [DOI: 10.1053/j.jvca.2016.05.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Indexed: 11/11/2022]
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Vamvakidou A, Gurunathan S, Senior R. Novel techniques in stress echocardiography: a focus on the advantages and disadvantages. Expert Rev Cardiovasc Ther 2016; 14:477-94. [DOI: 10.1586/14779072.2016.1135054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Yang L, Xia C, Mu Y, Guan L, Wang C, Tang Q, Verocai FG, Fonseca LMBD, Shih MC. Prognostic Value of Real Time Myocardial Contrast Echocardiography after Percutaneous Coronary Intervention. Echocardiography 2015; 33:421-30. [PMID: 26411872 DOI: 10.1111/echo.13061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Real time myocardial contrast echocardiography (RTMCE) is a cost-effective and simple method to quantify coronary flow reserve (CFR). We aimed to determine the value of RTMCE to predict cardiac events after percutaneous coronary intervention (PCI). We have studied myocardial blood volume (A), velocity (β), flow indexes (MBF, A × β), and vasodilator reserve (stress-to-rest ratios) in 36 patients with acute coronary syndrome (ACS) who underwent PCI. CFR (MBF at stress/MBF at rest) was calculated for each patient. Perfusion scores were used for visual interpretation by MCE and correlation with TIMI flow grade. In qualitative RTMCE assessment, post-PCI visual perfusion scores were higher than pre-PCI (Z = -7.26, P < 0.01). Among 271 arteries with TIMI flow grade 3 post-PCI, 72 (36%) did not reach visual perfusion score 1. The β- and A × β-reserve of the abnormal segments supplied by obstructed arteries increased after PCI comparing to pre-PCI values (P < 0.01). Patients with adverse cardiac events had significantly lower β- and lower A × β-reserve than patients without adverse cardiac events. In the former group, the CFR was ≥ 1.5 both pre- and post-PCI. CFR estimation by RTMCE can quantify myocardial perfusion in patients with ACS who underwent PCI. The parameters β-reserve and CFR combined might predict cardiac events on the follow-up.
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Affiliation(s)
- Lixia Yang
- Department of Image Center, Shanghai Xuhui Central Hospital, Shanghai, China.,Department of Echocardiography, Center of Medical Ultrasound, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Chunmei Xia
- Department of Physiology and Pathophysiology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuming Mu
- Department of Echocardiography, Center of Medical Ultrasound, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Lina Guan
- Department of Echocardiography, Center of Medical Ultrasound, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Chunmei Wang
- Department of Echocardiography, Center of Medical Ultrasound, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Qi Tang
- Department of Echocardiography, Center of Medical Ultrasound, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Flavia Gomes Verocai
- Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Image Diagnostics (CDPI) and Hospital Samaritano, Rio de Janeiro, Brazil
| | | | - Ming Chi Shih
- Department of Radiology, The University of Chicago, Chicago, Illinois.,Federal University of São Paulo, São Paulo, SP, Brazil
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Abstract
OBJECTIVES Takotsubo stress cardiomyopathy (TSC) is an increasingly recognised and diagnosed disease, although the underlying pathophysiology is still unknown. Our aim was to investigate the effect of the catecholamine dobutamine on coronary flow reserve (CFR) measured non-invasively in patients with TSC and controls. Our hypothesis was that dobutamine stress can induce microvascular dysfunction in patients with a previous episode of TSC. SETTING This is a case-control study and a substudy of the Stockholm Myocardial Infarction with Normal Coronaries (SMINC) study. Elective dobutamine investigations were performed focusing on non-invasive measurements of CFR. The investigations were performed more than 6 months after the acute event. PARTICIPANTS 22 patients with a previous episode of TSC and 22 sex-matched and age-matched controls were recruited from the SMINC study. All patients with TSC had a previous normal cardiovascular MR investigation. RESULTS CFR at low-dose dobutamine was significantly lower in the TSC group compared with controls, 1.51 and 1.72, respectively (p=0.017). At high-dose dobutamine, CFR was 1.95 and 2.21 in the TSC group and controls, respectively (p=0.098). CONCLUSIONS We could not confirm that the catecholamine dobutamine induced microvascular dysfunction in patients with TSC. However, we found a small but significant difference in CFR at low-dose dobutamine, which implies that the role of microvascular function in TSC needs to be further explored.
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Affiliation(s)
- Olov Collste
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Mahbubul Alam
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mats Frick
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Uenishi EK, Caldas MA, Tsutsui JM, Abduch MCD, Sbano JCN, Kalil Filho R, Mathias W. Evaluation of cardiac masses by real-time perfusion imaging echocardiography. Cardiovasc Ultrasound 2015; 13:23. [PMID: 25933602 PMCID: PMC4424545 DOI: 10.1186/s12947-015-0018-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 04/23/2015] [Indexed: 11/10/2022] Open
Abstract
Background Diagnosis of cardiac masses is still challenging by echocardiography and distinguishing tumors from thrombi has important therapeutical implications. We sought to determine the diagnostic value of real-time perfusion echocardiography (RTPE) for cardiac masses characterization. Methods We prospectively studied 86 patients, 23 with malignant tumors (MT), 26 with benign tumors (BT), 33 with thrombi and 6 with pseudotumors who underwent RTPE. Mass perfusion was analyzed qualitatively and blood flow volume (A), blood flow velocity (β), and microvascular blood flow (A x β) were determined by quantitative RTPE. Results Logistic regression models showed that the probability of having a tumor increased by 15.8 times with a peripheral qualitative perfusion pattern, and 34.5 times with a central perfusion pattern, in comparison with the absence of perfusion. Using quantitative RTPE analysis, thrombi group had parameters of blood flow lower than tumor group. A values for thrombi, MT, and BT were 0.1 dB (0.01-0.22), 2.78 dB (1–7) and 2.58 dB (1.44-5), respectively; p < 0.05, while A x β values were 0.0 dB/s−1 (0.01–0.14), 2.00 dB/s−1 (1–6), and 1.18 dB/s−1 (0.52–3), respectively; p < 0.05. At peak dipyridamole stress, MT had greater microvascular blood volume than BT [A = 4.18 dB (2.14-7.93) versus A = 2.04 dB (1.09-3.55); p < 0.05], but no difference in blood flow [Axβ = 2.46 dB/s−1 (1.42–4.59) versus Axβ = 1.55 dB/s [1] (0.51-4.08); p = NS]. An A value >3.28 dB at peak dipyridamole stress predicted MT (AUC = 0.75) and conferred 5.8-times higher chance of being MT rather than BT. Conclusion RTPE demonstrated that cardiac tumors have greater microvascular blood volume and regional blood flow when compared with thrombi. Dipyridamole stress was useful in differentiating MT from BT.
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Affiliation(s)
- Eliza K Uenishi
- Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil.
| | - Márcia A Caldas
- Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil.
| | - Jeane M Tsutsui
- Heart Institute (InCor), University of Sao Paulo Medical School and Fleury Group, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, 05403-000, Brazil.
| | - Maria C D Abduch
- Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil.
| | - João C N Sbano
- Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil.
| | - Roberto Kalil Filho
- Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil.
| | - Wilson Mathias
- Heart Institute (InCor), University of Sao Paulo Medical School and Fleury Group, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, 05403-000, Brazil.
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15
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Aldrighi JM, Tsutsui JM, Kowastch I, Ribeiro AL, Scapinelli A, Tamanaha S, Oliveira RM, Mathias W. Effects of Insulin Resistance on Myocardial Blood Flow and Arterial Peripheral Circulation in Patients with Polycystic Ovary Syndrome. Echocardiography 2014; 32:1277-84. [PMID: 25412756 DOI: 10.1111/echo.12849] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Polycystic ovary syndrome (PCOS) is associated with increased risk for cardiovascular disease. We sought to evaluate the effects of insulin resistance (IR) on myocardial microcirculation and peripheral artery function in patients with PCOS. METHODS We studied 55 women (28 with PCOS without IR, 18 with PCOS and IR and 11 normal controls) who underwent laboratorial analysis, high-resolution vascular ultrasound and real time myocardial contrast echocardiography (RTMCE). Intima-media thickness (IMT) and brachial artery flow-mediated dilation (FMD) were evaluated by vascular ultrasound. The replenishment velocity (β), plateau of acoustic intensity (A) and myocardial blood flow reserve (MBFR) were determined by quantitative dipyridamole stress RTMCE. RESULTS β reserve in group PCOS + IR was lower than control (2.34 ± 0.55 vs. 3.60 ± 0.6; P < 0.001) and than PCOS without IR (2.34 ± 0.55 vs. 3.17 ± 0.65; P < 0.001). MBFR in patients with PCOS without IR did not differ from those of control (4.59 ± 1.59 vs. 5.30 ± 1.64; P = 0.22) or from patients with PCOS + IR (4.59 ± 1.59 vs. 3.70 ± 1.47; P = 0.07). When comparing with control group, patients with PCOS + IR had lower MBFR (5.30 ± 1.64 vs. 3.70 ± 1.47; P = 0.01). No significant differences were found between control, PCOS without IR and PCOS + IR for FMD (0.18 ± 0.05, 0.15 ± 0.04 and 0.13 ± 0.07; P =NS) or IMT (0.48 ± 0.05, 0.47 ± 0.05 and 0.49 ± 0.07; P = NS). CONCLUSION Women with PCOS and IR had depressed β and MBFR as demonstrated by quantitative RTMCE, but no alteration in endothelial dysfunction or IMT. PCOS without IR showed isolated depression in β reserve, probably an earlier marker of myocardial flow abnormality.
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Affiliation(s)
- José M Aldrighi
- Department of Obstetrics and Gynecology, School of Medical Sciences of Santa Casa, São Paulo, Brazil
| | - Jeane M Tsutsui
- Heart Institute (InCor), University of Sao Paulo Medical School and Fleury Group, São Paulo, Brazil
| | - Ingrid Kowastch
- Heart Institute (InCor), University of Sao Paulo Medical School and Fleury Group, São Paulo, Brazil
| | - Alessandra L Ribeiro
- Department of Obstetrics and Gynecology, School of Medical Sciences of Santa Casa, São Paulo, Brazil
| | - Alessandro Scapinelli
- Department of Obstetrics and Gynecology, School of Medical Sciences of Santa Casa, São Paulo, Brazil
| | - Sonia Tamanaha
- Department of Obstetrics and Gynecology, School of Medical Sciences of Santa Casa, São Paulo, Brazil
| | - Ricardo M Oliveira
- Department of Obstetrics and Gynecology, School of Medical Sciences of Santa Casa, São Paulo, Brazil
| | - Wilson Mathias
- Heart Institute (InCor), University of Sao Paulo Medical School and Fleury Group, São Paulo, Brazil
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Kasprzak JD, Wejner-Mik P, Nouri A, Szymczyk E, Krzemińska-Pakuła M, Lipiec P. Transthoracic measurement of left coronary artery flow reserve improves the diagnostic value of routine dipyridamole-atropine stress echocardiogram. Arch Med Sci 2013; 9:802-7. [PMID: 24273560 PMCID: PMC3832825 DOI: 10.5114/aoms.2013.38673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 06/12/2011] [Accepted: 10/19/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION We hypothesized that coronary flow reserve (CFR) in the left anterior descending artery (LAD) can be effectively measured during an accelerated dipyridamole-atropine stress echocardiography (DASE) protocol to improve the diagnostic performance of the test. MATERIAL AND METHODS In 64 patients with suspected or known coronary artery disease scheduled for coronary angiography DASE with concomitant CFR measurement in LAD was performed. RESULTS Coronary flow reserve measurement and calculation were feasible in 83% of patients. The positive predictive value of undetectable LAD flow was 81% for severe LAD disease. Measured values of CFR were in the range 1.3-4.1 (mean: 2.2 ±0.7). Significantly lower CFR was found in patients with LAD disease (1.97 ±0.62 vs. 2.55 ±0.57, p = 0.0015). The optimal cutoff for detecting ≥ 50% stenosis was CFR ≤ 2.1 (ROC AUC 0.776), corresponding with 68% sensitivity and 84% specificity. In patients with negative DASE results 67% of patients with LAD disease had abnormal CFR, whereas in patients with a positive DASE result 92% of patients with normal LAD had normal CFR. The DASE diagnostic accuracy for the detection of coronary artery disease (CAD) increased from 75% to 85% when CFR measurement was added to wall motion abnormality (WMA) analysis. No test with both abnormalities was false positive for the detection of coronary disease. CONCLUSIONS Incorporation of CFR measurement into WMA-based stress echocardiography is feasible even in an accelerated DASE protocol and can be translated into an approximate gain of 10% in overall test accuracy.
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Mattoso AA, Kowatsch I, Tsutsui JM, de la Cruz VY, Ribeiro HB, Sbano JC, Ramires JA, Kalil Filho R, Porter TR, Mathias W. Prognostic Value of Qualitative and Quantitative Vasodilator Stress Myocardial Perfusion Echocardiography in Patients with Known or Suspected Coronary Artery Disease. J Am Soc Echocardiogr 2013; 26:539-47. [DOI: 10.1016/j.echo.2013.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Indexed: 10/27/2022]
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18
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Lima MF, Mathias W, Sbano JC, de la Cruz VY, Abduch MC, Lima MS, Bocchi EA, Hajjar LA, Ramires JA, Kalil Filho R, Tsutsui JM. Prognostic Value of Coronary and Microvascular Flow Reserve in Patients with Nonischemic Dilated Cardiomyopathy. J Am Soc Echocardiogr 2013; 26:278-87. [DOI: 10.1016/j.echo.2012.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Indexed: 11/16/2022]
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19
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Abdelmoneim SS, Hagen ME, Mendrick E, Pattan V, Wong B, Norby B, Roberson T, Szydel T, Basu R, Basu A, Mulvagh SL. Acute hyperglycemia reduces myocardial blood flow reserve and the magnitude of reduction is associated with insulin resistance: a study in nondiabetic humans using contrast echocardiography. Heart Vessels 2012. [PMID: 23180239 DOI: 10.1007/s00380-012-0305-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The effect of acute hyperglycemia per se on coronary perfusion in humans is undefined. We evaluated the effects of short-term hyperglycemia on myocardial blood flow reserve (MBFR) in healthy nondiabetic volunteers. Twenty-one nondiabetic volunteers (76 % females, mean ± SD, age 48 ± 5 years) had noninvasive MBFR assessment while exposed to pancreatic clamp with somatostatin and replacement glucagon and growth hormone infusions, with frequent interval plasma glucose (PG) monitoring. Insulin was infused at 0.75 mU/kg/min to mimic postprandial plasma insulin concentrations, and glucose was infused to maintain euglycemia (PG 93.9 ± 7.3 mg/dl) followed by hyperglycemia (PG 231.5 ± 18.1 mg/dl). Myocardial contrast echocardiography (MCE) was performed during each glycemic steady state using continuous infusion of Definity at rest and during regadenoson (Lexiscan 5 ml (400 μg) intravenous bolus) infusion to quantify myocardial blood flow (MBF) and determine MBFR. Insulin resistance (IR) was assessed by glucose infusion rate (GIR; mg/kg/min) at euglycemia. Median stress MBF, MBFR, and β reserve were significantly reduced during acute hyperglycemia versus euglycemia (stress MBF 3.9 vs 5.4, P = 0.02; MBFR 2.0 vs 2.7, P < 0.0001; β reserve 1.45 vs 2.4, P = 0.007). Using a median threshold GIR of 5 mg/kg/min, there was a correlation between GIR and hyperglycemic MBFR (r = 0.506, P = 0.019). MBFR, as determined noninvasively by MCE, is significantly decreased during acute hyperglycemia in nondiabetic volunteers, and the magnitude of this reduction is modulated by IR.
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Affiliation(s)
- Sahar S Abdelmoneim
- Mayo Clinic, Division of Cardiovascular Diseases and Internal Medicine, 200 First street SW, Rochester, MN, 55905, USA,
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de Jong MC, Genders TSS, van Geuns RJ, Moelker A, Hunink MGM. Diagnostic performance of stress myocardial perfusion imaging for coronary artery disease: a systematic review and meta-analysis. Eur Radiol 2012; 22:1881-95. [PMID: 22527375 PMCID: PMC3411304 DOI: 10.1007/s00330-012-2434-1] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 01/23/2012] [Accepted: 02/04/2012] [Indexed: 12/11/2022]
Abstract
Objectives To determine and compare the diagnostic performance of stress myocardial perfusion imaging (MPI) for the diagnosis of obstructive coronary artery disease (CAD), using conventional coronary angiography (CCA) as the reference standard. Methods We searched Medline and Embase for literature that evaluated stress MPI for the diagnosis of obstructive CAD using magnetic resonance imaging (MRI), contrast-enhanced echocardiography (ECHO), single-photon emission computed tomography (SPECT) and positron emission tomography (PET). Results All pooled analyses were based on random effects models. Articles on MRI yielded a total of 2,970 patients from 28 studies, articles on ECHO yielded a sample size of 795 from 10 studies, articles on SPECT yielded 1,323 from 13 studies. For CAD defined as either at least 50 %, at least 70 % or at least 75 % lumen diameter reduction on CCA, the natural logarithms of the diagnostic odds ratio (lnDOR) for MRI (3.63; 95 % CI 3.26–4.00) was significantly higher compared to that of SPECT (2.76; 95 % CI 2.28–3.25; P = 0.006) and that of ECHO (2.83; 95 % CI 2.29–3.37; P = 0.02). There was no significant difference between the lnDOR of SPECT and ECHO (P = 0.52). Conclusion Our results suggest that MRI is superior for the diagnosis of obstructive CAD compared with ECHO and SPECT. ECHO and SPECT demonstrated similar diagnostic performance. Key Points • MRI can assess myocardial perfusion. • MR perfusion diagnoses coronary artery disease better than echocardiography or SPECT. • Echocardiography and SPECT have similar diagnostic performance. • MRI can save coronary artery disease patients from more invasive tests. • MRI and SPECT show evidence of publication bias, implying possible overestimation. Electronic supplementary material The online version of this article (doi:10.1007/s00330-012-2434-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marcus C de Jong
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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Abdelmoneim SS, Mulvagh SL. Perflutren lipid microsphere injectable suspension for cardiac ultrasound. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/iim.12.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sanada S, Kitakaze M, Komuro I. The Less Embraces the Greater in Detecting Multiple Coronary Artery Disease. Circ J 2012; 76:299-300. [DOI: 10.1253/circj.cj-11-1456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shoji Sanada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
- Osaka University Health Care Center
- Department of Clinical Research and Development, National Cerebral and Cardiovascular Center
| | - Masafumi Kitakaze
- Department of Clinical Research and Development, National Cerebral and Cardiovascular Center
- Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Issei Komuro
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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Mathias Jr W, Kowatsch I, Saroute AN, Osório AFF, Sbano JCN, Dourado PMM, Ramires JAF, Tsutsui JM. Dynamic Changes in Microcirculatory Blood Flow during Dobutamine Stress Assessed by Quantitative Myocardial Contrast Echocardiography. Echocardiography 2011; 28:993-1001. [DOI: 10.1111/j.1540-8175.2011.01473.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Li D, Pan D, Xia Y, Xu W, Qian W. Use of an intracoronary Doppler guidewire for evaluation of coronary hemodynamics in the porcine model of acute hibernating myocardium during dobutamine stress tests. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:329-336. [PMID: 21469150 DOI: 10.1002/jcu.20801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 01/12/2011] [Indexed: 05/30/2023]
Abstract
PURPOSE To determine the coronary hemodynamic characteristics of acute hibernating myocardium (AHM), evaluate the changes in coronary hemodynamics during dobutamine infusion, and investigate the mechanisms by which dobutamine stress echocardiography (DSE) detects AHM. METHODS The porcine model of acute hibernating myocardium was created in 10 animals, all of which underwent DSE with doses of 0-40 μg/kg/min. Myocardial segments abnormality was used as a DSE criterion for evaluating AHM. An intracoronary Doppler guidewire was used to measure the coronary hemodynamics; electrocardiography and systemic hemodynamics were recorded simultaneously. The ischemic regions of myocardium were reperfused, and all variables were recorded. Finally, the animals were euthanized and pathologic changes in the heart tissue were documented. RESULTS There was no myocardium necrosis. There were 55 myocardial segments with abnormal DSE responses after stenosis, among which 41 segments were judged as AHM because of a biphasic response. Average peak velocity (APV) and coronary flow velocity reserve were improved during DSE. Coronary and systemic hemodynamics were increased during dobutamine infusion. There were significant differences for APV at all evaluated doses and for heart rate blood pressure product at higher doses. The difference between APV resting values and the values for peak dosage (ΔAPV) correlated with the amount of AHM during DSE. Coronary volume blood flow and coronary flow velocity reserve decreased after stenosis. CONCLUSIONS ΔAPV may reflect the number of hibernating segments. The relative imbalance between blood supply and oxygen consumption in regional myocardium may be one of the mechanisms by which DSE detects AHM.
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Affiliation(s)
- Dongye Li
- Cardiovascular Disease Institute, Xuzhou Medical College, Xuzhou, China
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Prognostic value of adenosine stress cardiovascular magnetic resonance and dobutamine stress echocardiography in patients with low-risk chest pain. Int J Cardiovasc Imaging 2011; 28:803-12. [PMID: 21562726 DOI: 10.1007/s10554-011-9885-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 05/03/2011] [Indexed: 01/03/2023]
Abstract
Excluding obstructive coronary artery disease (CAD) as the etiology of acute chest pain in patients without diagnostic electrocardiographic changes or elevated serum cardiac biomarkers is challenging. Stress testing is a valuable risk-stratifying technique reserved for the subset of these patients with low-risk chest pain who have an intermediate clinical probability of obstructive CAD. Given the risks of radiation inherent to nuclear and computed tomography imaging, both adenosine stress cardiovascular magnetic resonance (AS-CMR) imaging and dobutamine stress echocardiography (DSE) are attractive alternative stress modalities. An essential characteristic of stress modalities is their negative prognostic value; as one must exclude clinically-relevant CAD such that patients can be discharged safely. Therefore, the aim of this study was to validate a favorable negative prognostic value for both AS-CMR and DSE in patients presenting with low-risk acute chest pain. This retrospective study included 255 patients with low-risk acute chest pain and no prior history of CAD presenting to the emergency department at our institution, with 89 patients evaluated by AS-CMR and 166 by DSE. Median follow-up was 292 days, and consisted of medical record review. The primary end-point was the composite of cardiac death, nonfatal acute myocardial infarction, obstructive CAD on invasive coronary angiography (ICA) or recurrent chest pain requiring hospital admission. Test characteristics such as sensitivity and specificity could not be evaluated as patients were not routinely evaluated with ICA. All patients completed the stress protocol without adverse events during testing. 82/89 patients (92.1%) and 164/166 patients (98.8%) had negative AS-CMR and DSE studies, respectively. Both AS-CMR and DSE had excellent negative prognostic values for the primary endpoint, 100 and 99%, respectively. Both AS-CMR and DSE are effective stress modalities for excluding clinically significant coronary artery disease in patients presenting acute low-risk chest pain. Patients without findings to suggest ischemia have an excellent intermediate-term prognosis.
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Fernandes DRA, Tsutsui JM, Bocchi EA, César LAM, Sbano JCN, Ramires JAF, Mathias Jr W. Qualitative and Quantitative Real Time Myocardial Contrast Echocardiography for Detecting Hibernating Myocardium. Echocardiography 2011; 28:342-9. [DOI: 10.1111/j.1540-8175.2010.01317.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Gaibazzi N, Rigo F, Reverberi C. Detection of Coronary Artery Disease by Combined Assessment of Wall Motion, Myocardial Perfusion and Coronary Flow Reserve: A Multiparametric Contrast Stress-Echocardiography Study. J Am Soc Echocardiogr 2010; 23:1242-50. [DOI: 10.1016/j.echo.2010.09.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Indexed: 11/16/2022]
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Anantharam B, Janardhanan R, Hayat S, Hickman M, Chahal N, Bassett P, Senior R. Coronary flow reserve assessed by myocardial contrast echocardiography predicts mortality in patients with heart failure. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 12:69-75. [DOI: 10.1093/ejechocard/jeq109] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Galiuto L, Gabrielli FA, Lanza GA, Porfidia A, Paraggio L, Barchetta S, Locorotondo G, De Caterina AR, Rebuzzi AG, Crea F. Influence of left ventricular hypertrophy on microvascular dysfunction and left ventricular remodelling after acute myocardial infarction. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 11:677-82. [DOI: 10.1093/ejechocard/jeq041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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