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Alemany I, Rose JN, Ferreira PF, Pennell DJ, Nielles‐Vallespin S, Scott AD, Doorly DJ. Realistic numerical simulations of diffusion tensor cardiovascular magnetic resonance: The effects of perfusion and membrane permeability. Magn Reson Med 2023; 90:1641-1656. [PMID: 37415339 PMCID: PMC10952789 DOI: 10.1002/mrm.29737] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/19/2023] [Accepted: 05/16/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE To study the sensitivity of diffusion tensor cardiovascular magnetic resonance (DT-CMR) to microvascular perfusion and changes in cell permeability. METHODS Monte Carlo (MC) random walk simulations in the myocardium have been performed to simulate self-diffusion of water molecules in histology-based media with varying extracellular volume fraction (ECV) and permeable membranes. The effect of microvascular perfusion on simulations of the DT-CMR signal has been incorporated by adding the contribution of particles traveling through an anisotropic capillary network to the diffusion signal. The simulations have been performed considering three pulse sequences with clinical gradient strengths: monopolar stimulated echo acquisition mode (STEAM), monopolar pulsed-gradient spin echo (PGSE), and second-order motion-compensated spin echo (MCSE). RESULTS Reducing ECV intensifies the diffusion restriction and incorporating membrane permeability reduces the anisotropy of the diffusion tensor. Widening the intercapillary velocity distribution results in increased measured diffusion along the cardiomyocytes long axis when the capillary networks are anisotropic. Perfusion amplifies the mean diffusivity for STEAM while the opposite is observed for short diffusion encoding time sequences (PGSE and MCSE). CONCLUSION The effect of perfusion on the measured diffusion tensor is reduced using an increased reference b-value. Our results pave the way for characterization of the response of DT-CMR to microstructural changes underlying cardiac pathology and highlight the higher sensitivity of STEAM to permeability and microvascular circulation due to its longer diffusion encoding time.
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Affiliation(s)
- Ignasi Alemany
- Department of AeronauticsImperial College LondonLondonUK
- Cardiovascular Magnetic Resonance Unit, Royal Brompton HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Jan N. Rose
- Department of AeronauticsImperial College LondonLondonUK
| | - Pedro F. Ferreira
- Cardiovascular Magnetic Resonance Unit, Royal Brompton HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Dudley J. Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Sonia Nielles‐Vallespin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Andrew D. Scott
- Cardiovascular Magnetic Resonance Unit, Royal Brompton HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
- National Heart and Lung InstituteImperial College LondonLondonUK
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Mathew RC, Bourque JM, Salerno M, Kramer CM. Cardiovascular Imaging Techniques to Assess Microvascular Dysfunction. JACC Cardiovasc Imaging 2020; 13:1577-1590. [PMID: 31607665 PMCID: PMC7148179 DOI: 10.1016/j.jcmg.2019.09.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 08/02/2019] [Accepted: 09/03/2019] [Indexed: 02/08/2023]
Abstract
The understanding of microvascular dysfunction without evidence of epicardial coronary artery disease pales in comparison with that of obstructive epicardial coronary artery disease. A primary limitation in the past had been the lack of development of noninvasive methods of detecting and quantifying microvascular dysfunction. This limitation has particularly affected the ability to study the pathophysiology, morbidity, and treatment of this disease. More recently, almost all of the noninvasive cardiac imaging modalities have been used to quantify blood flow and advance understanding of microvascular dysfunction.
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Affiliation(s)
- Roshin C Mathew
- Department of Medicine (Cardiology), University of Virginia Health System, Charlottesville, Virginia
| | - Jamieson M Bourque
- Department of Medicine (Cardiology), University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
| | - Michael Salerno
- Department of Medicine (Cardiology), University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia; Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia
| | - Christopher M Kramer
- Department of Medicine (Cardiology), University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia.
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3
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Spinner GR, Stoeck CT, Mathez L, von Deuster C, Federau C, Kozerke S. On probing intravoxel incoherent motion in the heart‐spin‐echo versus stimulated‐echo DWI. Magn Reson Med 2019; 82:1150-1163. [DOI: 10.1002/mrm.27777] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 03/06/2019] [Accepted: 03/27/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Georg R. Spinner
- Institute for Biomedical Engineering University and ETH Zurich Zurich Switzerland
| | - Christian T. Stoeck
- Institute for Biomedical Engineering University and ETH Zurich Zurich Switzerland
| | - Linda Mathez
- Institute for Biomedical Engineering University and ETH Zurich Zurich Switzerland
| | | | - Christian Federau
- Institute for Biomedical Engineering University and ETH Zurich Zurich Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering University and ETH Zurich Zurich Switzerland
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4
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Coronary Microcirculatory Dysfunction in Human Cardiomyopathies: A Pathologic and Pathophysiologic Review. Cardiol Rev 2018; 25:165-178. [PMID: 28574936 DOI: 10.1097/crd.0000000000000140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cardiomyopathies are a heterogeneous group of diseases of the myocardium. The term cardiomyopathy involves a wide range of pathogenic mechanisms that affect the structural and functional states of cardiomyocytes, extravascular tissues, and coronary vasculature, including both epicardial coronary arteries and the microcirculation. In the developed phase, cardiomyopathies present with various clinical symptoms: dyspnea, chest pain, palpitations, swelling of the extremities, arrhythmias, and sudden cardiac death. Due to the heterogeneity of cardiomyopathic patterns and symptoms, their diagnosis and therapies are great challenges. Despite extensive research, the relation between the structural and functional abnormalities of the myocardium and the coronary circulation are still not well understood in the various forms of cardiomyopathy. The main pathological characteristics of cardiomyopathies and the coronary microcirculation develop in a progressive manner due to (1) genetic-immunologic-systemic factors; (2) comorbidities with endothelial, myogenic, metabolic, and inflammatory changes; (3) aging-induced arteriosclerosis; and (4) myocardial fibrosis. The aim of this review is to summarize the most important common pathological features and/or adaptations of the coronary microcirculation in various types of cardiomyopathies and to integrate the present understanding of the underlying pathophysiological mechanisms responsible for the development of various types of cardiomyopathies. Although microvascular dysfunction is present and contributes to cardiac dysfunction and the potential outcome of disease, the current therapeutic approaches are not specific for the given types of cardiomyopathy.
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5
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Feher A, Sinusas AJ. Quantitative Assessment of Coronary Microvascular Function: Dynamic Single-Photon Emission Computed Tomography, Positron Emission Tomography, Ultrasound, Computed Tomography, and Magnetic Resonance Imaging. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006427. [PMID: 28794138 DOI: 10.1161/circimaging.117.006427] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/26/2017] [Indexed: 01/09/2023]
Abstract
A healthy, functional microcirculation in combination with nonobstructed epicardial coronary arteries is the prerequisite of normal myocardial perfusion. Quantitative assessment in myocardial perfusion and determination of absolute myocardial blood flow can be achieved noninvasively using dynamic imaging with multiple imaging modalities. Extensive evidence supports the clinical value of noninvasively assessing indices of coronary flow for diagnosing coronary microvascular dysfunction; in certain diseases, the degree of coronary microvascular impairment carries important prognostic relevance. Although, currently positron emission tomography is the most commonly used tool for the quantification of myocardial blood flow, other modalities, including single-photon emission computed tomography, computed tomography, magnetic resonance imaging, and myocardial contrast echocardiography, have emerged as techniques with great promise for determination of coronary microvascular dysfunction. The following review will describe basic concepts of coronary and microvascular physiology, review available modalities for dynamic imaging for quantitative assessment of coronary perfusion and myocardial blood flow, and discuss their application in distinct forms of coronary microvascular dysfunction.
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Affiliation(s)
- Attila Feher
- From the Section of Cardiovascular Medicine, Department of Internal Medicine (A.F., A.J.S.) and Department of Radiology and Biomedical Imaging (A.J.S.), Yale University School of Medicine, New Haven, CT
| | - Albert J Sinusas
- From the Section of Cardiovascular Medicine, Department of Internal Medicine (A.F., A.J.S.) and Department of Radiology and Biomedical Imaging (A.J.S.), Yale University School of Medicine, New Haven, CT.
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6
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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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7
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Jonker SS, Davis L, Soman D, Belcik JT, Davidson BP, Atkinson TM, Wilburn A, Louey S, Giraud GD, Lindner JR. Functional adaptations of the coronary microcirculation to anaemia in fetal sheep. J Physiol 2016; 594:6165-6174. [PMID: 27291778 DOI: 10.1113/jp272696] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/02/2016] [Indexed: 01/17/2023] Open
Abstract
KEY POINTS In fetuses, chronic anaemia stimulates cardiac growth; simultaneously, blood flow to the heart muscle itself is increased, and reserve blood flow capacity of the coronary vascular bed is preserved. Here we examined functional adaptations of the capillaries and small blood vessels responsible for delivering oxygen to the anaemic fetal heart muscle using contrast-enhanced echocardiography. We demonstrate that coronary microvascular flux rate doubled in anaemic fetuses compared to control fetuses, both at rest and during maximal flow, suggesting reduced microvascular resistance consistent with capillary widening. Cardiac fractional microvascular blood volume was not greater in anaemic fetuses, suggesting that growth of new microvascular vessels does not contribute to the increased flow per volume of myocardium. These unusual changes in microvascular function during anaemia may indicate novel adaptive strategies in the fetal heart. ABSTRACT Fetal anaemia causes cardiac adaptations that have immediate and life-long repercussions on heart function and health. It is known that resting and maximal coronary conductance both increase during chronic fetal anaemia, but the coronary microvascular changes responsible for the adaptive response are unknown. Until recently, technical limitations have prevented quantifying functional capillary-level adaptations in the in vivo fetal heart. Our objective was to characterise functional microvascular adaptations in chronically anaemic fetal sheep. Chronically instrumented fetuses were randomized to a control group (n = 11) or were made anaemic by isovolumetric haemorrhage (n = 12) for 1 week prior to myocardial contrast echocardiography at 85% of gestation. Anaemia augmented cardiac mass by 23% without changing body weight. In anaemic fetuses, microvascular blood flow per volume of myocardium was twice that of control fetuses at rest, during vasodilatory hyperaemia, and during hyperaemia plus increased aortic pressure. The elevated blood flow was attributable almost entirely to an increase in microvascular blood flux rate whereas microvascular blood volumes were not different between groups at baseline, during hyperaemia, or with hyperaemia plus increased aortic pressure. Increased coronary microvascular flux rate in response to chronic fetal anaemia is consistent with expected reductions in capillary resistance from capillary diameter widening detected in earlier histological studies.
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Affiliation(s)
- Sonnet S Jonker
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA. .,Center for Developmental Health, Oregon Health & Science University, Portland, OR, USA.
| | - Lowell Davis
- Center for Developmental Health, Oregon Health & Science University, Portland, OR, USA.,Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Divya Soman
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA.,Center for Developmental Health, Oregon Health & Science University, Portland, OR, USA
| | - J Todd Belcik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Brian P Davidson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA.,VA Portland Health Care System, Portland, OR, USA
| | - Tamara M Atkinson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Adrienne Wilburn
- Center for Developmental Health, Oregon Health & Science University, Portland, OR, USA
| | - Samantha Louey
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA.,Center for Developmental Health, Oregon Health & Science University, Portland, OR, USA
| | - George D Giraud
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA.,Center for Developmental Health, Oregon Health & Science University, Portland, OR, USA.,VA Portland Health Care System, Portland, OR, USA
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
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8
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de Marchi SF. Determinants of human coronary collaterals. Curr Cardiol Rev 2015; 10:24-8. [PMID: 23638830 PMCID: PMC3968591 DOI: 10.2174/1573403x1001140317114411] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 02/28/2013] [Accepted: 04/19/2013] [Indexed: 01/09/2023] Open
Abstract
The human coronary collateral circulation is prognostically relevant. The understanding of collateral formation and its determinants may guide future therapeutic strategies aiming at promoting collateral growth and functionality, and hence reducing the global burden of coronary artery disease (CAD).
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9
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Affiliation(s)
- Nina Mann
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Harvard/MIT Health Sciences and Technology Program, Boston, MA
| | - Anthony Rosenzweig
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Lario FC, Miname MH, Tsutsui JM, Santos RD, Kowatsch I, Sbano JC, Ramires JA, Filho RK, Mathias W. Atorvastatin Treatment Improves Myocardial and Peripheral Blood Flow in Familial Hypercholesterolemia Subjects without Evidence of Coronary Atherosclerosis. Echocardiography 2012; 30:64-71. [DOI: 10.1111/j.1540-8175.2012.01810.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Fabio C. Lario
- Echocardiography Laboratory; Heart Institute (InCor)-University of São Paulo Medical School; São Paulo; Brazil
| | - Marcio H. Miname
- Dislipidemia Department; Heart Institute (InCor)-University of São Paulo Medical School; São Paulo; Brazil
| | - Jeane M. Tsutsui
- Fleury Group; Echocardiography Laboratory; Heart Institute (InCor)-University of São Paulo Medical School; São Paulo; Brazil
| | - Raul D. Santos
- Dislipidemia Department; Heart Institute (InCor)-University of São Paulo Medical School; São Paulo; Brazil
| | - Ingrid Kowatsch
- Echocardiography Laboratory; Heart Institute (InCor)-University of São Paulo Medical School; São Paulo; Brazil
| | - João C.N. Sbano
- Echocardiography Laboratory; Heart Institute (InCor)-University of São Paulo Medical School; São Paulo; Brazil
| | - Jose A.F. Ramires
- Dislipidemia Department; Heart Institute (InCor)-University of São Paulo Medical School; São Paulo; Brazil
| | - Roberto Kalil Filho
- Echocardiography Laboratory; Heart Institute (InCor)-University of São Paulo Medical School; São Paulo; Brazil
| | - Wilson Mathias
- Echocardiography Laboratory; Heart Institute (InCor)-University of São Paulo Medical School; São Paulo; Brazil
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11
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Rutz T, de Marchi SF, Schwerzmann M. Myocardial perfusion measurement by contrast echocardiography in congenital heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2012. [DOI: 10.1016/j.ppedcard.2012.05.012] [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: 10/28/2022]
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Abstract
Hypertrophic cardiomyopathy is a fascinating disease of marked heterogeneity. Hypertrophic cardiomyopathy was originally characterized by massive myocardial hypertrophy in the absence of known etiology, a dynamic left ventricular outflow obstruction, and increased risk of sudden death. It is now well accepted that multiple mutations in genes encoding for the cardiac sarcomere are responsible for the disease. Complex morphologic and pathophysiologic differences, disparate natural history studies, and novel treatment strategies underscore the challenge to the practicing cardiologist when faced with the management of the hypertrophic cardiomyopathy patient.
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13
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Abdelmoneim SS, Basu A, Bernier M, Dhoble A, Abdel-Kader SS, Pellikka PA, Mulvagh SL. Detection of myocardial microvascular disease using contrast echocardiography during adenosine stress in type 2 diabetes mellitus: prospective comparison with single-photon emission computed tomography. Diab Vasc Dis Res 2011; 8:254-61. [PMID: 21933841 DOI: 10.1177/1479164111419973] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate myocardial microvascular disease in patients with type 2 diabetes mellitus (DM) using myocardial contrast echocardiography (MCE) and to report on its diagnostic accuracy using single photon emission tomography (SPECT) as reference test. METHODS We prospectively enrolled 79 patients (25 DM; 66 ±11 years) who underwent simultaneous SPECT and MCE with contrast agent during adenosine stress. MCE and SPECT were visually analyzed using 17 segments. Quantitative MCE parameters were derived from replenishment curves. Microbubble velocity (β min(-1)), absolute myocardial blood flow (MBF ml/min/g), and reserve values were calculated. Diagnostic accuracy and area under curve (AUC) was reported. RESULTS Patients with DM had higher BMI vs non DM (33±7 vs 28±5kg/m(2) P=0 .007), with more prior myocardial infarction (40 vs 15% P=.01). Visual MCE was abnormal in 40 (51%) patients (60% in DM vs 46% in non DM P=0.04). SPECT was abnormal in 38 (48%) patients [60% in DM vs 42% non DM, P=0.01]. Reserve parameters were lower in DM vs. non DM patients: (β 1.77±1.12 vs 2.20±1.4, P<0.001 and MBF 2.86± 2.62 vs. 3.67±2.84, P<0.001). DM patients without CAD on SPECT had significantly lower β, and MBF reserve compared to non DM patients without CAD. Compared to SPECT, β reserve cutoff 1.6 had AUC 0.817, sensitivity 81%, and specificity 66% while MBF reserve cutoff 1.9 had AUC 0.760, sensitivity 79%, and specificity 63% in DM patients. CONCLUSION Diabetes is associated with myocardial microvascular abnormalities as evidenced by abnormal myocardial perfusion on visual and quantitative MCE.
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Affiliation(s)
- Sahar S Abdelmoneim
- Mayo Clinic, Division of Cardiovascular Diseases and Internal Medicine, MN 55905, USA
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14
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Nagueh SF, Bierig SM, Budoff MJ, Desai M, Dilsizian V, Eidem B, Goldstein SA, Hung J, Maron MS, Ommen SR, Woo A. American Society of Echocardiography Clinical Recommendations for Multimodality Cardiovascular Imaging of Patients with Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2011; 24:473-98. [PMID: 21514501 DOI: 10.1016/j.echo.2011.03.006] [Citation(s) in RCA: 266] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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15
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Indermühle A, Vogel R, Meier P, Zbinden R, Seiler C. Myocardial blood volume and coronary resistance during and after coronary angioplasty. Am J Physiol Heart Circ Physiol 2011; 300:H1119-24. [DOI: 10.1152/ajpheart.01022.2010] [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] [Indexed: 11/22/2022]
Abstract
Animal experiments have shown that the coronary circulation is pressure distensible, i.e., myocardial blood volume (MBV) increases with perfusion pressure. In humans, however, corresponding measurements are lacking so far. We sought to quantify parameters reflecting coronary distensibility such as MBV and coronary resistance (CR) during and after coronary angioplasty. Thirty patients with stable coronary artery disease underwent simultaneous coronary perfusion pressure assessment and myocardial contrast echocardiography (MCE) of 37 coronary arteries and their territories during and after angioplasty. MCE yielded MBV and myocardial blood flow (MBF; in ml·min−1·g−1). Complete data sets were obtained in 32 coronary arteries and their territories from 26 patients. During angioplasty, perfusion pressure, i.e., coronary occlusive pressure, and MBV varied between 9 and 57 mmHg (26.9 ± 11.9 mmHg) and between 1.2 and 14.5 ml/100 g (6.7 ± 3.7 ml/100 g), respectively. After successful angioplasty, perfusion pressure and MBV increased significantly ( P < 0.001 for both) and varied between 64 and 118 mmHg (93.5 ± 12.8 mmHg) and between 3.7 and 17.3 ml/100 g (9.8 ± 3.4 ml/100 g), respectively. Mean MBF increased from 31 ± 20 ml·min−1·g−1 during coronary occlusion, reflecting collateral flow, to 121 ± 33 ml·min−1·g−1 ( P < 0.01), whereas mean CR, i.e., the ratio of perfusion pressure and MBF, decreased by 20% ( P < 0.001). In conclusion, the human coronary circulation is pressure distensible. MCE allows for the quantification of CR and MBV in humans.
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Affiliation(s)
- Andreas Indermühle
- Department of Cardiology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Rolf Vogel
- Department of Cardiology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Pascal Meier
- Department of Cardiology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Rainer Zbinden
- Department of Cardiology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Christian Seiler
- Department of Cardiology, Bern University Hospital and University of Bern, Bern, Switzerland
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16
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de Marchi SF, Gloekler S, Meier P, Traupe T, Steck H, Cook S, Vogel R, Seiler C. Determinants of Preformed Collateral Vessels in the Human Heart without Coronary Artery Disease. Cardiology 2011; 118:198-206. [DOI: 10.1159/000328648] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 03/16/2011] [Indexed: 11/19/2022]
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Chelliah RK, Senior R. Pathological and physiological left ventricular hypertrophy: echocardiography for differentiation. Future Cardiol 2010; 5:495-502. [PMID: 19715413 DOI: 10.2217/fca.09.34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Distinguishing physiological left ventricular hypertrophy of an athlete's heart from that of pathological left ventricular (hypertrophic cardiomyopathy) can be difficult despite the advent of new imaging techniques. Nevertheless, the final diagnosis is of utmost importance as it will have a profound impact on an individual's life. A diagnosis of hypertrophic cardiomyopathy essentially excludes an individual from sport and strenuous exertion and necessitates the need for further tests and treatment, as well as the screening of family members. Hypertrophic cardiomyopathy remains the most common cause of a pathologically hypertrophied heart in young athletes, with a prevalence of one in 500. The issue of sudden death in athletes due to pathological left ventricular hypertrophy and hypertrophic cardiomyopathy has recently gained recognition owing to the death of several word class athletes during sporting participation. What compounds this further is the fact that a proportion of athletes fall into the 'grey zone' (ventricular wall thickness of 13-16 mm) where the increase in cardiac size overlaps with the phenotypic variation of hypertrophic cardiomyopathy - making echocardiographic differentiation of the two entities challenging. This review discusses the echocardiographic differentiation of the athlete's heart, including physiological left ventricular hypertrophy from pathological left ventricular hypertrophy. Although several of the cardiomyopathies cause pathological left ventricular hypertrophy, focus will be given to hypertrophic cardiomyopathy, for reasons mentioned above. Discussion will also focus on the newer and emerging echocardiographic techniques for this purpose. The term 'hypertrophic cardiomyopathy' is used to describe the nonobstuctive form of hypertrophic cardiomyopathy as this review article focuses on distinguishing the 'mild' form of hypertrophic cardiomyopathy from an athlete's heart. When the more severe obstructive form is being described, the term 'hypertrophic obstructive cardiomyopathy' is used.
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Affiliation(s)
- Rajesh K Chelliah
- Department of Cardiac Research, Northwick Park Hospital, Middlesex, Harrow, London HA1 3UJ, UK
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Franjic B, Marwick TH. The diabetic, hypertensive heart: epidemiology and mechanisms of a very high-risk situation. J Hum Hypertens 2009; 23:709-17. [DOI: 10.1038/jhh.2009.43] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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19
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Komatsu H, Yamada S, Iwano H, Okada M, Onozuka H, Mikami T, Yokoyama S, Inoue M, Kaga S, Nishida M, Shimizu C, Matsuno K, Tsutsui H. Angiotensin II Receptor Blocker, Valsartan, Increases Myocardial Blood Volume and Regresses Hypertrophy in Hypertensive Patients. Circ J 2009; 73:2098-103. [DOI: 10.1253/circj.cj-09-0324] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroshi Komatsu
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Satoshi Yamada
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Hiroyuki Iwano
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Masako Okada
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | | | | | - Shinobu Yokoyama
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital
| | - Mamiko Inoue
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital
| | - Sanae Kaga
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital
| | - Mutsumi Nishida
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital
| | - Chikara Shimizu
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital
| | - Kazuhiko Matsuno
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
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Soliman OII, Knaapen P, Geleijnse ML, Dijkmans PA, Anwar AM, Nemes A, Michels M, Vletter WB, Lammertsma AA, ten Cate FJ. Assessment of intravascular and extravascular mechanisms of myocardial perfusion abnormalities in obstructive hypertrophic cardiomyopathy by myocardial contrast echocardiography. Heart 2007; 93:1204-12. [PMID: 17488767 PMCID: PMC2000941 DOI: 10.1136/hrt.2006.110460] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To assess mechanisms of myocardial perfusion impairment in patients with hypertrophic cardiomyopathy (HCM). METHODS Fourteen patients with obstructive HCM (mean (SD) age 53 (10) years, 11 men) underwent intravenous adenosine myocardial contrast echocardiography (MCE), positron emission tomography (PET) and cardiac catheterisation. Fourteen healthy volunteers (mean age 31 (4) years, 11 men) served as controls. Relative myocardial blood volume (rBV), exchange flow velocity (beta), myocardial blood flow (MBF), MBF reserve (MFR) and endocardial-to-subepicardial (endo-to-epi) MBF ratio were measured from the steady state and contrast replenishment time-intensity curves. RESULTS Patients with HCM had lower rest MBF (for LVRPP-corrected)--mean (SD) (0.92 (0.12) vs 1.13 (0.25) ml/min/g, p<0.01)--and hyperaemic MBF--(2.56 (0.49) vs 4.34 (0.78) ml/min/g, p<0.01) than controls. Resting rBV was lower in patients with HCM (0.094 (0.016) vs 0.138 (0.014) ml/ml), and during hyperaemia (0.104 (0.018) ml/ml vs 0.185 (0.024) ml/ml) (all p<0.001) than in controls. beta tended to be higher in HCM at rest (9.4 (4.6) vs 7.7 (4.2) ml/min) and during hyperaemia (25.8 (6.4) vs 23.1 (6.2) ml/min) than in controls. Septal endo-to-epi MBF decreased during hyperaemia (0.86 (0.15) to 0.64 (0.18), p<0.01). rBV was inversely correlated with left ventricular (LV) mass index (p<0.05). Both hyperaemic and endo-to-epi MBF were inversely correlated with LV end-diastolic pressure, LV mass index, and LV outflow tract pressure gradient (all p<0.05). MCE-derived MBF correlated well with PET at rest (r = 0.84) and hyperaemia (r = 0.87) (all p<0.001). CONCLUSIONS In patients with HCM, LV end-diastolic pressure, LV outflow tract pressure gradient, and LV mass index are independent predictors of rBV and hyperaemic MBF.
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Affiliation(s)
- Osama I I Soliman
- Department of Cardiology, Thoraxcenter, Erasmus Medical Centre, Rotterdam, The Netherlands
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van der Laarse A, van der Wall EE. Myocardial contrast echocardiography: another discriminator of physiological and pathological left ventricular hypertrophy?The opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology. Eur Heart J 2006; 27:1517-8. [PMID: 16760214 DOI: 10.1093/eurheartj/ehl063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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