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Pompei G, Ganzorig N, Kotanidis CP, Alkhalil M, Collet C, Sinha A, Perera D, Beltrame J, Kunadian V. Novel diagnostic approaches and management of coronary microvascular dysfunction. Am J Prev Cardiol 2024; 19:100712. [PMID: 39161975 PMCID: PMC11332818 DOI: 10.1016/j.ajpc.2024.100712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 07/04/2024] [Accepted: 07/21/2024] [Indexed: 08/21/2024] Open
Abstract
The mechanism underlying ischaemic heart disease (IHD) has been primarily attributed to obstructive coronary artery disease (CAD). However, non-obstructive coronary arteries are identified in >50% of patients undergoing elective coronary angiography, recently leading to growing interest in the investigation and management of angina/ischaemia with non-obstructive coronary arteries (ANOCA/INOCA). INOCA is an umbrella term encompassing a multiple spectrum of possible pathogenetic entities, including coronary vasomotor disorders which consist of two major endotypes: coronary microvascular dysfunction (CMD) and vasospastic angina. Both conditions can coexist and be associated with concomitant obstructive CAD. Particularly, CMD refers to myocardial ischaemia due to reduced vasodilatory capacity of coronary microcirculation secondary to structural remodelling or impaired resting microvascular tone (functional) or a combination of both. CMD is not a benign condition and is more prevalent in women presenting with chronic coronary syndrome compared to men. In this setting, an impaired coronary flow reserve has been associated with increased risk of major adverse cardiovascular events. ANOCA/INOCA patients also experience impaired quality of life and associated increased healthcare costs. Therefore, research in this scenario has led to better definition, classification, and prognostic stratification based on the underlying pathophysiological mechanisms. The development and validation of non-invasive imaging modalities, invasive coronary vasomotor function testing and angiography-derived indices provide a comprehensive characterisation of CMD. The present narrative review aims to summarise current data relating to the diagnostic approach to CMD and provides details on the sequence that therapeutic management should follow.
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Affiliation(s)
- Graziella Pompei
- Translational and Clinical Research Institute, Faculty of Medical Sciences, NewcastleUniversity, Newcastle upon Tyne, UK
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, FE, Italy
| | - Nandine Ganzorig
- Translational and Clinical Research Institute, Faculty of Medical Sciences, NewcastleUniversity, Newcastle upon Tyne, UK
| | - Christos P. Kotanidis
- Translational and Clinical Research Institute, Faculty of Medical Sciences, NewcastleUniversity, Newcastle upon Tyne, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Mohammad Alkhalil
- Translational and Clinical Research Institute, Faculty of Medical Sciences, NewcastleUniversity, Newcastle upon Tyne, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Aish Sinha
- School of Cardiovascular Medicine and Sciences, British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King's College London, London, UK
| | - Divaka Perera
- School of Cardiovascular Medicine and Sciences, British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King's College London, London, UK
| | - John Beltrame
- Basil Hetzel Institute for Translational Health Research, Adelaide Medical School, University of Adelaide and Royal Adelaide Hospital & The Queen Elizabeth Hospital, Adelaide, Australia
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, NewcastleUniversity, Newcastle upon Tyne, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
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Ciaramella L, Di Serafino L, Mitrano L, De Rosa ML, Carbone C, Rea FS, Monaco S, Scalamogna M, Cirillo P, Esposito G. Invasive Assessment of Coronary Microcirculation: A State-of-the-Art Review. Diagnostics (Basel) 2023; 14:86. [PMID: 38201395 PMCID: PMC10795746 DOI: 10.3390/diagnostics14010086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/28/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
A significant proportion of patients presenting with signs and symptoms of myocardial ischemia have no "significant" epicardial disease; thereby, the assessment of coronary microcirculation gained an important role in improving diagnosis and guiding therapy. In fact, coronary microvascular dysfunction (CMD) could be found in a large proportion of these patients, supporting both symptoms and signs of myocardial ischemia. However, CMD represents a diagnostic challenge for two main reasons: (1) the small dimension of the coronary microvasculature prevents direct angiographic visualization, and (2) despite the availability of specific diagnostic tools, they remain invasive and underused in the current clinical practice. For these reasons, CMD remains underdiagnosed, and most of the patients remain with no specific treatment and quality-of-life-limiting symptoms. Of note, recent evidence suggests that a "full physiology" approach for the assessment of the whole coronary vasculature may offer a significant benefit in terms of symptom improvement among patients presenting with ischemia and non-obstructive coronary artery disease. We analyze the pathophysiology of coronary microvascular dysfunction, providing the readers with a guide for the invasive assessment of coronary microcirculation, together with the available evidence supporting its use in clinical practice.
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Affiliation(s)
| | - Luigi Di Serafino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy; (L.C.); (L.M.); (M.L.D.R.); (C.C.); (F.S.R.); (S.M.); (M.S.); (P.C.); (G.E.)
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de Oliveira Laterza Ribeiro M, Correia VM, Herling de Oliveira LL, Soares PR, Scudeler TL. Evolving Diagnostic and Management Advances in Coronary Heart Disease. Life (Basel) 2023; 13:951. [PMID: 37109480 PMCID: PMC10143565 DOI: 10.3390/life13040951] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
Despite considerable improvement in diagnostic modalities and therapeutic options over the last few decades, the global burden of ischemic heart disease is steadily rising, remaining a major cause of death worldwide. Thus, new strategies are needed to lessen cardiovascular events. Researchers in different areas such as biotechnology and tissue engineering have developed novel therapeutic strategies such as stem cells, nanotechnology, and robotic surgery, among others (3D printing and drugs). In addition, advances in bioengineering have led to the emergence of new diagnostic and prognostic techniques, such as quantitative flow ratio (QFR), and biomarkers for atherosclerosis. In this review, we explore novel diagnostic invasive and noninvasive modalities that allow a more detailed characterization of coronary disease. We delve into new technological revascularization procedures and pharmacological agents that target several residual cardiovascular risks, including inflammatory, thrombotic, and metabolic pathways.
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Affiliation(s)
| | | | | | | | - Thiago Luis Scudeler
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
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Fawaz S, Khan S, Simpson R, Clesham G, Cook CM, Davies JR, Karamasis GV, Keeble TR. Invasive Detection of Coronary Microvascular Dysfunction: How It Began, and Where We Are Now. Interv Cardiol 2023; 18:e07. [PMID: 37601734 PMCID: PMC10433108 DOI: 10.15420/icr.2022.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/02/2022] [Indexed: 03/17/2023] Open
Abstract
The landscape of interventional cardiology is ever evolving. Contemporary practice has shifted from a stenosis-centred approach to the total characterisation of both the epicardial and microcirculatory vessels. Microcirculatory dysfunction plays an important role in the pathophysiology of acute and chronic coronary syndromes, and characterisation of the microcirculation has important clinical consequences. Accordingly, the invasive diagnosis of microcirculatory dysfunction is becoming a key feature of the interventional cardiologist's toolkit. This review focuses on the methodology underpinning the invasive diagnosis of microvascular dysfunction and highlights the indices that have arisen from these methodologies.
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Affiliation(s)
- Samer Fawaz
- Research Department, Roding Ward, Essex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust Basildon, UK
- Department of Circulatory Health Research, Anglia Ruskin University Chelmsford, UK
| | - Sarosh Khan
- Research Department, Roding Ward, Essex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust Basildon, UK
- Department of Circulatory Health Research, Anglia Ruskin University Chelmsford, UK
| | - Rupert Simpson
- Research Department, Roding Ward, Essex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust Basildon, UK
- Department of Circulatory Health Research, Anglia Ruskin University Chelmsford, UK
| | - Gerald Clesham
- Research Department, Roding Ward, Essex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust Basildon, UK
- Department of Circulatory Health Research, Anglia Ruskin University Chelmsford, UK
| | - Christopher M Cook
- Research Department, Roding Ward, Essex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust Basildon, UK
- Department of Circulatory Health Research, Anglia Ruskin University Chelmsford, UK
| | - John R Davies
- Research Department, Roding Ward, Essex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust Basildon, UK
- Department of Circulatory Health Research, Anglia Ruskin University Chelmsford, UK
| | - Grigoris V Karamasis
- Department of Circulatory Health Research, Anglia Ruskin University Chelmsford, UK
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School Athens, Greece
| | - Thomas R Keeble
- Research Department, Roding Ward, Essex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust Basildon, UK
- Department of Circulatory Health Research, Anglia Ruskin University Chelmsford, UK
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Travieso A, Jeronimo-Baza A, Faria D, Shabbir A, Mejia-Rentería H, Escaned J. Invasive evaluation of coronary microvascular dysfunction. J Nucl Cardiol 2022; 29:2474-2486. [PMID: 35618991 PMCID: PMC9553758 DOI: 10.1007/s12350-022-02997-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/10/2022] [Indexed: 12/02/2022]
Abstract
Coronary microvascular dysfunction (CMD) is a prevalent cause of ischemic heart disease and is associated with poorer quality of life and worse patient outcomes. Both functional and structural abnormalities of the microcirculation can generate ischemia in the absence of epicardial stenosis or worsen concomitant obstructive coronary artery disease (CAD). The invasive assessment of CMD allows for the evaluation of the entirety of the coronary vascular tree, from the large epicardial vessels to the microcirculation, and enables the study of vasomotor function through vasoreactivity testing. The standard evaluation of CMD includes vasomotor assessment with acetylcholine, as well as flow- and resistance-derived indices calculated with either thermodilution or Doppler guidewires. Tailored treatment based upon the information gathered from the invasive evaluation of CMD has been demonstrated to reduce the burden of angina; therefore, a thorough understanding of these procedures is warranted with the aim of improving the quality of life of the patient. This review summarizes the most widespread approaches for the invasive evaluation of CMD, with a focus on patients with ischemia and non-obstructive CAD.
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Affiliation(s)
- Alejandro Travieso
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, c/ Profesor Martin Lagos, s/n, 28040, Madrid, Spain
| | - Adrian Jeronimo-Baza
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, c/ Profesor Martin Lagos, s/n, 28040, Madrid, Spain
| | - Daniel Faria
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, c/ Profesor Martin Lagos, s/n, 28040, Madrid, Spain
| | - Asad Shabbir
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, c/ Profesor Martin Lagos, s/n, 28040, Madrid, Spain
| | - Hernan Mejia-Rentería
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, c/ Profesor Martin Lagos, s/n, 28040, Madrid, Spain
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, c/ Profesor Martin Lagos, s/n, 28040, Madrid, Spain.
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Sabe SA, Feng J, Sellke FW, Abid MR. Mechanisms and clinical implications of endothelium-dependent vasomotor dysfunction in coronary microvasculature. Am J Physiol Heart Circ Physiol 2022; 322:H819-H841. [PMID: 35333122 PMCID: PMC9018047 DOI: 10.1152/ajpheart.00603.2021] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 12/16/2022]
Abstract
Coronary microvascular disease (CMD), which affects the arterioles and capillary endothelium that regulate myocardial perfusion, is an increasingly recognized source of morbidity and mortality, particularly in the setting of metabolic syndrome. The coronary endothelium plays a pivotal role in maintaining homeostasis, though factors such as diabetes, hypertension, hyperlipidemia, and obesity can contribute to endothelial injury and consequently arteriolar vasomotor dysfunction. These disturbances in the coronary microvasculature clinically manifest as diminished coronary flow reserve, which is a known independent risk factor for cardiac death, even in the absence of macrovascular atherosclerotic disease. Therefore, a growing body of literature has examined the molecular mechanisms by which coronary microvascular injury occurs at the level of the endothelium and the consequences on arteriolar vasomotor responses. This review will begin with an overview of normal coronary microvascular physiology, modalities of measuring coronary microvascular function, and clinical implications of CMD. These introductory topics will be followed by a discussion of recent advances in the understanding of the mechanisms by which inflammation, oxidative stress, insulin resistance, hyperlipidemia, hypertension, shear stress, endothelial cell senescence, and tissue ischemia dysregulate coronary endothelial homeostasis and arteriolar vasomotor function.
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Affiliation(s)
- Sharif A Sabe
- Cardiovascular Research Center, Rhode Island Hospital, Providence, Rhode Island
- Division of Cardiothoracic Surgery, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island
| | - Jun Feng
- Cardiovascular Research Center, Rhode Island Hospital, Providence, Rhode Island
- Division of Cardiothoracic Surgery, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island
| | - Frank W Sellke
- Cardiovascular Research Center, Rhode Island Hospital, Providence, Rhode Island
- Division of Cardiothoracic Surgery, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island
| | - M Ruhul Abid
- Cardiovascular Research Center, Rhode Island Hospital, Providence, Rhode Island
- Division of Cardiothoracic Surgery, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island
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Mangiacapra F, Viscusi MM, Verolino G, Paolucci L, Nusca A, Melfi R, Ussia GP, Grigioni F. Invasive Assessment of Coronary Microvascular Function. J Clin Med 2021; 11:jcm11010228. [PMID: 35011968 PMCID: PMC8745537 DOI: 10.3390/jcm11010228] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 01/01/2023] Open
Abstract
The critical role of the coronary microvascular compartment and its invasive functional assessment has become apparent in light of the significant proportion of patients presenting signs and symptoms of myocardial ischemia, despite the absence of epicardial disease, or after the adequate treatment of it. However, coronary microvascular dysfunction (CMD) represents a diagnostic challenge because of the small dimensions of the coronary microvasculature, which prevents direct angiographic visualization. Several diagnostic tools are now available for the invasive assessment of the coronary microvascular function, which, in association with the physiological indices used to investigate the epicardial department, may provide a comprehensive evaluation of the coronary circulation as a whole. Recent evidence suggests that the physiology-guided management of CMD, although apparently costly and time-consuming, may offer a net clinical benefit in terms of symptom improvement among patients with angina and ischemic heart disease. However, despite the results of several observational studies, the prognostic effect of the physiology-driven management of CMD within this population is currently a matter of debate, and therefore represents an unmet clinical need that urgently deserves further investigation.
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Li Y, Tao T, Song D, He T, Liu X. Effects of Xuefu Zhuyu Granules on Patients with Stable Coronary Heart Disease: A Double-Blind, Randomized, and Placebo-Controlled Study. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:8877296. [PMID: 34326921 PMCID: PMC8302386 DOI: 10.1155/2021/8877296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/26/2020] [Accepted: 05/20/2021] [Indexed: 11/23/2022]
Abstract
Despite advances in the drug treatment strategy for stable coronary heart disease (CHD), the mortality of CHD continues to rise. New or adjuvant treatments would be desirable for CHD. Xuefu Zhuyu granules are derived from the formula of traditional Chinese medicine. To determine whether Xuefu Zhuyu granules might have adjuvant effects on stable CHD, we conducted a controlled clinical trial. Patients with stable CHD were enrolled and randomly assigned to receive Xuefu Zhuyu granules or placebo for 12 weeks in addition to their standard medications for the treatment of CHD. The primary endpoints comprise the Canadian Cardiovascular Society Angina Grading Scale (CCS class), echocardiographic measures, Seattle Angina Questionnaire (SAQ), and coronary artery CT. The secondary endpoints included the parameters of nailfold capillary measurement and cutaneous blood perfusion (CBP). After 12 weeks of follow-up, there was a great improvement of the Canadian Cardiovascular Society Angina Grading Scale (CCS class) in the Xuefu Zhuyu group compared with the placebo group (p < 0.01). Also, a decrease was found in the percentage of patients with CCS class II in the Xuefu Zhuyu group between follow-up at 12 weeks and baseline (p < 0.01). We observed a significant increase in SAQ scores of physical limitation (p < 0.01) and treatment satisfaction (p < 0.05) in patients receiving Xuefu Zhuyu treatment at 12 weeks in comparison with those at baseline, but not in placebo treatment (p > 0.05). Amelioration in coronary artery stenosis in the Xuefu Zhuyu group was noted (p < 0.05). Xuefu Zhuyu granule treatment led to great improvements in cutaneous blood perfusion at follow-up of 12 weeks compared with placebo (p < 0.05). These findings suggest that on a background of standard medications, Xuefu Zhuyu granules have the ability to further improve the prognosis of patients with stable CHD.
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Affiliation(s)
- Yuzhen Li
- Department of Pathophysiology, Graduate School, PLA General Hospital, 100853 Beijing, China
| | - Tianqi Tao
- Department of Pathophysiology, Graduate School, PLA General Hospital, 100853 Beijing, China
| | - Dandan Song
- Department of Pathophysiology, Graduate School, PLA General Hospital, 100853 Beijing, China
| | - Tao He
- Department of Pathophysiology, Graduate School, PLA General Hospital, 100853 Beijing, China
| | - Xiuhua Liu
- Department of Pathophysiology, Graduate School, PLA General Hospital, 100853 Beijing, China
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Liu H, Ou S, Liu P, Xu Y, Gong Y, Xia L, Leng X, Leung TWH, Shi L, Zheng D. Effect of microcirculatory resistance on coronary blood flow and instantaneous wave-free ratio: A computational study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 196:105632. [PMID: 32615491 DOI: 10.1016/j.cmpb.2020.105632] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/21/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE The instantaneous wave-free ratio (iFR) has been proposed to estimate the hemodynamic severity of atherosclerotic stenosis in coronary arteries. The atherosclerotic stenosis in a proximal coronary artery could change its distal microcirculatory resistance (MR). However, there is a lack of investigation about the effect of MR variation on the blood flow and iFR of stenotic coronary arteries. We aim to investigate the changes of blood flow and iFR caused by distal MR variation. METHODS Four three-dimensional models of coronary arteries were reconstructed from the computed tomography images of two normal cases and two cases with 74.9% and 96.4% (in area) stenoses in a large branch of left anterior descending artery (LAD). Computational fluid dynamics simulation was performed on each model under 6 MR situations: hyperemia as the reference situation, resting when MR was multiplied by 8/3 in all outlet branches, h-one-1.5 and h-one-2 when MR was multiplied by 1.5 and 2.0 in one branch (the stenotic, or the corresponding branch in normal case) of LAD, h-branches-1.5 and h-branches-2 when MR was multiplied by 1.5 and 2.0 in the stenotic/corresponding and its cognate branches. Flow rate and iFR of each outlet branch were then calculated and compared between different MR situations to investigate the effect of MR variation on flow rate and iFR. RESULTS In the 74.9% stenosed and normal cases, referring to the hyperemia situation, the increase of MR in any branch significantly decreased its flow rate and increased its iFR, with limited effect on the flow rate (<3%) and iFR (<0.01) of other branches. However, in the 96.4% stenosed case, the doubled MR in the stenosed branch (h-one-2) significantly increased the flow rate (>10%) and iFR (>0.05) of its cognate branches. CONCLUSION The increase of MR in a normal or mildly stenosed branch of coronary artery decreases its blood flow and increases its iFR, with limited effect on other branches. Whereas, the increase of MR in a severely stenotic large branch could significantly increase the flow velocity and iFR of its cognate branches.
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Affiliation(s)
- Haipeng Liu
- Research Centre for Intelligent Healthcare, Faculty of Health and Life Sciences, Coventry University, Coventry CV1 5FB, UK
| | - Shanxing Ou
- Department of Radiology, General Hospital of Southern Theater Command, PLA, Guangzhou, China
| | - Panli Liu
- Department of Radiology, Guangzhou First People's Hospital, Nansha Hospital, Guangzhou, China
| | - Yuhang Xu
- Research Centre for Intelligent Healthcare, Faculty of Health and Life Sciences, Coventry University, Coventry CV1 5FB, UK
| | - Yinglan Gong
- Department of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Ling Xia
- Department of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Xinyi Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Thomas Wai Hong Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Lin Shi
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
| | - Dingchang Zheng
- Research Centre for Intelligent Healthcare, Faculty of Health and Life Sciences, Coventry University, Coventry CV1 5FB, UK.
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Jo YS, Moon H, Park K. Different Microcirculation Response Between Culprit and Non-Culprit Vessels in Patients With Acute Coronary Syndrome. J Am Heart Assoc 2020; 9:e015507. [PMID: 32410526 PMCID: PMC7660838 DOI: 10.1161/jaha.119.015507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background This study investigated whether the microvascular dysfunction differed between culprit and non‐culprit vessels in patients with acute coronary syndrome who underwent percutaneous coronary intervention. Methods and Results In 115 prospectively recruited patients, after successful percutaneous coronary intervention, culprit and non‐culprit intracoronary hemodynamic measurements were performed and repeated at 6‐month follow‐up. 13N‐ammonia positron emission tomography was performed at 6‐month follow‐up visit to determine absolute myocardial blood flow. The resistance values of each vessel were calculated using the coronary pressure data and the myocardial blood flow values obtained from 13N‐ammonia positron emission tomography data. We compared the measurements between culprit and non‐culprit vessels and assessed changes in microvascular dysfunction during the study period. In 334 vessels (115 culprit and 219 non‐culprit), the culprit vessel group showed a lower fractional flow reserve and coronary flow reserve than the non‐culprit vessel group at baseline and 6‐month follow‐up, respectively. The value of index of microcirculatory resistance was different between the 2 groups in the baseline but not at 6‐month follow‐up. The microvascular resistance at rest and hyperemic microvascular resistance were not different between the 2 groups, but resistance to stenosis was higher in the culprit vessel group, under both resting and hyperemic status (P=0.02 and P<0.01, respectively). In the culprit vessel analysis, the fractional flow reserve and index of microcirculatory resistance decreased whereas coronary flow reserve increased (P<0.01 for all) at 6‐month follow‐up. However, there was no change in index of microcirculatory resistance, coronary flow reserve, and fractional flow reserve from baseline to 6‐month follow‐up in the non‐culprit vessel analysis. Conclusions The observed microvascular dysfunction in acute coronary syndrome is limited to the culprit vessel territory in the acute phase, which is relatively recovered in the chronic phase and there is no out‐of‐culprit territory involvement. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04169516.
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Affiliation(s)
- Yoon-Sung Jo
- Regional Cardiocerebrovascular Center Dong-A University Hospital Busan South Korea.,Division of Cardiology Department of Internal Medicine Dong-A University College of Medicine Busan South Korea
| | - Hyeyeon Moon
- Regional Cardiocerebrovascular Center Dong-A University Hospital Busan South Korea.,Division of Cardiology Department of Internal Medicine Dong-A University College of Medicine Busan South Korea
| | - Kyungil Park
- Regional Cardiocerebrovascular Center Dong-A University Hospital Busan South Korea.,Division of Cardiology Department of Internal Medicine Dong-A University College of Medicine Busan South Korea
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Hirahatake KM, Bruno RS, Bolling BW, Blesso C, Alexander LM, Adams SH. Dairy Foods and Dairy Fats: New Perspectives on Pathways Implicated in Cardiometabolic Health. Adv Nutr 2020; 11:266-279. [PMID: 31555799 PMCID: PMC7442361 DOI: 10.1093/advances/nmz105] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/19/2019] [Accepted: 09/03/2019] [Indexed: 12/13/2022] Open
Abstract
Low-fat and nonfat dairy products have been promoted as part of a healthy dietary pattern by both US dietary guidelines and professional organizations for several decades. The basis for this recommendation stems in part from the putative negative cardiometabolic effects associated with saturated fat consumption. However, as nutrition research has shifted from a single nutrient to a whole-food/dietary pattern approach, the role of dairy foods and dairy fat in the diet-disease relationship is being reexamined. Most observational and experimental evidence does not support a detrimental relationship between full-fat dairy intake and cardiometabolic health, including risks of cardiovascular disease and type 2 diabetes. Indeed, an expanded understanding of the dairy food matrix and the bioactive properties of dairy fats and other constituents suggests a neutral or potentially beneficial role in cardiometabolic health. To consider how consuming dairy foods, including full-fat dairy, is associated with cardiometabolic health, this review provides an innovative perspective on mechanisms that link dairy consumption to 3 main biological systems at the core of metabolic health, the gastrointestinal, hepatic, and vascular systems.
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Affiliation(s)
- Kristin M Hirahatake
- Department of Epidemiology, College of Health Sciences, University of California, Irvine, CA, USA
| | - Richard S Bruno
- Human Nutrition Program, Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH, USA
| | - Bradley W Bolling
- Department of Food Science, University of Wisconsin-Madison, Madison, WI, USA
| | - Christopher Blesso
- Department of Nutritional Sciences, College of Agriculture, Health and Natural Resources, University of Connecticut, Storrs, CT, USA
| | - Lacy M Alexander
- Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, State College, PA, USA
| | - Sean H Adams
- Arkansas Children's Nutrition Center, Little Rock, AR, USA,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA,Address correspondence to SHA (e-mail: )
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de Waard GA, Hollander MR, Ruiter D, Ten Bokkel Huinink T, Meer R, van der Hoeven NW, Meinster E, Beliën JAM, Niessen HW, van Royen N. Downstream Influence of Coronary Stenoses on Microcirculatory Remodeling: A Histopathology Study. Arterioscler Thromb Vasc Biol 2019; 40:230-238. [PMID: 31665906 DOI: 10.1161/atvbaha.119.313462] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Inducible myocardial ischemia is influenced by contributions of both the epicardial artery and the coronary microcirculation. Experimental studies have found adverse microcirculatory remodeling to occur downstream of severe coronary stenoses. Coronary physiology studies in patients contradict the experimental findings, as the minimal microvascular resistance is not modified by stenoses. The objective was to determine whether microcirculatory remodeling occurs downstream of coronary stenoses in the human coronary circulation. Approach and Results: Myocardium corresponding to 115 coronary arteries of 55 deceased patients was investigated. Histopathologic staining of the microcirculation was performed using antibodies against SMA-α (smooth muscle actin-α) and CD31, to stain arterioles and capillaries, respectively. The following parameters were analyzed: ratio between lumen and vesel area, ratio between lumen and vessel diameter (both ratios for arterioles of <40, 40-100, and 100-200 µm diameter), arteriolar density, and capillary density. From the 55 patients, 32 pairs of an unobstructed coronary artery and a coronary artery with a stenosis were formed. No statistically significant differences between any of the microcirculatory parameters were found. A confirmatory unpaired analysis compared 3 groups: (1) coronary arteries in patients without coronary artery disease (n=53), (2) unobstructed coronary arteries in patients with a stenosis in one of the other coronary arteries (n=23), and (3) coronary stenoses (n=39). No statistically significant differences were observed between the groups. CONCLUSIONS The microcirculation distal to noncritical stenoses does not undergo structural remodeling in the human coronary circulation.
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Affiliation(s)
- Guus A de Waard
- From the Department of Cardiology (G.A.d.W., M.R.H., D.R., T.t.B.H., R.M., N.W.v.d.H., N.v.R.), VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, The Netherlands (G.A.d.W., M.R.H., N.W.v.d.H., H.W.N.)
| | - Maurits R Hollander
- From the Department of Cardiology (G.A.d.W., M.R.H., D.R., T.t.B.H., R.M., N.W.v.d.H., N.v.R.), VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, The Netherlands (G.A.d.W., M.R.H., N.W.v.d.H., H.W.N.)
| | - Danique Ruiter
- From the Department of Cardiology (G.A.d.W., M.R.H., D.R., T.t.B.H., R.M., N.W.v.d.H., N.v.R.), VU University Medical Center, Amsterdam, The Netherlands
| | - Thomas Ten Bokkel Huinink
- From the Department of Cardiology (G.A.d.W., M.R.H., D.R., T.t.B.H., R.M., N.W.v.d.H., N.v.R.), VU University Medical Center, Amsterdam, The Netherlands
| | - Romain Meer
- From the Department of Cardiology (G.A.d.W., M.R.H., D.R., T.t.B.H., R.M., N.W.v.d.H., N.v.R.), VU University Medical Center, Amsterdam, The Netherlands
| | - Nina W van der Hoeven
- From the Department of Cardiology (G.A.d.W., M.R.H., D.R., T.t.B.H., R.M., N.W.v.d.H., N.v.R.), VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, The Netherlands (G.A.d.W., M.R.H., N.W.v.d.H., H.W.N.)
| | - Elisa Meinster
- Department of Pathology and Cardiac Surgery (E.M., J.A.M.B., H.W.N.), VU University Medical Center, Amsterdam, The Netherlands
| | - Jeroen A M Beliën
- Department of Pathology and Cardiac Surgery (E.M., J.A.M.B., H.W.N.), VU University Medical Center, Amsterdam, The Netherlands
| | - Hans W Niessen
- Department of Pathology and Cardiac Surgery (E.M., J.A.M.B., H.W.N.), VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, The Netherlands (G.A.d.W., M.R.H., N.W.v.d.H., H.W.N.)
| | - Niels van Royen
- From the Department of Cardiology (G.A.d.W., M.R.H., D.R., T.t.B.H., R.M., N.W.v.d.H., N.v.R.), VU University Medical Center, Amsterdam, The Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.)
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13
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Xu J, Lo S, Juergens CP, Leung DY. Assessing Coronary Microvascular Dysfunction in Ischaemic Heart Disease: Little Things Can Make a Big Difference. Heart Lung Circ 2019; 29:118-127. [PMID: 31255478 DOI: 10.1016/j.hlc.2019.05.187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 04/10/2019] [Accepted: 05/29/2019] [Indexed: 01/01/2023]
Abstract
The role of coronary microvascular dysfunction (CMD) in the pathogenesis of ischaemic heart disease and in determining long-term prognosis is increasingly recognised. In selected patients, a comprehensive coronary assessment including an assessment of microvascular function may help refine risk stratification and improve patient outcomes. Various non-invasive and invasive techniques have been developed to assess the coronary microcirculation. Many of these tests utilise the indicator-dilution principle to determine coronary or myocardial blood flow. However, these techniques are often limited by their variability and lack of specificity for the coronary microvasculature. Consequently, there is still paucity of data on targeted therapies for CMD and their implications on long-term clinical outcomes, particularly in the setting of non-ST elevation acute coronary syndromes. Recent technical advancements, such as the index of microcirculatory resistance, have largely overcome these limitations and are able to provide novel insights into the assessment and treatment of CMD. This review summarises the currently available techniques for the assessment of CMD and provides an overview of its clinical implications.
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Affiliation(s)
- James Xu
- Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of NSW, Sydney, NSW, Australia.
| | - Sidney Lo
- Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of NSW, Sydney, NSW, Australia
| | - Craig P Juergens
- Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of NSW, Sydney, NSW, Australia
| | - Dominic Y Leung
- Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of NSW, Sydney, NSW, Australia
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14
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van der Hoeven NW, de Waard GA, Quirós A, De Hoyos A, Broyd CJ, Nijjer SS, van de Hoef TP, Petraco R, Driessen RS, Mejía-Rentería H, Kikuta Y, Echavarría Pinto M, van de Ven PM, Meuwissen M, Knaapen P, Piek JJ, Davies JE, van Royen N, Escaned J. Comprehensive physiological evaluation of epicardial and microvascular coronary domains using vascular conductance and zero flow pressure. EUROINTERVENTION 2019; 14:e1593-e1600. [PMID: 29688179 DOI: 10.4244/eij-d-18-00021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Assessment of the coronary circulation has been based largely on pressure ratios (epicardial) and resistance (micro-vessels). Simultaneous assessment of epicardial (CEPI) and microvascular conductance (CMICRO) provides an intuitive approach using the same units for both coronary domains and expressing the actual deliverability of blood. The aim of this study was to develop a novel integral method for assessing the functional severity of epicardial and microvascular disease. METHODS AND RESULTS We performed intracoronary pressure and Doppler flow velocity measurements in 403 vessels in 261 patients with stable coronary artery disease. Hyperaemic mid-to-late diastolic pressure and flow velocity (PV) relationships were calculated. The slope of the aortic PV indicates the overall conductance and the slope of the distal PV relationship represents CMICRO. The intercept with the x-axis represents zero-flow pressure (Pzf). CEPI was derived from microvascular and overall conductance. Median CEPI was higher compared to CMICRO (4.2 [2.1-8.0] versus 1.3 [1.0-1.7] cm/s/mmHg, p<0.001). CMICRO was independent of stenosis severity (1.3 [1.0-1.7] in FFR ≤0.80 versus 1.4 [1.0-1.8] in FFR >0.8, p=0.797). ROC curves (using FFR and HSR concordant vessels as standard) demonstrated an excellent ability of CEPI to characterise significant stenoses (AUC 0.93). When CEPI<CMICRO, a decrease in flow velocity and coronary pressure (optimal cut-off value 0.97, AUC 0.90) was demonstrated. CONCLUSIONS A comprehensive assessment of separate CEPI and CMICRO was feasible. CEPI has a remarkable diagnostic efficiency to detect a clinically relevant stenosis. When CEPI<CMICRO, distal flow and pressure decrease steeply, indicating myocardial ischaemia. CMICRO can be used to explore the severity of microvascular disease.
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15
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Liu H, Leung TWH, Shi L. Microvascular resistance and collateral circulation in simulating the stenotic coronary arteries. J Appl Physiol (1985) 2018; 125:1352. [PMID: 30354945 DOI: 10.1152/japplphysiol.00283.2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Haipeng Liu
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.,Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Thomas Wai Hong Leung
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Lin Shi
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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16
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Øhrn AM, Schirmer H, von Hanno T, Mathiesen EB, Arntzen KA, Bertelsen G, Njølstad I, Løchen ML, Wilsgaard T, Bairey Merz CN, Lindekleiv H. Small and large vessel disease in persons with unrecognized compared to recognized myocardial infarction: The Tromsø Study 2007-2008. Int J Cardiol 2018; 253:14-19. [PMID: 29306455 DOI: 10.1016/j.ijcard.2017.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Unrecognized myocardial infarction (MI) is a frequent condition with unknown underlying reason. We hypothesized the lack of recognition of MI is related to pathophysiology, specifically differences in underlying small and large vessel disease. METHODS 6128 participants were examined with retinal photography, ultrasound of the carotid artery and a 12‑lead electrocardiography (ECG). Small vessel disease was defined as narrower retinal arterioles and/or wider retinal venules measured on retinal photographs. Large vessel disease was defined as carotid artery pathology. We defined unrecognized MI as ECG-evidence of MI without a clinically recognized event. We analyzed the cross-sectional relationship between MI recognition and markers of small and large vessel disease, adjusted for age and sex. RESULTS Unrecognized MI was present in 502 (8.2%) and recognized MI in 326 (5.3%) of the 6128 participants. Compared to recognized MI, unrecognized MI was associated with small vessel disease indicated by narrower retinal arterioles (OR 1.66, 95% CI 1.05-2.62, highest vs. lowest quartile). Unrecognized MI was less associated with wider retinal venules (OR 0.55, 95% CI 0.35-0.87, lowest vs. highest quartile). Compared to recognized MI, unrecognized MI was less associated with large vessel disease indicated by presence of plaque in the carotid artery (OR for presence of carotid artery plaque in unrecognized MI 0.51, 95% CI 0.37-0.69). No significant sex interaction was present. CONCLUSIONS Unrecognized MI was more associated with small vessel disease and less associated with large vessel disease compared to recognized MI. These findings suggest that the pathophysiology behind unrecognized and recognized MI may differ.
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Affiliation(s)
- Andrea Milde Øhrn
- Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway.
| | - Henrik Schirmer
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Therese von Hanno
- Brain and Circulation Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Ophthalmology, Nordland Hospital, Bodø, Norway
| | - Ellisiv B Mathiesen
- Brain and Circulation Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Kjell Arne Arntzen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Geir Bertelsen
- Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Ophthalmology, University Hospital of North Norway, Tromsø, Norway
| | - Inger Njølstad
- Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - C Noel Bairey Merz
- NBM Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Haakon Lindekleiv
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
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17
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Williams RP, Asrress KN, Lumley M, Arri S, Patterson T, Ellis H, Manou‐Stathopoulou V, Macfarlane C, Chandran S, Moschonas K, Oakeshott P, Lockie T, Chiribiri A, Clapp B, Perera D, Plein S, Marber MS, Redwood SR. Deleterious Effects of Cold Air Inhalation on Coronary Physiological Indices in Patients With Obstructive Coronary Artery Disease. J Am Heart Assoc 2018; 7:e008837. [PMID: 30762468 PMCID: PMC6064824 DOI: 10.1161/jaha.118.008837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 04/11/2018] [Indexed: 01/09/2023]
Abstract
Background Cold air inhalation during exercise increases cardiac mortality, but the pathophysiology is unclear. During cold and exercise, dual-sensor intracoronary wires measured coronary microvascular resistance ( MVR ) and blood flow velocity ( CBF ), and cardiac magnetic resonance measured subendocardial perfusion. Methods and Results Forty-two patients (62±9 years) undergoing cardiac catheterization, 32 with obstructive coronary stenoses and 10 without, performed either (1) 5 minutes of cold air inhalation (5°F) or (2) two 5-minute supine-cycling periods: 1 at room temperature and 1 during cold air inhalation (5°F) (randomized order). We compared rest and peak stress MVR , CBF , and subendocardial perfusion measurements. In patients with unobstructed coronary arteries (n=10), cold air inhalation at rest decreased MVR by 6% ( P=0.41), increasing CBF by 20% ( P<0.01). However, in patients with obstructive stenoses (n=10), cold air inhalation at rest increased MVR by 17% ( P<0.01), reducing CBF by 3% ( P=0.85). Consequently, in patients with obstructive stenoses undergoing the cardiac magnetic resonance protocol (n=10), cold air inhalation reduced subendocardial perfusion ( P<0.05). Only patients with obstructive stenoses performed this protocol (n=12). Cycling at room temperature decreased MVR by 29% ( P<0.001) and increased CBF by 61% ( P<0.001). However, cold air inhalation during cycling blunted these adaptations in MVR ( P=0.12) and CBF ( P<0.05), an effect attributable to defective early diastolic CBF acceleration ( P<0.05) and associated with greater ST -segment depression ( P<0.05). Conclusions In patients with obstructive coronary stenoses, cold air inhalation causes deleterious changes in MVR and CBF . These diminish or abolish the normal adaptations during exertion that ordinarily match myocardial blood supply to demand.
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Affiliation(s)
- Rupert P. Williams
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Kaleab N. Asrress
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Matthew Lumley
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Satpal Arri
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Tiffany Patterson
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Howard Ellis
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | | | - Catherine Macfarlane
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Shruthi Chandran
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Kostantinos Moschonas
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Pippa Oakeshott
- Population Health Research InstituteSt George's University of LondonUnited Kingdom
| | - Timothy Lockie
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Amedeo Chiribiri
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Brian Clapp
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Divaka Perera
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Sven Plein
- Leeds UniversityLeeds Teaching Hospitals NHS TrustLeedsUnited Kingdom
| | - Michael S. Marber
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
| | - Simon R. Redwood
- Cardiovascular DivisionRayne InstituteSt Thomas’ HospitalKing's College LondonLondonUnited Kingdom
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18
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de Waard GA, Cook CM, van Royen N, Davies JE. Coronary autoregulation and assessment of stenosis severity without pharmacological vasodilation. Eur Heart J 2017; 39:4062-4071. [DOI: 10.1093/eurheartj/ehx669] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/20/2017] [Indexed: 01/10/2023] Open
Affiliation(s)
- Guus A de Waard
- Department of Cardiology, VU University Medical Center, de Boelelaan 1117, HV Amsterdam, The Netherlands
- National Heart and Lung Institute - Cardiovascular Science, Imperial College London, The Hammersmith Hospital, Du Cane Road, London, UK
| | - Christopher M Cook
- National Heart and Lung Institute - Cardiovascular Science, Imperial College London, The Hammersmith Hospital, Du Cane Road, London, UK
| | - Niels van Royen
- Department of Cardiology, VU University Medical Center, de Boelelaan 1117, HV Amsterdam, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, GA, Nijmegen, The Netherlands
| | - Justin E Davies
- National Heart and Lung Institute - Cardiovascular Science, Imperial College London, The Hammersmith Hospital, Du Cane Road, London, UK
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19
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de Waard GA, Fahrni G, de Wit D, Kitabata H, Williams R, Patel N, Teunissen PF, van de Ven PM, Umman S, Knaapen P, Perera D, Akasaka T, Sezer M, Kharbanda RK, van Royen N. Hyperaemic microvascular resistance predicts clinical outcome and microvascular injury after myocardial infarction. Heart 2017; 104:127-134. [PMID: 28663361 DOI: 10.1136/heartjnl-2017-311431] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Early detection of microvascular dysfunction after acute myocardial infarction (AMI) could identify patients at high risk of adverse clinical outcome, who may benefit from adjunctive treatment. Our objective was to compare invasively measured coronary flow reserve (CFR) and hyperaemic microvascular resistance (HMR) for their predictive power of long-term clinical outcome and cardiac magnetic resonance (CMR)-defined microvascular injury (MVI). METHODS Simultaneous intracoronary Doppler flow velocity and pressure measurements acquired immediately after revascularisation for AMI from five centres were pooled. Clinical follow-up was completed for 176 patients (mean age 60±10 years; 140(80%) male; ST-elevation myocardial infarction (STEMI) 130(74%) and non-ST-segment elevation myocardial infarction 46(26%)) with median follow-up time of 3.2 years. In 110 patients with STEMI, additional CMR was performed. RESULTS The composite end point of death and hospitalisation for heart failure occurred in 17 patients (10%). Optimal cut-off values to predict the composite end point were 1.5 for CFR and 3.0 mm Hg cm-1•s for HMR. CFR <1.5 was predictive for the composite end point (HR 3.5;95% CI 1.1 to 10.8), but not for its individual components. HMR ≥3.0 mm Hg cm-1 s was predictive for the composite end point (HR 7.0;95% CI 1.5 to 33.7) as well as both individual components. HMR had significantly greater area under the receiver operating characteristic curve for MVI than CFR. HMR remained an independent predictor of adverse clinical outcome and MVI, whereas CFR did not. CONCLUSIONS HMR measured immediately following percutaneous coronary intervention for AMI with a cut-off value of 3.0 mm Hg cm-1 s, identifies patients with MVI who are at high risk of adverse clinical outcome. For this purpose, HMR is superior to CFR.
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Affiliation(s)
- Guus A de Waard
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Gregor Fahrni
- Oxford Heart Centre, Oxford University Hospitals, Oxford, UK
| | - Douwe de Wit
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Hironori Kitabata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Rupert Williams
- Cardiovascular Division, British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King's College London, London, UK
| | - Niket Patel
- Oxford Heart Centre, Oxford University Hospitals, Oxford, UK
| | - Paul F Teunissen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Sabahattin Umman
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Divaka Perera
- Cardiovascular Division, British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King's College London, London, UK
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Murat Sezer
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Niels van Royen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
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