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Suppogu N, Tjoe B, Wei J, Maughan J, Joung S, Quesada O, Shufelt CL, Samuels B, Azarbal B, Bairey Merz CN. Case report: Repeat coronary function testing in women with ischemia and no obstructive coronary artery disease. Front Cardiovasc Med 2023; 10:1096265. [PMID: 37485267 PMCID: PMC10357037 DOI: 10.3389/fcvm.2023.1096265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
Women with signs and symptoms of ischemia and no obstructive coronary artery disease (INOCA) often have coronary microvascular dysfunction (CMD). It can be diagnosed by coronary function testing (CFT), which is an invasive coronary angiogram procedure. Frequently, these women have persistent angina despite medical therapy, but it is not clear whether it is due to worsening or persistent CMD or inadequate therapy. In this brief report, we describe findings of repeat CFT in a case series of 12 women undergoing repeat CFT for the assessment of persistent angina in order to better understand the evolving pathology.
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Affiliation(s)
- Nissi Suppogu
- Department of Cardiology, University of California, Irvine School of Medicine, Orange, CA, United States
| | - Benita Tjoe
- Department of Cardiology, University of California, Irvine School of Medicine, Orange, CA, United States
| | - Janet Wei
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Jenna Maughan
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Sandy Joung
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Odayme Quesada
- Women’s Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, OH, United States
| | - Chrisandra L. Shufelt
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Bruce Samuels
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Babak Azarbal
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - C. Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
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Bai W, Huang W, Xu R, Fu H, Zou Q, Chen L, Xu H, Wen L, Xie L, Wu J, Guo Y. Evaluation of coronary microvascular dysfunction and risk factors in children and youth with Turner syndrome by magnetic resonance myocardial perfusion imaging. Clin Endocrinol (Oxf) 2023; 98:578-586. [PMID: 36536468 DOI: 10.1111/cen.14866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/11/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Turner syndrome (TS) has an increased predisposition to ischaemic heart disease and the status of coronary microcirculation in TS is largely unknown. This study aims to evaluate myocardial microvascular function in TS using first-pass magnetic resonance perfusion imaging and determine significant risk factors contributing to microvascular dysfunction in the early stage. DESIGN Perspective cohort study. PATIENTS The study cohort consisted of 67 children and youth with TS and 32 age- and gender-matched controls. Measurements Clinical characteristics, left ventricle (LV) volume and function and cardiovascular magnetic resonance-derived myocardial perfusion parameters were assessed. Univariable and multivariable linear regression analyses were performed to assess the potential risk factors for microvascular dysfunction. RESULT Microvascular perfusion decreased in TS in global and segmented myocardium as reflected in the lower upslopecor and maximum signal intensity (MaxSI) of LV myocardium compared to controls. Multivariable linear regression analysis indicated that age (β = -0.107, 95% confidence interval [CI] = -0.201 to -0.013, p = .026) and being overweight/obese (β = -1.155, CI = -2.134 to -0.176, p = .021) were independent impact factors of microvascular dysfunction. Subgroup analysis showed the upslopecor of older patients with TS decreased more significantly compared with that of normal controls. Upslopecor and MaxSI were lower in overweight/obese patients with TS than in patients with normal body mass index (BMI) and controls. CONCLUSION Myocardial microvascular dysfunction can occur in children and youth patients with TS. Age and overweight/obesity were the independent risk factors of microvascular dysfunction, which imply the importance of lowering BMI for the prevention of coronary heart disease in young TS population.
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Affiliation(s)
- Wei Bai
- Department of Radiology, State Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei Huang
- Department of Radiology, State Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rong Xu
- Department of Radiology, State Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hang Fu
- Department of Radiology, State Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qing Zou
- Department of Radiology, Deyang People's Hospital, Deyang, Sichuan, China
| | - Lin Chen
- Department of Radiology, Su Zhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Huayan Xu
- Department of Radiology, State Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lingyi Wen
- Department of Radiology, State Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Linjun Xie
- Department of Radiology, State Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jin Wu
- Department of Pediatric Endocrinology and Metabolism, Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second Hospital of Sichuan University, Chengdu, China
| | - Yingkun Guo
- Department of Radiology, State Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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3
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Kelshiker MA, Seligman H, Howard JP, Rahman H, Foley M, Nowbar AN, Rajkumar CA, Shun-Shin MJ, Ahmad Y, Sen S, Al-Lamee R, Petraco R. Coronary flow reserve and cardiovascular outcomes: a systematic review and meta-analysis. Eur Heart J 2022; 43:1582-1593. [PMID: 34849697 PMCID: PMC9020988 DOI: 10.1093/eurheartj/ehab775] [Citation(s) in RCA: 126] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/07/2021] [Accepted: 10/26/2021] [Indexed: 01/04/2023] Open
Abstract
AIMS This meta-analysis aims to quantify the association of reduced coronary flow with all-cause mortality and major adverse cardiovascular events (MACE) across a broad range of patient groups and pathologies. METHODS AND RESULTS We systematically identified all studies between 1 January 2000 and 1 August 2020, where coronary flow was measured and clinical outcomes were reported. The endpoints were all-cause mortality and MACE. Estimates of effect were calculated from published hazard ratios (HRs) using a random-effects model. Seventy-nine studies with a total of 59 740 subjects were included. Abnormal coronary flow reserve (CFR) was associated with a higher incidence of all-cause mortality [HR: 3.78, 95% confidence interval (CI): 2.39-5.97] and a higher incidence of MACE (HR 3.42, 95% CI: 2.92-3.99). Each 0.1 unit reduction in CFR was associated with a proportional increase in mortality (per 0.1 CFR unit HR: 1.16, 95% CI: 1.04-1.29) and MACE (per 0.1 CFR unit HR: 1.08, 95% CI: 1.04-1.11). In patients with isolated coronary microvascular dysfunction, an abnormal CFR was associated with a higher incidence of mortality (HR: 5.44, 95% CI: 3.78-7.83) and MACE (HR: 3.56, 95% CI: 2.14-5.90). Abnormal CFR was also associated with a higher incidence of MACE in patients with acute coronary syndromes (HR: 3.76, 95% CI: 2.35-6.00), heart failure (HR: 6.38, 95% CI: 1.95-20.90), heart transplant (HR: 3.32, 95% CI: 2.34-4.71), and diabetes mellitus (HR: 7.47, 95% CI: 3.37-16.55). CONCLUSION Reduced coronary flow is strongly associated with increased risk of all-cause mortality and MACE across a wide range of pathological processes. This finding supports recent recommendations that coronary flow should be measured more routinely in clinical practice, to target aggressive vascular risk modification for individuals at higher risk.
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Affiliation(s)
- Mihir A Kelshiker
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, 72 Du Cane Road, London W12 0HS, UK
| | - Henry Seligman
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, 72 Du Cane Road, London W12 0HS, UK
| | - James P Howard
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, 72 Du Cane Road, London W12 0HS, UK
| | - Haseeb Rahman
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, 72 Du Cane Road, London W12 0HS, UK
| | - Michael Foley
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, 72 Du Cane Road, London W12 0HS, UK
| | - Alexandra N Nowbar
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, 72 Du Cane Road, London W12 0HS, UK
| | - Christopher A Rajkumar
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, 72 Du Cane Road, London W12 0HS, UK
| | - Matthew J Shun-Shin
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, 72 Du Cane Road, London W12 0HS, UK
| | - Yousif Ahmad
- Yale School of Medicine, Yale University, 333 Cedar St, New Haven, Connecticut 06510, USA
| | - Sayan Sen
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, 72 Du Cane Road, London W12 0HS, UK
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, 72 Du Cane Road, London W12 0HS, UK
| | - Ricardo Petraco
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, 72 Du Cane Road, London W12 0HS, UK
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Putot A, Putot S, Chagué F, Cottin Y, Zeller M, Manckoundia P. New horizons in Type 2 myocardial infarction: pathogenesis, assessment and management of an emerging geriatric disease. Age Ageing 2022; 51:6565797. [PMID: 35397160 DOI: 10.1093/ageing/afac085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Type 2 myocardial infarction (MI) is characterised by a functional imbalance between myocardial oxygen supply and demand in the absence of a thrombotic process, leading to myocardial necrosis. This type of MI was relatively unknown among clinicians until the third universal definition of MI was published in 2017, differentiating Type 2 from Type 1 MI, which follows an acute atherothrombotic event. The pathogenesis, diagnostic and therapeutic aspects of Type 2 MI are described in the present review. Type 2 MI is a condition that is strongly linked to age because of vascular ageing concerning both epicardic vessels and microcirculation, age-related atherosclerosis and stress maladaptation. This condition predominantly affects multimorbid individuals with a history of cardiovascular disease. However, the conditions that lead to the functional imbalance between oxygen supply and demand are frequently extra-cardiac (e.g. pneumonia or anaemia). The great heterogeneity of the underlying etiological factors requires a comprehensive approach that is tailored to each case. In the absence of evidence for the benefit of invasive reperfusion strategies, the treatment of Type 2 MI remains to date essentially based on the restoration of the balance between oxygen supply and demand. For older co-morbid patients with Type 2 MI, geriatricians and cardiologists need to work together to optimise etiological investigations, treatment and prevention of predisposing conditions and precipitating factors.
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Affiliation(s)
- Alain Putot
- Unité Post Urgence Gériatrique, Centre Hospitalier Universitaire Sud Réunion, 97410 Saint Pierre, France
- Laboratoire Physiopathologie et Epidémiologie Cérébro-Cardiovasculaire – EA7460, Université de Bourgogne Franche Comté, 21000 Dijon, France
| | - Sophie Putot
- Unité Post Urgence Gériatrique, Centre Hospitalier Universitaire Sud Réunion, 97410 Saint Pierre, France
| | - Frédéric Chagué
- Service de Cardiologie, Centre Hospitalier Universitaire Dijon Bourgogne, 21000 Dijon, France
| | - Yves Cottin
- Service de Cardiologie, Centre Hospitalier Universitaire Dijon Bourgogne, 21000 Dijon, France
| | - Marianne Zeller
- Laboratoire Physiopathologie et Epidémiologie Cérébro-Cardiovasculaire – EA7460, Université de Bourgogne Franche Comté, 21000 Dijon, France
| | - Patrick Manckoundia
- Service de Médecine Interne Gériatrie, Centre Hospitalier Universitaire Dijon Bourgogne, 21000 Dijon, France
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Ueki Y, Kuramitsu S, Saigusa T, Senda K, Matsuo H, Horie K, Takashima H, Terai H, Kikuta Y, Ishihara T, Sakamoto T, Suematsu N, Shiono Y, Asano T, Tsujita K, Masamura K, Doijiri T, Sasaki Y, Ogita M, Kurita T, Matsuo A, Harada K, Yaginuma K, Kanemura N, Sonoda S, Yokoi H, Tanaka N. Long-Term Outcomes in Elderly Patients After Deferral of Coronary Revascularization Guided by Fractional Flow Reserve. Circ J 2022; 86:1329-1336. [DOI: 10.1253/circj.cj-21-1024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yasushi Ueki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | | | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Keisuke Senda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Kazunori Horie
- Department of Cardiovascular Medicine, Sendai Kousei Hospital
| | | | - Hidenobu Terai
- Department of Cardiology, Kanazawa Cardiovascular Hospital
| | - Yuetsu Kikuta
- Department of Cardiology, Fukuyama Cardiovascular Hospital
| | | | - Tomohiro Sakamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | | | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Taku Asano
- Department of Cardiology, St. Luke’s International Hospital
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | | | | | | | - Manabu Ogita
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Tairo Kurita
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | - Akiko Matsuo
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital
| | - Ken Harada
- Department of Cardiology, Chubu Rosai Hospital
| | - Kenji Yaginuma
- Department of Cardiology, Juntendo University Urayasu Hospital
| | | | - Shinjo Sonoda
- Department of Cardiovascular Failure Therapy, Saga University
| | | | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
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Coronary artery spasm and impaired myocardial perfusion in patients with ANOCA: Predictors from a multimodality study using stress CMR and acetylcholine testing. Int J Cardiol 2021; 343:5-11. [PMID: 34499976 DOI: 10.1016/j.ijcard.2021.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 08/06/2021] [Accepted: 09/02/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Functional coronary disorders such as coronary spasm and microvascular dysfunction (including microvascular spasm and impaired microvascular dilatation) are frequent findings among patients with angina and non-obstructed coronary arteries (ANOCA). In this study, we investigated a potential association of coronary spasm and myocardial perfusion abnormalities as well as predictors of such functional coronary disorders in ANOCA patients using a multimodality diagnostic strategy including adenosine stress CMR and intracoronary acetylcholine testing. METHODS We enrolled 129 patients with ANOCA who underwent acetylcholine testing and adenosine stress perfusion CMR. Patients were allocated to 3 groups according to their spasm testing result with regard to standardized COVADIS criteria: 1) epicardial spasm, 2) microvascular spasm, and 3) no spasm. The myocardial perfusion reserve index (MPRI) was semiquantitatively determined from adenosine stress perfusion CMR. Multivariate regression analyses were performed to identify predictors of coronary functional disorders. RESULTS Patients with epicardial spasm had lower MPRI than patients without, whereas MPRI was preserved in patients with microvascular spasm. Multivariate analyses revealed age, previous myocardial infarction, LVEF and epicardial spasm as independent predictors of diminished MPRI, whereas previous PCI was associated with epicardial spasm, and female sex was a strong predictor of microvascular spasm. CONCLUSIONS Our results demonstrate coexistence of different functional coronary disorder endotypes involving the macro- and microvascular level of the coronary circulation in patients with ANOCA. We demonstrate that epicardial spasm is associated with diminished myocardial perfusion reserve and report further predictors of coronary functional disorders.
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7
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Stegehuis VE, Wijntjens G, Bax M, Meuwissen M, Chamuleau S, Voskuil M, Koch K, Di Mario C, Vrints C, Haude M, Boersma E, Serruys P, Piek JJ, van de Hoef T. Impact of clinical and haemodynamic factors on coronary flow reserve and invasive coronary flow capacity in non-obstructed coronary arteries: a patient-level pooled analysis of the DEBATE and ILIAS studies. EUROINTERVENTION 2021; 16:e1503-e1510. [PMID: 31951205 PMCID: PMC9724860 DOI: 10.4244/eij-d-19-00774] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Coronary flow reserve (CFR) is a physiological index for the assessment of myocardial flow impairment due to focal or microcirculatory coronary artery disease (CAD). Coronary flow capacity (CFC) is another flow-based concept in diagnosing ischaemic heart disease, based on hyperaemic average peak velocity (hAPV) and CFR. We evaluated clinical and haemodynamic factors which potentially influence CFR and CFC in non-obstructed coronary arteries. METHODS AND RESULTS Intracoronary Doppler flow velocity measurements to obtain CFR and CFC were performed after inducing hyperaemia in 390 non-obstructed vessels of patients who were scheduled for elective percutaneous coronary intervention (PCI) of another vessel. Akaike's information criterion (AIC) revealed age, female gender, history of myocardial infarction, hypercholesterolaemia, diastolic blood pressure, oral nitrates and rate pressure product as independent predictors of CFR and CFC. After regression analysis, age and female gender were associated with lower CFR and age was associated with worse CFC in angiographically non-obstructed vessels. CONCLUSIONS Age and female gender are associated with lower CFR, and age with worse CFC in an angiographically non-obstructed coronary artery. CFC seems to be less sensitive to variations in clinical and haemodynamic parameters than CFR and is therefore a promising tool in contemporary clinical decision making in the cardiac catheterisation laboratory.
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Affiliation(s)
- Valérie E. Stegehuis
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Gilbert Wijntjens
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Matthijs Bax
- Haga Teaching Hospital, The Hague, the Netherlands
| | | | - Steven Chamuleau
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | | | - Karel Koch
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | | | - Christiaan Vrints
- University of Antwerp - Antwerp University Hospital, Antwerp, Belgium
| | - Michael Haude
- Med. Klinik I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
| | - Eric Boersma
- Erasmus Medical Center, Rotterdam, the Netherlands
| | - Patrick Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland,Imperial College London, London, United Kingdom
| | - Jan J. Piek
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Tim van de Hoef
- Amsterdam UMC, Heart Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
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Impact of aging on the effects of intracoronary adenosine, peak hyperemia and its duration during fractional flow reserve assessment. Coron Artery Dis 2021; 32:625-631. [PMID: 33471468 DOI: 10.1097/mca.0000000000001019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Functional assessment of coronary stenoses is crucial for determining the correct therapeutic strategy. Age-related modifications in cardiovascular function could alter the functional significance of an intermediate coronary lesion. Therefore, the aim of the present study was to investigate the impact of age on fractional flow reserve (FFR) measurements in patients with intermediate coronary artery disease. METHODS We included patients undergoing coronary angiography at our Division of Cardiology from June 2008 to February 2019 for elective indication or recent acute coronary syndrome and receiving FFR assessment for an intermediate coronary stenosis (angiographic 40-70% stenoses). FFR measurement was performed by pressure-recording guidewire (Prime Wire; Volcano Imaging System Philips Healthcare, San Diego, California, USA), after induction of hyperemia with intracoronary boluses of adenosine (from 60 to 720 μg, with dose doubling at each step). RESULTS We included in our study 276 patients, undergoing FFR evaluation on 314 lesions, that were divided according to age (< or ≥70 years). Elderly patients displayed a higher cardiovascular risk profile and received more often specific therapy. We found significantly higher FFR values and lower Delta FFR and time to recovery in patients with age ≥70 years old even with high-dose adenosine. Elderly patients showed a trend in lower percentage of positive FFRs, especially with high-dose (P = 0.09). Overall, any FFR ≤ 0.80 was observed in 33.5% of younger patients and 21.1% of patients ≥70 years (P = 0.02). Results were confirmed after correction for baseline differences [adjusted odds ratio (95% confidence interval) = 0.60 (0.33-1.09), P = 0.08]. CONCLUSION This is one of the first studies investigating the impact of age on the measurement of FFR with high-dose adenosine. Patients with age >70 years old with intermediate CAD are more likely to have higher FFR values and lower duration of hyperemia after adenosine boluses, as compared with younger patients.
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9
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Verdoia M, Gioscia R, Nardin M, Negro F, Tonon F, Suryapranata H, Khedi E, Marcolongo M, De Luca G. Impact of Age on the Functional Evaluation of Intermediate Coronary Stenoses With Instantaneous Wave-Free Ratio and Fractional Flow Reserve. Angiology 2020; 72:62-69. [PMID: 32815383 DOI: 10.1177/0003319720947578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The optimal strategy for assessing the ischemic significance of intermediate coronary stenoses with adenosine-induced fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) is still debated. Few studies have previously assessed the impact of age on FFR and iFR, which was the aim of our study. Patients undergoing FFR and iFR evaluation for intermediate (40%-70%) coronary lesions were included and divided according to age. Fractional flow reserve was performed by intracoronary boluses of adenosine (60-1440 μg). Instantaneous wave-free ratio was automatically calculated. Among 148 patients undergoing FFR measurement of 166 lesions, 45.3% were ≥70 years. Elderly patients had higher minimal lumen diameter (P = .03). We also observed a linear relationship between iFR and FFR independently of age. Fractional flow reserve values were higher in the elderly patients, whereas iFR was not related to age. A total of 33 lesions had a positive iFR with no difference for age (17.3% vs 22%, P = .56), while FFR <0.80 was more infrequent in the elderly patients (17.1% vs 34.8%, P = .02). In intermediate coronary stenoses, iFR and FFR correlation is unaffected by age. Fractional flow reserve is higher in the elderly patients, whereas iFR is less affected by age. Future large-scale studies are needed to define whether iFR should be the preferred choice in elderly patients.
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Affiliation(s)
- Monica Verdoia
- Division of Cardiology Ospedale degli Infermi, ASL Biella, Biella, Italy.,Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
| | - Rocco Gioscia
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
| | - Matteo Nardin
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy.,Internal Medicine, 18515ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Federica Negro
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
| | - Francesco Tonon
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
| | - Harry Suryapranata
- Department of Cardiology, UMC St. 6034Radboud, Nijmegen, the Netherlands
| | - Elvin Khedi
- Department of Cardiology, ISALA Hospital, Zwolle, the Netherlands
| | - Marco Marcolongo
- Division of Cardiology Ospedale degli Infermi, ASL Biella, Biella, Italy
| | - Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
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Ramandika E, Kurisu S, Nitta K, Hidaka T, Utsunomiya H, Ishibashi K, Ikenaga H, Fukuda Y, Kihara Y, Nakano Y. Effects of aging on coronary flow reserve in patients with no evidence of myocardial perfusion abnormality. Heart Vessels 2020; 35:1633-1639. [PMID: 32524236 DOI: 10.1007/s00380-020-01643-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/05/2020] [Indexed: 11/27/2022]
Abstract
Coronary flow reserve (CFR) reflects the functional capacity of microcirculation to adapt to blood demand during increased cardiac work. We tested the hypothesis that aging had impacts on coronary flow velocities and CFR in patients with no evidence of myocardial perfusion abnormality on single photon emission computed tomography (SPECT). Seventy-six patients undergoing transthoracic Doppler echocardiography with no evidence of myocardial perfusion abnormality on SPECT were enrolled in this study. CFR was defined as the ratio of hyperemic to resting peak diastolic coronary flow velocity. Patients were divided into the three groups based on age: 17 patients aged less than 70 years (Group I), 38 patients aged 70-79 years (Group II), and 21 patients aged 80 years or more (Group III). Compared with Group I, CFR was significantly lower in Group II (p < 0.01) and Group III (p < 0.01). Multivariate linear regression analysis showed that female (β = - 0.26, p = 0.03), cigarette smoking (β = - 0.32, p = 0.004), hemoglobin level (β = - 0.40, p = 0.001) and LV mass index (β = 0.24, p = 0.03) were determinants for resting coronary flow velocity. On the other hand, age (β = -0.30, p = 0.008), hemoglobin level (β = -0.47, p < 0.001) and LV mass index (β = 0.24, p = 0.04) were determinants for hyperemic coronary flow velocity. Age was only determinant for CFR (β = -0.48, p < 0.001). Our data suggested that that aging had a decreased effect on hyperemic coronary flow velocity rather than resting coronary flow velocity, and was further associated with impaired CFR in patients with no evidence of myocardial perfusion abnormality.
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Affiliation(s)
- Erasta Ramandika
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi-cho, Minami-ku, Hiroshima, Japan
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi-cho, Minami-ku, Hiroshima, Japan.
| | - Kazuhiro Nitta
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi-cho, Minami-ku, Hiroshima, Japan
| | - Takayuki Hidaka
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi-cho, Minami-ku, Hiroshima, Japan
| | - Hiroto Utsunomiya
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi-cho, Minami-ku, Hiroshima, Japan
| | - Ken Ishibashi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi-cho, Minami-ku, Hiroshima, Japan
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi-cho, Minami-ku, Hiroshima, Japan
| | - Yukihiro Fukuda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi-cho, Minami-ku, Hiroshima, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi-cho, Minami-ku, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi-cho, Minami-ku, Hiroshima, Japan
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11
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Javed A, Yoon A, Cen S, Nayak KS, Garg P. Feasibility of coronary endothelial function assessment using arterial spin labeled CMR. NMR IN BIOMEDICINE 2020; 33:e4183. [PMID: 31799707 PMCID: PMC6980265 DOI: 10.1002/nbm.4183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 06/10/2023]
Abstract
Coronary endothelial dysfunction (CED) is an independent predictor of cardiovascular disease, but its assessment has been limited to invasive coronary angiography. Myocardial perfusion imaging using arterial spin labeled (ASL) cardiac magnetic resonance (CMR) may be an effective non-invasive alternative for detection of CED. Thirty-four patients were recruited: 10 healthy volunteers, 13 at high-risk for coronary artery disease (CAD), and 11 with established CAD. ASL-CMR was performed continuously in a single mid-short axis slice during rest, stress, and recovery. Stress was induced with sustained isometric handgrip exercise, an endothelial dependent stressor. Myocardial perfusion (MP) during rest, peak stress, and recovery were calculated and compared. After excluding subjects unable to complete the protocol or who exhibited poor data quality, 6 healthy, 10 high-risk, and 7 CAD patients were included in the analysis. Average MP (ml/g/min) was 1.31 ± 1.23, 1.61 ± 1.12, and 1.40 ± 0.97 at rest, and 1.64 ± 1.49, 2.31 ± 1.61, and 2.84 ± 1.77 during stress, for the CAD, high-risk and healthy group, respectively. The average MP response (MPstress - MPrest , ml/g/min) was 0.32 ± 1.93, 0.69 ± 1.34, and 1.44 ± 1.46 for CAD, high-risk and healthy group, respectively. MP during handgrip stress was significantly lower for both the CAD (p = 0.0005) and high-risk groups (p = 0.05) compared to the healthy volunteers. In only the healthy subjects, MP was significantly higher in stress compared to rest (p = 0.0002). Participants with CAD had significantly lower MP response compared to healthy volunteers, as detected by ASL-CMR. These findings support the feasibility of ASL-CMR for non-invasive assessment of CED.
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Affiliation(s)
- Ahsan Javed
- Ming Hsieh Department of Electrical and computer Engineering, University of Southern California, Los Angeles, California, USA
| | - Andrew Yoon
- Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Steven Cen
- Department of Neurology and Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Krishna S Nayak
- Ming Hsieh Department of Electrical and computer Engineering, University of Southern California, Los Angeles, California, USA
| | - Parveen Garg
- Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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12
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Cortigiani L, Ciampi Q, Lombardo A, Rigo F, Bovenzi F, Picano E. Age- and Gender-Specific Prognostic Cutoff Values of Coronary Flow Velocity Reserve in Vasodilator Stress Echocardiography. J Am Soc Echocardiogr 2019; 32:1307-1317. [DOI: 10.1016/j.echo.2019.05.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/18/2019] [Accepted: 05/25/2019] [Indexed: 01/09/2023]
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13
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Honda K, Yuzaki M, Kaneko M, Funahashi R, Kunimoto H, Fujimoto T, Nakanishi Y, Agematsu K, Nagashima M, Nishimura Y. Functional assessment of improvement of myocardial ischemia using coronary flow velocity reserve after coronary artery bypass surgery in hemodialysis. J Card Surg 2019; 34:663-669. [DOI: 10.1111/jocs.14098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Kentaro Honda
- Department of Thoracic and Cardiovascular SurgeryWakayama Medical University Wakayama Japan
| | - Mitsuru Yuzaki
- Department of Thoracic and Cardiovascular SurgeryWakayama Medical University Wakayama Japan
| | - Masahiro Kaneko
- Department of Thoracic and Cardiovascular SurgeryWakayama Medical University Wakayama Japan
| | - Ryosuke Funahashi
- Department of Thoracic and Cardiovascular SurgeryWakayama Medical University Wakayama Japan
| | - Hideki Kunimoto
- Department of Thoracic and Cardiovascular SurgeryWakayama Medical University Wakayama Japan
| | - Takahiro Fujimoto
- Department of Thoracic and Cardiovascular SurgeryWakayama Medical University Wakayama Japan
| | - Yasuka Nakanishi
- Department of Thoracic and Cardiovascular SurgeryWakayama Medical University Wakayama Japan
| | - Kota Agematsu
- Department of Thoracic and Cardiovascular SurgeryWakayama Medical University Wakayama Japan
| | - Mitsugi Nagashima
- Department of Thoracic and Cardiovascular SurgeryWakayama Medical University Wakayama Japan
| | - Yoshiharu Nishimura
- Department of Thoracic and Cardiovascular SurgeryWakayama Medical University Wakayama Japan
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14
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Dérimay F, Johnson NP, Zimmermann FM, Adjedj J, Witt N, Hennigan B, Koo B, Barbato E, Esposito G, Trimarco B, Rioufol G, Park S, Baptista SB, Chrysant GS, Leone AM, Jeremias A, Berry C, De Bruyne B, Oldroyd KG, Pijls NH, Fearon WF. Predictive factors of discordance between the instantaneous wave‐free ratio and fractional flow reserve. Catheter Cardiovasc Interv 2019; 94:356-363. [PMID: 30702186 DOI: 10.1002/ccd.28116] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/28/2018] [Accepted: 01/20/2019] [Indexed: 11/08/2022]
Affiliation(s)
- François Dérimay
- Department of cardiology, Stanford University School of Medicine and Stanford Cardiovascular Institute Stanford CA
- Department of Interventional CardiologyHospices Civils de Lyon and CARMEN, INSERM 1060 Lyon France
| | - Nils P. Johnson
- Weatherhead PET Center, Division of Cardiology, Department of MedicineMcGovern Medical School at UTHealth and Memorial Hermann Hospital Houston Texas
| | | | - Julien Adjedj
- Department of CardiologyCentre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - Nils Witt
- Department of Clinical Science and Education, Division of CardiologyKarolinska Institutet Stockholm Sweden
| | - Barry Hennigan
- Department of Cardiology, West of Scotland Heart and Lung CentreGolden Jubilee National Hospital Clydebank Scotland
- Department of Cardiology, British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical Sciences, University of Glasgow Glasgow Scotland
| | - Bon‐Kwon Koo
- Department of Internal MedicineSeoul National University Hospital Seoul South Korea
| | - Emanuele Barbato
- Department of Cardiology, Cardiovascular CenterOLV Clinic Aalst Belgium
- Division of Cardiology, Department of Advanced Biomedical SciencesUniversity of Naples Federico II Naples Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical SciencesUniversity of Naples Federico II Naples Italy
| | - Bruno Trimarco
- Division of Cardiology, Department of Advanced Biomedical SciencesUniversity of Naples Federico II Naples Italy
| | - Gilles Rioufol
- Department of Interventional CardiologyHospices Civils de Lyon and CARMEN, INSERM 1060 Lyon France
| | - Seung‐Jung Park
- Department of Cardiology, Asan Medical CenterHeart Institute, University of Ulsan College of Medicine Seoul South Korea
| | | | - George S. Chrysant
- Department of CardiologyINTEGRIS Baptist Medical Center Oklahoma City Oklahoma
| | | | - Allen Jeremias
- Division of Cardiovascular MedicineStony Brook University Medical Center Stony Brook New York
- Department of Interventional Cardiology, Cardiovascular Research Foundation (CRF) New York New York
| | - Colin Berry
- Department of Cardiology, West of Scotland Heart and Lung CentreGolden Jubilee National Hospital Clydebank Scotland
- Department of Cardiology, British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical Sciences, University of Glasgow Glasgow Scotland
| | - Bernard De Bruyne
- Department of Cardiology, Cardiovascular CenterOLV Clinic Aalst Belgium
| | - Keith G. Oldroyd
- Department of Cardiology, West of Scotland Heart and Lung CentreGolden Jubilee National Hospital Clydebank Scotland
| | - Nico H.J. Pijls
- Department of CardiologyCatharina Hospital Eindhoven The Netherlands
- Department of Biomedical EngineeringEindhoven University of Technology Eindhoven The Netherlands
| | - William F. Fearon
- Department of cardiology, Stanford University School of Medicine and Stanford Cardiovascular Institute Stanford CA
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15
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Honda K, Yuzaki M, Kaneko M, Nakai T, Kunimoto H, Nagashima M, Nishimura Y. Functional Evaluation of the Myocardial Ischemia After Coronary Artery Bypass Surgery Using Coronary Flow Velocity Reserve in Left Ventricular Hypertrophy. Semin Thorac Cardiovasc Surg 2019; 31:166-173. [DOI: 10.1053/j.semtcvs.2018.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 09/21/2018] [Indexed: 12/31/2022]
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16
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Aburadani I, Usuda K, Sumiya H, Sakagami S, Kiyokawa H, Matsuo S, Takamura M, Murai H, Takashima S, Kitano T, Okuda K, Nakajima K. Ability of the prognostic model of J-ACCESS study to predict cardiac events in a clinical setting: The APPROACH study. J Cardiol 2018; 72:81-86. [PMID: 29317133 DOI: 10.1016/j.jjcc.2017.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/26/2017] [Accepted: 12/04/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND In patients with coronary artery disease (CAD), one of the risk models available in Japan was a multivariate risk prediction model based on a Japanese multicenter database: the Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS). The aim of this study was to clinically validate the accuracy of this risk model. METHODS We evaluated the performance of the J-ACCESS model using data derived from the Assessment of the Predicted value of PROgnosis of cArdiaC events in Hokuriku (APPROACH) registry. Variables of age, summed stress score (SSS), left ventricular ejection fraction (LVEF), estimated glomerular filtration rate (eGFR), and diabetes mellitus were included. The major cardiac events were defined as cardiac death, non-fatal myocardial infarction, and heart failure that required hospitalization. The patients were followed up for three years to compare between predicted risk and actual events. RESULTS We evaluated 283 patients with suspected or confirmed CAD receiving myocardial perfusion imaging using 99mTc-tetrofosmin between March 2009 and August 2011. Mean age was 68.9±10.1 years, mean eGFR 67.4±24.3mL/min/1.73m2, mean SSS 5.2±7.2, and mean LVEF 65.4±14.0%. Fourteen (4.9%) patients experienced major cardiac events including cardiac death in 4 patients (1.4%), non-fatal myocardial infarction in 1 patient (0.3%), and severe heart failure in 9 patients (3.2%), respectively. While SSS≥8, LVEF<50%, eGFR<45mL/min/1.73m2, and event risk≥10% were significant variables in survival analysis, multivariate proportional hazard analysis showed that only LVEF and eGFR were significant. The event rate estimated from the J-ACCESS model was comparable to the actual number of major cardiac events (9 and 6, respectively, p=0.58 by Chi-square test). CONCLUSIONS The predictive ability of the J-ACCESS risk model is clinically valid among patients with CAD and could be applicable in clinical practice.
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Affiliation(s)
- Isao Aburadani
- Toyama Prefectural Central Hospital, Division of Cardiology, Department of Internal Medicine, Toyama, Japan.
| | - Kazuo Usuda
- Toyama Prefectural Central Hospital, Division of Cardiology, Department of Internal Medicine, Toyama, Japan
| | - Hisashi Sumiya
- Toyama Prefectural Central Hospital, Division of Radiology, Toyama, Japan
| | - Satoru Sakagami
- National Hospital Organization Kanazawa Medical Center, Division of Cardiology, Kanazawa, Japan
| | | | - Shinro Matsuo
- Kanazawa University, Department of Nuclear Medicine, Kanazawa, Japan
| | | | - Hisayoshi Murai
- Kanazawa University, Department of Cardiology, Kanazawa, Japan
| | | | - Teppei Kitano
- Kanazawa University, Department of Cardiology, Kanazawa, Japan
| | - Koichi Okuda
- Kanazawa Medical University, Department of Physics, Uchinada, Kahoku, Japan
| | - Kenichi Nakajima
- Kanazawa University, Department of Nuclear Medicine, Kanazawa, Japan.
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17
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Sampietro T, Sbrana F, Pasanisi EM, Bigazzi F, Petersen C, Coceani M, Dal Pino B, Ripoli A, Pianelli M, Luciani R. LDL apheresis improves coronary flow reserve on the left anterior descending artery in patients with familial hypercholesterolemia and chronic ischemic heart disease. ATHEROSCLEROSIS SUPP 2017; 30:135-140. [DOI: 10.1016/j.atherosclerosissup.2017.05.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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LeBlanc AJ, Kelm NQ. Thrombospondin-1, Free Radicals, and the Coronary Microcirculation: The Aging Conundrum. Antioxid Redox Signal 2017; 27:785-801. [PMID: 28762749 PMCID: PMC5647494 DOI: 10.1089/ars.2017.7292] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
SIGNIFICANCE Successful matching of cardiac metabolism to perfusion is accomplished primarily through vasodilation of the coronary resistance arterioles, but the mechanism that achieves this effect changes significantly as aging progresses and involves the contribution of reactive oxygen species (ROS). Recent Advances: A matricellular protein, thrombospondin-1 (Thbs-1), has been shown to be a prolific contributor to the production and modulation of ROS in large conductance vessels and in the peripheral circulation. Recently, the presence of physiologically relevant circulating Thbs-1 levels was proven to also disrupt vasodilation to nitric oxide (NO) in coronary arterioles from aged animals, negatively impacting coronary blood flow reserve. CRITICAL ISSUES This review seeks to reconcile how ROS can be successfully utilized as a substrate to mediate vasoreactivity in the coronary microcirculation as "normal" aging progresses, but will also examine how Thbs-1-induced ROS production leads to dysfunctional perfusion and eventual ischemia and why this is more of a concern in advancing age. FUTURE DIRECTIONS Current therapies that may effectively disrupt Thbs-1 and its receptor CD47 in the vascular wall and areas for future exploration will be discussed. Antioxid. Redox Signal. 27, 785-801.
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Affiliation(s)
- Amanda J LeBlanc
- Department of Physiology, Cardiovascular Innovation Institute, University of Louisville , Louisville, Kentucky
| | - Natia Q Kelm
- Department of Physiology, Cardiovascular Innovation Institute, University of Louisville , Louisville, Kentucky
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19
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Anchisi C, Marti G, Bellacosa I, Mary D, Vacca G, Marino P, Grossini E. Coronary flow reserve/diastolic function relationship in angina-suffering patients with normal coronary angiography. J Cardiovasc Med (Hagerstown) 2017; 18:325-331. [PMID: 26657083 DOI: 10.2459/jcm.0000000000000344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIMS Coronary blood flow and diastolic function are well known to interfere with each other through mechanical and metabolic mechanisms. We aimed to assess the relationship between coronary flow reserve (CFR) and diastolic dysfunction in patients suffering from angina but with normal coronary angiography. METHODS In 16 patients with chest pain and angiographically normal coronary arteries, CFR was measured using transthoracic echo-Doppler by inducing hyperemia through dipyridamole infusion. Diastolic function (E/A, deceleration time, isovolumetric relaxation time [IVRT], propagation velocity [Vp]) and left ventricular mass were evaluated by means of two-dimensional transthoracic echocardiography. RESULTS The patients were initially divided into two groups on the grounds of CFR only (ACFR: altered CFR, n = 9; NACFR: unaltered CFR, n = 7). Thereafter they were divided into four groups on the grounds of CFR and diastolic function (NN: normal; AA: altered CFR/diastole; AN: altered CFR/normal diastole; NA: normal CFR/altered diastole). Most of the subjects were scheduled in AA (n = 8) or NA (n = 5) groups, which were taken into consideration for further analysis. Patients were not different regarding various risk factors. ACFR and AA patients were older with normal body weight in comparison with NACFR and NA patients (P < 0.05). In the AA group, CFR and diastolic variables were found to be related to each other. CONCLUSION Diastolic dysfunction and reduced CFR were correlated in patients with concomitant alterations of those variables only. Because most risk factors were shared with patients with altered diastolic properties only, our findings could represent a direct relationship between altered CFR and diastole.
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Affiliation(s)
- Chiara Anchisi
- aCardiology Clinic bLaboratory of Physiology and Experimental Surgery, Department of Translational Medicine, Università del Piemonte Orientale 'A. Avogadro,' AOU 'Maggiore della Carità', Novara, Italy
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20
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Trifunovic D, Cenko E, Torromeo C, Ricci B, Schiariti M, Zdravkovic M, Vasiljevic Z, Manfrini O. Usefulness of coronary flow reserve measured by transthoracic coronary Doppler ultrasound in the elderly. J Geriatr Cardiol 2017; 14:436-441. [PMID: 28868072 PMCID: PMC5545186 DOI: 10.11909/j.issn.1671-5411.2017.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Danijela Trifunovic
- Department of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Edina Cenko
- Department of Experimental, Diagnostics and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Concetta Torromeo
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza, University of Rome, Italy
| | - Beatrice Ricci
- Department of Experimental, Diagnostics and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Michele Schiariti
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza, University of Rome, Italy
| | - Marija Zdravkovic
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Cardiology, University Hospital Medical Center “Bezanijska kosa”, Belgrade, Serbia
| | | | - Olivia Manfrini
- Department of Experimental, Diagnostics and Specialty Medicine, University of Bologna, Bologna, Italy
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21
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Lembo M, Sicari R, Esposito R, Rigo F, Cortigiani L, Lo Iudice F, Picano E, Trimarco B, Galderisi M. Association Between Elevated Pulse Pressure and High Resting Coronary Blood Flow Velocity in Patients With Angiographically Normal Epicardial Coronary Arteries. J Am Heart Assoc 2017; 6:e005710. [PMID: 28663250 PMCID: PMC5586295 DOI: 10.1161/jaha.117.005710] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/17/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim of our study was to evaluate the relationship of pulse pressure (PP), a raw index of arterial stiffness, with noninvasively determined coronary flow reserve (CFR) and its components, in patients with angiographically normal epicardial coronary arteries. METHODS AND RESULTS The study population included 398 patients without angiographic evidence of coronary stenosis, who underwent high-dose dipyridamole stress echocardiography with transthoracic-derived CFR evaluation on the left anterior descending artery. CFR was calculated as the ratio between high-dose dipyridamole and resting coronary diastolic peak velocities. Patients were divided into 2 groups: the first group included the first and second PP tertiles (n=298, PP ≤60 mm Hg) and the second group included the highest PP tertile (n=100, PP >60 mm Hg). Mean blood pressure, systolic blood pressure (both P<0.0001), age (P<0.002), and left ventricular mass index (P=0.013) were higher in the highest PP tertile, which also showed higher resting coronary flow velocity (31.6±9.6 cm/s versus 27.7±6.4 cm/s, P<0.0001) and marginally lower CFR (2.5±0.6 versus 2.6±0.6, P=0.044). Hyperemic coronary flow velocity did not differ between the 2 groups. By separate multiple linear regression analyses, after adjusting for sex, age, the highest systolic blood pressure tertile (≥140 mm Hg), left ventricular mass index, and cardiovascular risk factors, the highest PP tertile was associated with resting coronary flow velocity (P=0.003) and only marginally with hyperemic coronary flow velocity (P<0.02), whereas its association with CFR was not significant. CONCLUSIONS In patients without epicardial coronary artery stenosis, the highest PP tertile is associated with an increased coronary flow velocity at rest.
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Affiliation(s)
- Maria Lembo
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Rosa Sicari
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Fausto Rigo
- Department of Cardiology, Dell'Angelo Hospital, Mestre, Italy
| | | | - Francesco Lo Iudice
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Eugenio Picano
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
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22
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Nevitt C, McKenzie G, Christian K, Austin J, Hencke S, Hoying J, LeBlanc A. Physiological levels of thrombospondin-1 decrease NO-dependent vasodilation in coronary microvessels from aged rats. Am J Physiol Heart Circ Physiol 2016; 310:H1842-50. [PMID: 27199114 DOI: 10.1152/ajpheart.00086.2016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/21/2016] [Indexed: 11/22/2022]
Abstract
Aging and cardiovascular disease are associated with the loss of nitric oxide (NO) signaling and a decline in the ability to increase coronary blood flow reserve (CFR). Thrombospondin-1 (Thbs-1), through binding of CD47, has been shown to limit NO-dependent vasodilation in peripheral vascular beds via formation of superoxide (O2 (-)). The present study tests the hypothesis that, similar to the peripheral vasculature, blocking CD47 will improve NO-mediated vasoreactivity in coronary arterioles from aged individuals, resulting in improved CFR. Isolated coronary arterioles from young (4 mo) or old (24 mo) female Fischer 344 rats were challenged with the NO donor, DEA-NONO-ate (1 × 10(-7) to 1 × 10(-4) M), and vessel relaxation and O2 (-) production was measured before and after Thbs-1, αCD47, and/or Tempol and catalase exposure. In vivo CFR was determined in anesthetized rats (1-3% isoflurane-balance O2) via injected microspheres following control IgG or αCD47 treatment (45 min). Isolated coronary arterioles from young and old rats relax similarly to exogenous NO, but addition of 2.2 nM Thbs-1 inhibited NO-mediated vasodilation by 24% in old rats, whereas young vessels were unaffected. Thbs-1 increased O2 (-) production in coronary arterioles from rats of both ages, but this was exaggerated in old rats. The addition of CD47 blocking antibody completely restored NO-dependent vasodilation in isolated arterioles from aged rats and attenuated O2 (-) production. Furthermore, αCD47 treatment increased CFR from 9.6 ± 9.3 (IgG) to 84.0 ± 23% in the left ventricle in intact, aged animals. These findings suggest that the influence of Thbs-1 and CD47 on coronary perfusion increases with aging and may be therapeutically targeted to reverse coronary microvascular dysfunction.
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Affiliation(s)
- Chris Nevitt
- Cardiovascular Innovation Institute, University of Louisville, Louisville, Kentucky; Department of Biochemistry and Molecular Genetics, University of Louisville, Louisville, Kentucky; and
| | - Grant McKenzie
- Cardiovascular Innovation Institute, University of Louisville, Louisville, Kentucky
| | - Katelyn Christian
- Cardiovascular Innovation Institute, University of Louisville, Louisville, Kentucky
| | - Jeff Austin
- Cardiovascular Innovation Institute, University of Louisville, Louisville, Kentucky
| | - Sarah Hencke
- Cardiovascular Innovation Institute, University of Louisville, Louisville, Kentucky
| | - James Hoying
- Cardiovascular Innovation Institute, University of Louisville, Louisville, Kentucky; Department of Physiology, University of Louisville, Louisville, Kentucky
| | - Amanda LeBlanc
- Cardiovascular Innovation Institute, University of Louisville, Louisville, Kentucky; Department of Physiology, University of Louisville, Louisville, Kentucky
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23
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Broyd CJ, Echavarria-Pinto M, Cerrato E, Escaned J. Evaluation of Microvascular Disease and Clinical Outcomes. Interv Cardiol Clin 2015; 4:443-457. [PMID: 28581931 DOI: 10.1016/j.iccl.2015.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Although coronary microcirculatory dysfunction occurs in numerous cardiac conditions and influences prognosis, it has been largely ignored in clinical practice due to the lack of adequate methods for its assessment. Microcirculatory dysfuntion may result from a variety of causes, including structural remodelling (arterioles or capillaries), dysregulation (paradoxical arteriolar vasoconstriction), hypersensitivity to vasoactive factors or adrenergic drive, and extravascular compression of collapsable elements. Thus, the selection of a method to interrogate coronary microcirculation should be based on the suspected cause of dysfunction. This article reviews such assessment tools and their prognostic information.
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Affiliation(s)
| | | | - Enrico Cerrato
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid 28040, Spain
| | - Javier Escaned
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid 28040, Spain.
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24
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Dikic M, Tesic M, Markovic Z, Giga V, Djordjevic-Dikic A, Stepanovic J, Beleslin B, Jovanovic I, Mladenovic A, Seferovic J, Ostojic M, Arandjelovic A. Prognostic value of calcium score and coronary flow velocity reserve in asymptomatic diabetic patients. Cardiovasc Ultrasound 2015; 13:41. [PMID: 26340922 PMCID: PMC4560883 DOI: 10.1186/s12947-015-0035-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/02/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The risk stratification of patients with diabetes mellitus (DM) is a major objective for the clinicians, and it can be achieved by coronary flow velocity reserve (CFVR) or with coronary artery calcium score (CS). CS evaluates underlying coronary atherosclerotic plaque burden and CFVR estimates both presence of coronary artery stenosis and microvascular function. Consequently, CFVR may provide unique risk information beyond the extent of coronary atherosclerosis. AIM Our aim is to assess joint prognostic value of CFVR and CS in asymptomatic DM patients. MATERIALS AND METHODS We prospectively included 200 asymptomatic patients (45,5 % male, mean age 57,35 ± 11,25), out of which, there were 101 asymptomatic patients with DM and 99 asymptomatic patients without DM, but with one or more conventionally risk factors for coronary artery disease. We analyzed clinical, biochemical, metabolic, inflammatory parameters, CS by Agatston method, transthoracic Doppler echocardiography CFVR of left anterior descending artery and echocardiographic parameters. RESULTS Total CS and CS LAD were significantly higher, while mean CFVR was lower in diabetics compared to the nondiabetics. During 1 year follow-up, 24 patients experienced cardio-vascular events (one cardiovascular death, two strokes, three myocardial infarctions, nine new onsets of unstable angina and nine myocardial revascularizations): 19 patients with DM and five non DM patients, (p = 0,003). Overall event free survival was significantly higher in non DM group, compared to the DM group (94,9 % vs. 81,2 %, p = 0,002 respectively), while the patients with CS ≥200 and CFVR <2 had the worst outcome during 1 year follow up in the whole study population as well as in the DM group. At multivariable analysis CFVR on LAD (HR 12.918, 95 % CI 3.865-43.177, p < 0.001) and total CS (HR 13.393, 95 % CI 1.675-107.119, p = 0.014) were independent prognostic predictors of adverse events in DM group of patients. CONCLUSION Both CS and CFVR provide independent and complementary prognostic information in asymptomatic DM patients. When two parameters are analyzed together, the risk stratification ability improves, even when DM patients are analyzed together with non DM patients. As a result, DM patients with CS ≥200 and CFVR <2 had the worst outcome. Consequently, the use of two tests identified subset of patients who can derive the most benefit from the intensive prevention measures.
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Affiliation(s)
- Miodrag Dikic
- Clinic for Cardiology, Clinical Center of Serbia, Visegradska 26, 11000, Belgrade, Serbia.
| | - Milorad Tesic
- Clinic for Cardiology, Clinical Center of Serbia, Visegradska 26, 11000, Belgrade, Serbia.
| | - Zeljko Markovic
- Medical School, University of Belgrade, Belgrade, Serbia. .,Clinic for Radiology, Clinical Center of Serbia, Belgrade, Serbia.
| | - Vojislav Giga
- Clinic for Cardiology, Clinical Center of Serbia, Visegradska 26, 11000, Belgrade, Serbia. .,Medical School, University of Belgrade, Belgrade, Serbia.
| | - Ana Djordjevic-Dikic
- Clinic for Cardiology, Clinical Center of Serbia, Visegradska 26, 11000, Belgrade, Serbia. .,Medical School, University of Belgrade, Belgrade, Serbia.
| | - Jelena Stepanovic
- Clinic for Cardiology, Clinical Center of Serbia, Visegradska 26, 11000, Belgrade, Serbia. .,Medical School, University of Belgrade, Belgrade, Serbia.
| | - Branko Beleslin
- Clinic for Cardiology, Clinical Center of Serbia, Visegradska 26, 11000, Belgrade, Serbia. .,Medical School, University of Belgrade, Belgrade, Serbia.
| | - Ivana Jovanovic
- Clinic for Cardiology, Clinical Center of Serbia, Visegradska 26, 11000, Belgrade, Serbia.
| | - Ana Mladenovic
- Clinic for Radiology, Clinical Center of Serbia, Belgrade, Serbia.
| | - Jelena Seferovic
- Medical School, University of Belgrade, Belgrade, Serbia. .,Clinic for Endocrinology, Clinical Center of Serbia, Belgrade, Serbia.
| | | | - Aleksandra Arandjelovic
- Medical School, University of Belgrade, Belgrade, Serbia. .,Cardiology Department, Clinical Hospital Zvezdara, Belgrade, Serbia.
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25
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Simova I. Coronary Flow Velocity Reserve Assessment with Transthoracic Doppler Echocardiography. Eur Cardiol 2015; 10:12-18. [PMID: 30310417 PMCID: PMC6159450 DOI: 10.15420/ecr.2015.10.01.12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/23/2015] [Indexed: 11/04/2022] Open
Abstract
Coronary flow velocity reserve (CFVR) reflects global coronary atherosclerotic burden, endothelial function and state of the microvasculature. It could be measured using transthoracic Doppler echocardiography in a non-invasive, feasible, reliable and reproducible fashion, following a standardised protocol with different vasodilatory stimuli. CFVR measurement is a recommended complement to vasodilator stress echocardiography. It could serve as a diagnostic tool for coronary microvascular dysfunction and in the setting of epicardial coronary artery stenoses could help in identification and assessment of functional significance of coronary lesions and follow-up of patients after coronary interventions. CFVR has also a prognostic significance in different clinical situations.
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Affiliation(s)
- Iana Simova
- National Cardiology Hospital, Sofia, Bulgaria
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26
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Cortigiani L, Rigo F, Gherardi S, Bovenzi F, Picano E, Sicari R. Prognostic value of Doppler echocardiographic-derived coronary flow velocity reserve of left anterior descending artery in octogenarians with stress echocardiography negative for wall motion criteria. Eur Heart J Cardiovasc Imaging 2015; 16:653-60. [PMID: 25588801 DOI: 10.1093/ehjci/jeu311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 12/14/2014] [Indexed: 11/14/2022] Open
Abstract
AIMS Doppler-derived coronary flow velocity reserve (CFVR) of left anterior descending (LAD) artery is an effective tool to predict overall mortality. The aim was to investigate the capability of CFVR to predict outcome in an unselected cohort of patients older than 80 years having stress echo negative by wall motion criteria. METHODS AND RESULTS The study group refers to 369 patients aged > 80 years (156 men; mean age 83 ± 2 years) who had undergone dipyridamole stress echocardiography with CFVR assessment of LAD artery of known (n = 144) or suspected (n = 225) coronary artery disease. Stress echocardiography was negative for wall motion criteria in all cases. Mean CFVR was 2.07 ± 0.53. During a median follow-up of 21 months, there were 62 major adverse cardiac events (MACEs; 45 deaths and 17 non-fatal myocardial infarctions). With a receiver operating characteristic analysis, a CFVR of ≤ 1.93 was the best cut-off for predicting mortality and MACE. At individual patient analysis, 152 (41%) subjects had a CFVR of < 1.93. Annual mortality was 9.8% in patients with CFVR <1.93 and 3.7% in those with CFVR > 1.93 (P = 0.001); an annual MACE rate was 14.8% in the former and 4.5% in the latter (P < 0.0001). Of 15 clinical and echocardiographic parameters analysed, CFVR ≤ 1.93 [hazard ratio (HR) = 2.17, 95% CI 1.14-4.10] and resting wall motion abnormality (RWMA; HR = 2.60; 95% CI 1.35-5.00) were multivariable indicators of mortality. Moreover, CFVR ≤ 1.93 (HR = 2.69, 95% CI 1.56-4.67), and RWMA (HR = 2.38; 95% CI 1.31-4.33) were also strong independent predictors of MACEs. At incremental analysis, CFR ≤ 1.93 added prognostic information over clinical evaluation and RWMA when both mortality and MACE were taken as clinical end points. CONCLUSIONS A reduced CFVR of LAD artery is a strong and independent indicator of both mortality and MACE, adding prognostic information over clinical evaluation and RWMA. Conversely, a preserved CFVR predicts a favourable outcome particularly in subjects with no RWMA.
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Affiliation(s)
| | - Fausto Rigo
- Divisione di Cardiologia, Ospedale dell'Angelo, Mestre-Venezia, Italy
| | | | | | - Eugenio Picano
- CNR, Institute of Clinical Physiology, Via G. Moruzzi, 1, 56124 Pisa, Italy
| | - Rosa Sicari
- CNR, Institute of Clinical Physiology, Via G. Moruzzi, 1, 56124 Pisa, Italy
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27
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Lim HS, Tonino PA, De Bruyne B, Yong AS, Lee BK, Pijls NH, Fearon WF. The impact of age on fractional flow reserve-guided percutaneous coronary intervention: A FAME (Fractional Flow Reserve versus Angiography for Multivessel Evaluation) trial substudy. Int J Cardiol 2014; 177:66-70. [DOI: 10.1016/j.ijcard.2014.09.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/23/2014] [Accepted: 09/15/2014] [Indexed: 10/24/2022]
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28
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Yuksel Kalkan G, Gur M, Eksi Haydardedeoğlu F, Kırım S, Baykan AO, Kuloğlu O, Uçar H, Sahin DY, Elbasan Z, Seker T, Turkoğlu C, Yildirim A, Cayli M. The association between aortic distensibility and coronary flow reserve in newly diagnosed diabetic patients. Echocardiography 2014; 32:205-12. [PMID: 24815036 DOI: 10.1111/echo.12631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Aortic distensibility (AD) is an important parameter affecting coronary hemodynamics. Coronary flow velocity reserve (CFVR) is a reliable marker of coronary endothelial function in diabetic patients. The aim of this study was to investigate the association between AD and CFVR in newly diagnosed diabetic patients. METHOD We studied 77 patients with newly diagnosed diabetes mellitus (DM) and 30 age- and sex-matched healthy control subjects. CFVR was calculated as the hyperemic to resting coronary diastolic velocities ratio by using transthoracic echocardiography. Pulse pressure (PP) and AD were calculated. RESULTS Fasting blood glucose, HbA1c and PP were significantly higher in patients with diabetes (P < 0.001, P < 0.001 and P = 0.009, respectively). Other clinical and demographical characteristics, laboratory findings and echocardiographic findings were similar in both groups (P > 0.05, for all). The measurement of CFVR and AD in patients with diabetes were significantly lower compared with the controls (P < 0.001 and P = 0.001, respectively). CFVR was significantly negatively correlated with age, body mass index, HbA1c, systolic blood pressure, and PP, while significantly positively correlated with AD (P < 0.05, for all). Multivariate regression analysis showed that only AD (β = 0.485, P < 0.0001) and HbA1c (β = -0.362, P < 0.0001) were independently associated with CFVR. The cutoff value of AD obtained by the receiver operator characteristic (ROC) curve analysis was 2.44 for the prediction of impaired CFVR. CONCLUSION Aortic distensibility and HbA1c were independently associated with CFVR. The decrease in AD may be used as a marker of impaired coronary microcirculation in asymptomatic diabetic patients.
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Affiliation(s)
- Gulhan Yuksel Kalkan
- Department of Cardiology, Adana Numune Training and Research Hospital, Adana, Turkey
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29
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Picano E, Bruno RM, Ferrari GF, Bonuccelli U. Cognitive impairment and cardiovascular disease: so near, so far. Int J Cardiol 2014; 175:21-9. [PMID: 24856805 DOI: 10.1016/j.ijcard.2014.05.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 04/30/2014] [Accepted: 05/05/2014] [Indexed: 01/08/2023]
Abstract
In the spectrum of cognitive impairment, ranging from "pure" vascular dementia to Alzheimer's disease (AD), clinical interest has recently expanded from the brain to also include the vessels, shifting the pathophysiological focus from the leaves of synaptic dysfunction to the sap of cerebral microcirculation and the roots of cardiovascular function. From a diagnostic viewpoint, a thorough clinical evaluation of individuals presenting cognitive impairment might systematically include the assessment of the major cardiovascular rings of the chain linking regional perfusion to brain function: 1) lung (with assessment of asthma, chronic obstructive pulmonary disease, obstructive sleep apnea syndrome); 2) heart function (with clinical examination and echocardiography) and cardiovascular risk factors; 3) orthostatic hypotension (with medical history and measurement of heart rate and blood pressure in supine and upright positions); 4) aorta and large artery stiffness (with assessment of pulse wave velocity); 5) large cerebro-vascular vessel status (with neuroimaging techniques); 6) assessment of microcirculation (with cerebrovascular reactivity testing with transcranial Doppler sonography or MRI perfusion imaging); and 7) assessment of venous cerebral circulation. The apparent difference in approaches to "brain" and "vascular" environmental enrichment with physical, cognitive and sensorial training is conceptually identical to that of a constant gardener caring for an unhealthy tree, watering the leaves ("train the brain") or simply the roots ("mind the vessel"). The therapeutic difference probably consists in the amount and quality of water added to the tree, rather than by where one pours it, with either a top-down (leaves to roots) or bottom-up (roots to leaves) approach.
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Affiliation(s)
| | | | | | - Ubaldo Bonuccelli
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
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30
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Imamura S, Hirata K, Orii M, Shimamura K, Shiono Y, Ishibashi K, Tanimoto T, Yamano T, Ino Y, Kitabata H, Yamaguchi T, Kubo T, Tanaka A, Imanishi T, Akasaka T. Relation of albuminuria to coronary microvascular function in patients with chronic kidney disease. Am J Cardiol 2014; 113:779-85. [PMID: 24406110 DOI: 10.1016/j.amjcard.2013.11.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 11/12/2013] [Accepted: 11/12/2013] [Indexed: 12/19/2022]
Abstract
The relation between albuminuria and coronary microvascular function in patients with chronic kidney disease (CKD) has not been fully investigated. Therefore, we sought to assess whether albuminuria is associated with coronary flow velocity reserve (CFVR) impairment in patients with CKD. Coronary flow study was prospectively performed in 175 patients with CKD. CFVR of the left anterior descending artery was measured to evaluate coronary microvascular function using transthoracic echocardiography. We divided the patients into 5 groups according to the stages of CKD and analyzed the effect of albuminuria. CFVR gradually decreased with an increase in CKD stages. CFVR in patients with albuminuria was lower than those without albuminuria. In groups with CKD stages 2 and 3, the patients with albuminuria showed lower CFVR than those without albuminuria. Multiple logistic regression analysis revealed that albuminuria, age, and gender were independently associated with CFVR impairment. Of these factors, albuminuria was the most powerful predictor with the risk ratio of 12.4 for CFVR impairment. In conclusion, the more the CKD stages progressed, the more severe CFVR was impaired. Albuminuria was associated with CFVR impairment in patients with CKD; even in mild-to-moderate CKD, patients with albuminuria showed further reduced coronary vasodilator capacity.
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31
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Cognet T, Vervueren PL, Dercle L, Bastié D, Richaud R, Berry M, Marchal P, Gautier M, Fouilloux A, Galinier M, Carrié D, Massabuau P, Berry I, Lairez O. New concept of myocardial longitudinal strain reserve assessed by a dipyridamole infusion using 2D-strain echocardiography: the impact of diabetes and age, and the prognostic value. Cardiovasc Diabetol 2013; 12:84. [PMID: 23759020 PMCID: PMC3685519 DOI: 10.1186/1475-2840-12-84] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 05/28/2013] [Indexed: 12/20/2022] Open
Abstract
AIMS Although dipyridamole is a widely used pharmacological stress agent, the direct effects on myocardium are not entirely known. Diabetic cardiomyopathy can be investigated by 2D-strain echocardiography. The aim of this study was to assess myocardial functional reserve after dipyridamole infusion using speckle-tracking echocardiography. METHODS Seventy-five patients referred for dipyridamole stress myocardial perfusion gated SPECT (MPGS) were examined by echocardiography to assess a new concept of longitudinal strain reserve (LSR) and longitudinal strain rate reserve (LSRR) respectively defined by the differences of global longitudinal strain (GLS) and longitudinal strain rate between peak stress after dipyridamole and rest. Twelve patients with myocardial ischemia were excluded on the basis of MPGS as gold standard. RESULTS Mean LSR was -2.28±2.19% and was more important in the 28 (44%) diabetic patients (-3.27±1.93%; p=0.001). After multivariate analyses, only diabetes improved LSR (p=0.011) after dipyridamole infusion and was not associated with glycaemic control (p=0.21), insulin therapy (p=0.46) or duration of the disease (p=0.80). Conversely, age (p=0.002) remained associated with a decrease in LSR. LSSR was also correlated to age (p=0.005). Patients with a LSR<0% have a better survival after 15 months (log-rank p=0.0012). CONCLUSION LSR explored by 2D speckle-tracking echocardiography after dipyridamole infusion is a simple and new concept that provides new insights into the impact of diabetes and age on the myocardium with a potential prognostic value.
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Affiliation(s)
- Thomas Cognet
- Department of Nuclear Medicine, University Hospital of Rangueil, Toulouse, France.
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