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Gao B, Wu G, Xie J, Ruan J, Xu P, Qian Y, Gu J, Li W, Jin X, Tong G, Huang J. Quantitative Flow Ratio-Derived Index of Microcirculatory Resistance as a Novel Tool to Identify Microcirculatory Function in Patients with Ischemia and No Obstructive Coronary Artery Disease. Cardiology 2023; 149:14-22. [PMID: 37839404 PMCID: PMC10836850 DOI: 10.1159/000534287] [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: 02/18/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Coronary microvascular disease (CMVD) is associated with adverse cardiovascular outcomes. However, there is no reliable and noninvasive quantitative diagnostic method available for CMVD. The use of a pressure wire to measure the index of microcirculatory resistance (IMR) is possible, but it has inevitable practical restrictions. We hypothesized that computation of the quantitative flow ratio could be used to predict CMVD with symptoms of ischemia and no obstructive coronary artery disease (INOCA). METHODS We retrospectively assessed the diagnostic efficiency of the quantitative flow ratio-derived index of microcirculatory resistance (QMR) in 103 vessels from 66 patients and compared it with invasive IMR using the thermodilution technique. RESULTS Patients were divided into the CMVD group (41/66, 62.1%) and non-CMVD group (25/66, 37.9%). Pressure wire IMR measurements were made in 103 coronary vessels, including 44 left descending arteries, 18 left circumflex arteries, and 41 right coronary arteries. ROC curve analysis showed a good diagnostic performance of QMR for all arteries (area under the curve = 0.820, 95% confidence interval 0.736-0.904, p < 0.001) in predicting microcirculatory function. The optimal cut-off for QMR to predict microcirculatory function was 266 (sensitivity: 82.9%, specificity: 72.6%, and diagnostic accuracy: 76.7%). CONCLUSION QMR is a promising tool for the assessment of coronary microcirculation. The assessment of the IMR without the use of a pressure wire may enable more rapid, convenient, and cost-effective assessment of coronary microvascular function.
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Affiliation(s)
- Beibei Gao
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Guomin Wu
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Jianchang Xie
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Jie Ruan
- Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peng Xu
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Yufeng Qian
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Junjie Gu
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of Medicine, Hangzhou, China
- Cardiac Catheterization Room, Affiliated Hangzhou First People’s Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Li
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiangbo Jin
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Guoxin Tong
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Jinyu Huang
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of Medicine, Hangzhou, China
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Iskandar NP, Reddy AJ, Dang A, Ghauri MS, Min M, Bachir M, Bachir A, Wagh H, Tak N, Brahmbhatt H. An Examination of Clopidogrel in the Treatment of Coronary Microvascular Disease. Cureus 2022; 14:e28406. [PMID: 36171852 PMCID: PMC9509004 DOI: 10.7759/cureus.28406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 11/05/2022] Open
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Gao B, Zhu D, Xie J, Wu B, Xu P, Liu J, Tong X, Chen R, Zhu L, Zhou L, Qian Y, Ye X, Yang J, Meng S, Gu J, Tong G, Huang J. A clinical trial for computed tomography myocardial perfusion based non-invasive index of microcirculatory resistance (MPBIMR): rationale and trial design. Am J Transl Res 2022; 14:5552-5562. [PMID: 36105013 PMCID: PMC9452323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/23/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Accurate and rapid assessment of the coronary microcirculation has become an important medical challenge. However, reliable and non-invasive quantitative methods to diagnose coronary microvascular disease (CMVD), select treatments for coronary artery disease (CAD), and therefore improve coronary microcirculation are lacking. Current detection methods have limitations. Therefore, we will assess whether a new detection method, the non-invasive index of microcirculatory resistance (IMR), based on computed tomography (CT) perfusion and hydrodynamics (CT-IMR), can effectively evaluate the function of coronary microvessels. METHODS We will conduct a multicenter, randomized, open-label study, including a Phase I single-center and Phase II multicenter trial, to assess the accuracy of the non-invasive CT-IMR coronary measurement of microcirculation function. The study will enroll 295 patients who will undergo coronary CT angiography (CCTA), dynamic CT-myocardial perfusion imaging (CT-MPI), invasive coronary angiography (ICA), and invasive IMR. This study will identify the key influencing factors when calculating myocardial microcirculation perfusion and develop an accurate three-dimensional coronary reconstruction method and a non-invasive coronary IMR calculation method based on computational fluid dynamics (CFD). This will facilitate the development of a non-invasive system to detect and measure coronary microcirculation. CONCLUSION The clinical trial for computed tomography myocardial perfusion based non-invasive index of microcirculatory resistance (MPBIMR) will establish the key influencing factors when calculating myocardial microcirculation perfusion and create a non-invasive CT-IMR calculation method based on CFD. This method may diagnose patients with simple coronary microvascular lesions and those with coronary microvascular lesions combined with coronary vascular lesions.
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Affiliation(s)
- Beibei Gao
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of MedicineHangzhou 310000, Zhejiang Province, China
| | - Darong Zhu
- Department of Radiology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of MedicineHangzhou 310000, Zhejiang Province, China
| | - Jianchang Xie
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of MedicineHangzhou 310000, Zhejiang Province, China
| | - Bokai Wu
- Institute of Advanced Computing and Digital Engineering, Institutes of Advanced Technology, Chinese Academy of SciencesShenzhen 518000, Guangdong Province, China
| | - Peng Xu
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of MedicineHangzhou 310000, Zhejiang Province, China
| | - Jia Liu
- Institute of Advanced Computing and Digital Engineering, Institutes of Advanced Technology, Chinese Academy of SciencesShenzhen 518000, Guangdong Province, China
| | - Xiaoshan Tong
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of MedicineHangzhou 310000, Zhejiang Province, China
- Department of Cardiac Catheterization Room, Affiliated Hangzhou First People’s Hospital Zhejiang University School of MedicineHangzhou 310000, Zhejiang Province, China
| | - Rongliang Chen
- Institute of Advanced Computing and Digital Engineering, Institutes of Advanced Technology, Chinese Academy of SciencesShenzhen 518000, Guangdong Province, China
| | - Lijun Zhu
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of MedicineHangzhou 310000, Zhejiang Province, China
| | - Liang Zhou
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of MedicineHangzhou 310000, Zhejiang Province, China
| | - Yufeng Qian
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of MedicineHangzhou 310000, Zhejiang Province, China
| | - Xianhua Ye
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of MedicineHangzhou 310000, Zhejiang Province, China
- Department of Cardiac Catheterization Room, Affiliated Hangzhou First People’s Hospital Zhejiang University School of MedicineHangzhou 310000, Zhejiang Province, China
| | - Jianmin Yang
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of MedicineHangzhou 310000, Zhejiang Province, China
| | - Shasha Meng
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of MedicineHangzhou 310000, Zhejiang Province, China
- Department of Cardiac Catheterization Room, Affiliated Hangzhou First People’s Hospital Zhejiang University School of MedicineHangzhou 310000, Zhejiang Province, China
| | - Junjie Gu
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of MedicineHangzhou 310000, Zhejiang Province, China
- Department of Cardiac Catheterization Room, Affiliated Hangzhou First People’s Hospital Zhejiang University School of MedicineHangzhou 310000, Zhejiang Province, China
| | - Guoxin Tong
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of MedicineHangzhou 310000, Zhejiang Province, China
| | - Jinyu Huang
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of MedicineHangzhou 310000, Zhejiang Province, China
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Mechanical and Pharmacological Revascularization Strategies for Prevention of Microvascular Dysfunction in ST-Segment Elevation Myocardial Infarction: Analysis from Index of Microcirculatory Resistance Registry Data. J Interv Cardiol 2020; 2020:5036396. [PMID: 32728350 PMCID: PMC7368229 DOI: 10.1155/2020/5036396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 02/02/2023] Open
Abstract
Objectives We aimed to identify mechanical and pharmacological revascularization strategies correlated with the index of microcirculatory resistance (IMR) in ST-elevation myocardial infarction (STEMI) patients. Background Microvascular dysfunction (MVD) after STEMI is correlated with infarct size and poor long-term prognosis, and the IMR is a useful analytical method for the quantitative assessment of MVD. However, therapeutic strategies that can reliably reduce MVD remain uncertain. Methods Patients with STEMI who underwent primary percutaneous coronary intervention (PCI) were enrolled. The IMR was measured with a pressure sensor/thermistor-tipped guidewire immediately after primary PCI. High IMR was defined as values ≥66th percentile of IMR in enrolled patients (IMR > 30.9 IU). Results A total of 160 STEMI patients were analyzed (high IMR = 54 patients). Clinical factors for Killip class (P=0.006), delayed hospitalization from symptom onset (P=0.004), peak troponin-I level (P=0.042), and multivessel disease (P=0.003) were associated with high IMR. Achieving final thrombolysis in myocardial infarction myocardial perfusion grade 3 tended to be associated with low IMR (P=0.119), whereas the presence of distal embolization was significantly associated with high IMR (P=0.034). In terms of therapeutic strategies that involved adjusting clinical and angiographic factors associated with IMR, preloading of third-generation P2Y12 inhibitors correlated with reducing IMR value (β = −10.30, P < 0.001). Mechanical therapeutic strategies including stent diameter/length, preballoon dilatation, direct stenting, and thrombectomy were not associated with low IMR value (all P > 0.05), and postballoon dilatation was associated with high IMR (β = 8.30, P=0.020). Conclusions In our study, mechanical strategies were suboptimal in achieving myocardial salvage. Preloading of third-generation P2Y12 inhibitors revealed decreased IMR value, indicative of MVD prevention.
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Danielak D, Karaźniewicz-Łada M, Główka F. Ticagrelor in modern cardiology - an up-to-date review of most important aspects of ticagrelor pharmacotherapy. Expert Opin Pharmacother 2017; 19:103-112. [DOI: 10.1080/14656566.2017.1421634] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Dorota Danielak
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, Poznań, Poland
| | - Marta Karaźniewicz-Łada
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, Poznań, Poland
| | - Franciszek Główka
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, Poznań, Poland
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Shang LL, Guo DD, Zhao HY, Quan AJ, Cao PG. Comparison of pharmacodynamic effects of ticagrelor vs prasugrel in type 2 diabetes mellitus patients with coronary heart disease. J Clin Pharm Ther 2017; 43:342-347. [PMID: 29150850 DOI: 10.1111/jcpt.12651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/28/2017] [Indexed: 02/06/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Patients with type 2 diabetes mellitus (T2DM) are at higher risk of thrombotic complications. Studies have indicated that patients with T2DM have impaired clopidogrel-induced antiplatelet effect. Ticagrelor and prasugrel are two latest generation P2Y12 inhibitors with advantageous platelet inhibitory profiles. However, the pharmacodynamic differences between the two drugs in patients with T2DM remain poorly explored. METHODS This study, involving 140 patients with T2DM following percutaneous coronary intervention (PCI), evaluated the efficacy of aspirin upon concomitant use of prasugrel (10 mg/d) or ticagrelor (90 mg/d). Platelet reactivity was assessed by value of ADP-induced light transmittance aggregometry (LTA) and vasodilator-stimulated phosphoprotein phosphorylation-platelet reactivity index (VASP-PRI) at baseline, 7 and 30 days after randomized P2Y12 inhibitor treatment. RESULTS The study showed a decreased platelet reactivity after use of P2Y12 inhibitors (both P < .001). On the basis of comparison between regimens, apart from the prasugrel group having a significantly higher LTA value at the 30-day time point (P = .043), there existed no significant differences in platelet reactivity at separate time points (all P > .05). As for intragroup measurements, when compared with 7-day and 30-day time points, similar platelet reactivity was documented in the ticagrelor group (both P > .05), but LTA tests showed a significant increase with time (days 7-30) in the prasugrel group (P = .050). WHAT IS NEW AND CONCLUSION Although ticagrelor and prasugrel have similar platelet inhibitory effects in patients with T2DM, if a P2Y12 inhibitor is necessitated in patients with T2DM, ticagrelor might exert a more stable antiplatelet effect with 30-day short-term treatment.
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Affiliation(s)
- L-L Shang
- Department of Intensive Medicine, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Ha'erbin, China
| | - D-D Guo
- Department of Cardiology, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Ha'erbin, China
| | - H-Y Zhao
- Department of Cardiology, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Ha'erbin, China
| | - A-J Quan
- Department of Intensive Medicine, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Ha'erbin, China
| | - P-G Cao
- Department of Cardiology, General Hospital of Heilongjiang Agricultural Reclamation Bureau, Ha'erbin, China
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