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Minten L, Bennett J, McCutcheon K, Oosterlinck W, Algoet M, Otsuki H, Takahashi K, Fearon WF, Dubois C. Optimization of Absolute Coronary Blood Flow Measurements to Assess Microvascular Function: In Vivo Validation of Hyperemia and Higher Infusion Speeds. Circ Cardiovasc Interv 2024; 17:e013860. [PMID: 38682331 DOI: 10.1161/circinterventions.123.013860] [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: 11/20/2023] [Accepted: 03/15/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Reliable assessment of coronary microvascular function is essential. Techniques to measure absolute coronary blood flow are promising but need validation. The objectives of this study were: first, to validate the potential of saline infusion to generate maximum hyperemia in vivo. Second, to validate absolute coronary blood flow measured with continuous coronary thermodilution at high (40-50 mL/min) infusion speeds and asses its safety. METHODS Fourteen closed-chest sheep underwent absolute coronary blood flow measurements with increasing saline infusion speeds at different dosages under general anesthesia. An additional 7 open-chest sheep underwent these measurements with epicardial Doppler flow probes. Coronary flows were compared with reactive hyperemia after 45 s of coronary occlusion. RESULTS Twenty milliliters per minute of saline infusion induced a significantly lower hyperemic coronary flow (140 versus 191 mL/min; P=0.0165), lower coronary flow reserve (1.82 versus 3.21; P≤0.0001), and higher coronary resistance (655 versus 422 woods units; P=0.0053) than coronary occlusion. On the other hand, 30 mL/min of saline infusion resulted in hyperemic coronary flow (196 versus 192 mL/min; P=0.8292), coronary flow reserve (2.77 versus 3.21; P=0.1107), and coronary resistance (415 versus 422 woods units; P=0.9181) that were not different from coronary occlusion. Hyperemic coronary flow was 40.7% with 5 mL/min, 40.8% with 10 mL/min, 73.1% with 20 mL/min, 102.3% with 30 mL/min, 99.0% with 40 mL/min, and 98.0% with 50 mL/min of saline infusion when compared with postocclusive hyperemic flow. There was a significant bias toward flow overestimation (Bland-Altman: bias±SD, -73.09±30.52; 95% limits of agreement, -132.9 to -13.27) with 40 to 50 mL/min of saline. Occasionally, ischemic changes resulted in ventricular fibrillation (9.5% with 50 mL/min) at higher infusion rates. CONCLUSIONS Continuous saline infusion of 30 mL/min but not 20 mL/min induced maximal hyperemia. Absolute coronary blood flow measured with saline infusion speeds of 40 to 50 mL/min was not accurate and not safe.
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Affiliation(s)
- Lennert Minten
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (L.M., J.B., K.M.C., W.O., M.A., C.D.)
- Division of Cardiovascular Medicine, Stanford University, CA (L.M., H.O., K.T., W.F.F.)
| | - Johan Bennett
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (L.M., J.B., K.M.C., W.O., M.A., C.D.)
- Departments of Cardiovascular Medicine (J.B., C.D.), UZ Leuven, Belgium
| | - Keir McCutcheon
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (L.M., J.B., K.M.C., W.O., M.A., C.D.)
| | - Wouter Oosterlinck
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (L.M., J.B., K.M.C., W.O., M.A., C.D.)
- Cardiac Surgery (W.O., M.A.), UZ Leuven, Belgium
| | - Michiel Algoet
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (L.M., J.B., K.M.C., W.O., M.A., C.D.)
- Cardiac Surgery (W.O., M.A.), UZ Leuven, Belgium
| | - Hisao Otsuki
- Division of Cardiovascular Medicine, Stanford University, CA (L.M., H.O., K.T., W.F.F.)
| | - Kuniaki Takahashi
- Division of Cardiovascular Medicine, Stanford University, CA (L.M., H.O., K.T., W.F.F.)
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University, CA (L.M., H.O., K.T., W.F.F.)
- VA Palo Alto Health Care System, CA (W.F.F.)
| | - Christophe Dubois
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (L.M., J.B., K.M.C., W.O., M.A., C.D.)
- Departments of Cardiovascular Medicine (J.B., C.D.), UZ Leuven, Belgium
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2
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Bennett J, McCutcheon K, Ameloot K, Vanhaverbeke M, Lesizza P, Castaldi G, Adriaenssens T, Minten L, Palmers PJ, de Hemptinne Q, de Wilde W, Ungureanu C, Vandeloo B, Colletti G, Coussement P, Van Mieghem NM, Dens J. ShOckwave ballooN or Atherectomy with Rotablation in calcified coronary artery lesions: Design and rationale of the SONAR trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 60:82-86. [PMID: 37714726 DOI: 10.1016/j.carrev.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/31/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND The percutaneous treatment of calcified coronary lesions remains challenging and is associated with worse clinical outcomes. In addition, coronary artery calcification is associated with more frequent peri-procedural myocardial infarction. STUDY DESIGN AND OBJECTIVES The ShOckwave ballooN or Atherectomy with Rotablation in calcified coronary artery lesions (SONAR) study is an investigator-initiated, prospective, randomized, international, multicenter, open label trial (NCT05208749) comparing a lesion preparation strategy with either shockwave intravascular lithotripsy (IVL) or rotational atherectomy (RA) before drug-eluting stent implantation in 170 patients with moderate to severe calcified coronary lesions. The primary endpoint is difference in the rate of peri-procedural myocardial infarction. Key secondary endpoints include rate of peri-procedural microvascular dysfunction, peri-procedural myocardial injury, descriptive study of IMR measurements in calcified lesions, technical and procedural success, interaction between OCT calcium score and primary endpoint, 30-day and 1-year major adverse clinical events. CONCLUSIONS The SONAR trial is the first randomized controlled trial comparing the incidence of peri-procedural myocardial infarction between 2 contemporary calcium modification strategies (Shockwave IVL and RA) in patients with calcified coronary artery lesions. Furthermore, for the first time, the incidence of peri-procedural microvascular dysfunction after Shockwave IVL and RA will be evaluated and compared.
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Affiliation(s)
- Johan Bennett
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
| | - Keir McCutcheon
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Koen Ameloot
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Pierluigi Lesizza
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Gianluca Castaldi
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Tom Adriaenssens
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Lennert Minten
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Quentin de Hemptinne
- Department of Cardiology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Willem de Wilde
- Department of Cardiology, Imelda Ziekenhuis, Bonheiden, Belgium
| | - Claudiu Ungureanu
- Department of Cardiology, Hôpital de Jolimont, Haine-Saint-Paul, Belgium
| | - Bert Vandeloo
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | | | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Jo Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
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3
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Januszek R, Kołtowski Ł, Tomaniak M, Wańha W, Wojakowski W, Grygier M, Siłka W, Jan Horszczaruk G, Czarniak B, Kręcki R, Guzik B, Legutko J, Pawłowski T, Wnęk P, Roik M, Sławek-Szmyt S, Jaguszewski M, Roleder T, Dziarmaga M, Bartuś S. Implementation of Microcirculation Examination in Clinical Practice-Insights from the Nationwide POL-MKW Registry. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:277. [PMID: 38399564 PMCID: PMC10890290 DOI: 10.3390/medicina60020277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/10/2023] [Accepted: 01/31/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: The assessment of coronary microcirculation may facilitate risk stratification and treatment adjustment. The aim of this study was to evaluate patients' clinical presentation and treatment following coronary microcirculation assessment, as well as factors associated with an abnormal coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) values. Materials and Results: This retrospective analysis included 223 patients gathered from the national registry of invasive coronary microvascular testing collected between 2018 and 2023. Results: The frequency of coronary microcirculatory assessments in Poland has steadily increased since 2018. Patients with impaired IMR (≥25) were less burdened with comorbidities. Patients with normal IMR underwent revascularisation attempts more frequently (11.9% vs. 29.8%, p = 0.003). After microcirculation testing, calcium channel blockers (CCBs) and angiotensin-converting enzyme inhibitors were added more often for patients with IMR and CFR abnormalities, respectively, as compared to control groups. Moreover, patients with coronary microvascular dysfunction (CMD, defined as CFR and/or IMR abnormality), regardless of treatment choice following microcirculation assessment, were provided with trimetazidine (23.2%) and dihydropyridine CCBs (26.4%) more frequently than those without CMD who were treated conservatively (6.8%) and by revascularisation (4.2% with p = 0.002 and 0% with p < 0.001, respectively). Multivariable analysis revealed no association between angina symptoms and IMR or CFR impairment. Conclusions: The frequency of coronary microcirculatory assessments in Poland has steadily increased. Angina symptoms were not associated with either IMR or CFR impairment. After microcirculation assessment, patients with impaired microcirculation, expressed as either low CFR, high IMR or both, received additional pharmacotherapy treatment more often.
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Affiliation(s)
- Rafał Januszek
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Cracow University, 30-705 Kraków, Poland
| | - Łukasz Kołtowski
- 1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (Ł.K.); (M.T.)
| | - Mariusz Tomaniak
- 1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (Ł.K.); (M.T.)
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (W.W.); (W.W.)
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (W.W.); (W.W.)
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61-701 Poznań, Poland; (M.G.); (S.S.-S.)
| | - Wojciech Siłka
- Faculty of Medicine, Jagiellonian University Medical College, 31-008 Kraków, Poland; (W.S.); (S.B.)
| | - Grzegorz Jan Horszczaruk
- Faculty of Medical Science, Collegium Medicum. Cardinal Stefan Wyszyński University in Warsaw, 01-938 Warsaw, Poland;
- Department of Cardiology, Voivodeship Hospital in Łomża, 18-404 Łomża, Poland
| | - Bartosz Czarniak
- Provincial Specialist Hospital in Wloclawek, 87-800 Włocławek, Poland;
| | | | - Bartłomiej Guzik
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Kraków, Poland; (B.G.); (J.L.)
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Kraków, Poland; (B.G.); (J.L.)
- Department of Interventional Cardiology, The John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
| | - Tomasz Pawłowski
- Department of Cardiology, National Institute of Medicine of the Ministry of Internal Affairs and Administration, 02-507 Warsaw, Poland;
- Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
| | - Paweł Wnęk
- Provincial Specialist Hospital in Wroclaw, 51-124 Wrocław, Poland;
| | - Marek Roik
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Sylwia Sławek-Szmyt
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61-701 Poznań, Poland; (M.G.); (S.S.-S.)
| | - Miłosz Jaguszewski
- 1st Department of Cardiology, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Tomasz Roleder
- Department of Cardiology, Wroclaw Medical University, 50-556 Wrocław, Poland;
| | - Miłosz Dziarmaga
- Department of Cardiology-Intensive Therapy and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznań, Poland;
| | - Stanisław Bartuś
- Faculty of Medicine, Jagiellonian University Medical College, 31-008 Kraków, Poland; (W.S.); (S.B.)
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Harano Y, Kawase Y, Warisawa T, Matsuo H. Impact of Left Ventricular Outflow Tract Obstruction on Coronary Physiological Assessment. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 53S:S317-S319. [PMID: 36863975 DOI: 10.1016/j.carrev.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/08/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023]
Abstract
Hypertrophic cardiomyopathy which is known to occasionally have coronary artery disease as concomitant disease may require coronary physiological assessment (Okayama et al., 2015; Shin et al., 2019 [1,2]). However, no study clarified the impact of left ventricular outflow tract obstruction on coronary physiological assessment. Herein, a case of hypertrophic obstructive cardiomyopathy concomitant with moderate coronary lesion was reported, in which dynamic change of physiological values was observed during pharmacological intervention. Specifically, fractional flow reserve (FFR) and resting full-cycle ratio (RFR) changed in an opposite fashion when the left ventricular outflow tract pressure gradient was decreased by intravenous propranolol and cibenzoline: in FFR from 0.83 to 0.79 and in RFR from 0.73 to 0.91. Cardiologists should pay attention to the presence of concomitant cardiovascular disorders in interpreting coronary physiological data.
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Affiliation(s)
- Yoshihiro Harano
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan.
| | - Yoshiaki Kawase
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Takayuki Warisawa
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan; Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
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Iwańczyk S, Woźniak P, Smukowska-Gorynia A, Araszkiewicz A, Nowak A, Jankowski M, Konwerska A, Urbanowicz T, Lesiak M. Microcirculatory Disease in Patients after Heart Transplantation. J Clin Med 2023; 12:jcm12113838. [PMID: 37298033 DOI: 10.3390/jcm12113838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
Although the treatment and prognosis of patients after heart transplantation have significantly improved, late graft dysfunction remains a critical problem. Two main subtypes of late graft dysfunction are currently described: acute allograft rejection and cardiac allograft vasculopathy, and microvascular dysfunction appears to be the first stage of both. Studies revealed that coronary microcirculation dysfunction, assessed by invasive methods in the early post-transplant period, correlates with a higher risk of late graft dysfunction and death during long-term follow-up. The index of microcirculatory resistance, measured early after heart transplantation, might identify the patients at higher risk of acute cellular rejection and major adverse cardiovascular events. It may also allow optimization and enhancement of post-transplantation management. Moreover, cardiac allograft vasculopathy is an independent prognostic factor for transplant rejection and survival rate. The studies showed that the index of microcirculatory resistance correlates with anatomic changes and reflects the deteriorating physiology of the epicardial arteries. In conclusion, invasive assessment of the coronary microcirculation, including the measurement of the microcirculatory resistance index, is a promising approach to predict graft dysfunction, especially the acute allograft rejection subtype, during the first year after heart transplantation. However, further advanced studies are needed to fully grasp the importance of microcirculatory dysfunction in patients after heart transplantation.
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Affiliation(s)
- Sylwia Iwańczyk
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-701 Poznań, Poland
| | - Patrycja Woźniak
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-701 Poznań, Poland
| | - Anna Smukowska-Gorynia
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-701 Poznań, Poland
| | | | - Alicja Nowak
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-701 Poznań, Poland
| | - Maurycy Jankowski
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 60-701 Poznań, Poland
- Department of Histology and Embryology, Poznan University of Medical Sciences, 60-701 Poznań, Poland
| | - Aneta Konwerska
- Department of Histology and Embryology, Poznan University of Medical Sciences, 60-701 Poznań, Poland
| | - Tomasz Urbanowicz
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 60-701 Poznań, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, 60-701 Poznań, Poland
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Ishihara M, Asakura M, Hibi K, Okada K, Shimizu W, Takano H, Suwa S, Fujii K, Okumura Y, Mano T, Tsujita K, Igeta M, Okamoto R, Suna S. Evolocumab for prevention of microvascular dysfunction in patients undergoing percutaneous coronary intervention: the randomised, open-label EVOCATION trial. EUROINTERVENTION 2022; 18:e647-e655. [PMID: 35837711 PMCID: PMC10241273 DOI: 10.4244/eij-d-22-00269] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/09/2022] [Indexed: 09/29/2023]
Abstract
BACKGROUND Statins have been shown to prevent microvascular dysfunction that may cause periprocedural myocardial infarction after percutaneous coronary intervention (PCI). Evolocumab has more potent lipid-lowering properties than statins. Aims: The aims of this study were to investigate whether evolocumab pretreatment on top of statin therapy could prevent periprocedural microvascular dysfunction. Methods: This study included 100 patients with stable coronary artery disease who were scheduled to undergo PCI and had high low-density lipoprotein cholesterol (LDL-C) under statin therapy. Patients were randomised to receive evolocumab 140 mg every 2 weeks for 2 to 6 weeks before PCI (evolocumab group: N=54) or not (control group: N=46). The primary endpoint was the index of microvascular resistance (IMR) after PCI. Troponin T was measured before and 24 hours after PCI. Results: Geometric mean LDL-C was 94.1 (95% confidence interval [CI]: 86.8-102.1) mg/dl and 89.4 (95% CI: 83.5-95.7) mg/dl at baseline, and 25.6 (95% CI: 21.9-30.0) mg/dl and 79.8 (95% CI: 73.9-86.3) mg/dl before PCI, in the evolocumab group and in the control group, respectively. PCI was performed 22.1±8.5 days after allocation. Geometric mean IMR was 20.6 (95% CI: 17.2-24.6) in the evolocumab group and 20.6 (95% CI: 17.0-25.0) in the control group (p=0.98). There was no significant difference in the geometric mean of post-PCI troponin T (0.054, 95% CI: 0.041-0.071 ng/ml vs 0.054, 95% CI: 0.038-0.077 ng/ml; p=0.99) and in the incidence of major periprocedural myocardial infarction between the 2 groups (44.4% vs 44.2%; p=1.00). Conclusions: Evolocumab pretreatment did not prevent periprocedural microvascular dysfunction in patients on modern medical management with statins.
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Affiliation(s)
- Masaharu Ishihara
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Masanori Asakura
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Hyogo, Japan
- Center for Clinical Research and Education, Hyogo College of Medicine, Hyogo, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Kanagawa, Japan
| | - Kozo Okada
- Division of Cardiology, Yokohama City University Medical Center, Kanagawa, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hitoshi Takano
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Kenshi Fujii
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Toshiaki Mano
- Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masataka Igeta
- Department of Biostatistics, Hyogo College of Medicine, Hyogo, Japan
| | - Rika Okamoto
- Clinical Study Support Center, Wakayama Medical University Hospital, Wakayama, Japan
| | - Shinichiro Suna
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Hyogo, Japan
- Center for Clinical Research and Education, Hyogo College of Medicine, Hyogo, Japan
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The Coronary Angiography-Derived Index of Microcirculatory Resistance Predicts Left Ventricular Performance Recovery in Patients with ST-Segment Elevation Myocardial Infarction. J Interv Cardiol 2022; 2022:9794919. [PMID: 35911662 PMCID: PMC9303485 DOI: 10.1155/2022/9794919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives The present study is designed to investigate the impact of coronary angiography-derived index of microcirculatory resistance (caIMR) on left ventricular performance recovery. Background IMR has been established as a gold standard for coronary microvascular assessment and a predictor of left ventricular recovery after ST-segment elevation myocardial infarction (STEMI). CaIMR is a novel and accurate alternative of IMR. Methods The present study retrospectively included 80 patients with STEMI who underwent primary percutaneous coronary intervention (PCI). We offline performed the post-PCI caIMR analysis of the culprit vessel. Echocardiography was performed within the first 24 hours and at 3 months after the index procedure. Left ventricular recovery was defined as the change in left ventricular ejection fraction (LVEF) more than zero. Results The mean age of the patients was 58.0 years with 80.0% male. The average post-PCI caIMR was 43.2. Overall left ventricular recovery was seen in 41 patients. Post-PCI caIMR (OR: 0.948, 95% CI: 0.916–0.981, p = 0.002), left anterior descending as the culprit vessel (OR: 3.605, 95% CI: 1.23–10.567, p = 0.019), and male (OR: 0.254, 95% CI: 0.066–0.979, p = 0.047) were independent predictors of left ventricular recovery at 3 months follow-up. A predictive model was established with the best cutoff value for the prediction of left ventricular recovery 2.33 (sensitivity 0.610, specificity 0.897, and area under the curve 0.765). In patients with a predictive model score less than 2.33, the LVEF increased significantly at 3 months. Conclusions The post-PCI caIMR can accurately predict left ventricular functional recovery at 3 months follow-up in patients with STEMI treated by primary PCI, supporting its use in clinical practice.
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Lyu WY, Qin CY, Wang XT, Shi SL, Liu HL, Wang JW. The application of myocardial contrast echocardiography in assessing microcirculation perfusion in patients with acute myocardial infarction after PCI. BMC Cardiovasc Disord 2022; 22:233. [PMID: 35596141 PMCID: PMC9123760 DOI: 10.1186/s12872-021-02404-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/23/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND To evaluate the myocardial microcirculation perfusion of patients with acute ST-segment elevation myocardial infarction (STEMI) with a different index of microcirculatory resistance (IMR) after percutaneous coronary intervention (PCI) by myocardial contrast echocardiography (MCE) and analyse the value of MCE in predicting myocardial perfusion after PCI. METHODS Fifty-six patients with acute STEMI who underwent an emergency PCI were selected from October 2018 to October 2019 in our hospital. According to the IMR values measured during PCI treatment, the patients were divided into three groups. Traditional ultrasound and MCE were performed one week after PCI. The left ventricular ejection fraction (LVEF), ventricular wall motion score index (WMSI), A value, β value and A × β value (which refers to the patient's myocardial blood flow) were measured. The receiver operating characteristic curve was drawn to evaluate the effectiveness of the MCE parameters in the diagnosis of myocardial microcirculation perfusion disorders. RESULTS The results showed that there was no significant difference in the LVEF among the groups. The WMSI in Group 3 was statistically different from that in Groups 1 and 2 (P < 0.05), but there was no statistically significant difference in the WMSI between Groups 1 and 2. Among the three groups, the A value, β value and A × β value were significantly different (P < 0.05). According to Spearman's correlation analysis, the MCE quantitative parameters (i.e. the A value, β value and A × β value) were negatively correlated with the IMR value (r = -0.523, -0.471, -0.577, P < 0.01). CONCLUSIONS The A value, β value and A × β value were negatively correlated with the IMR value. Furthermore, MCE could be used to observe the myocardial perfusion in patients with acute STEMI after PCI and may be one of the indicators used to accurately evaluate myocardial microcirculation.
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Affiliation(s)
- Wei-Yang Lyu
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Qiqihar Medical University, 37 Zhonghua West Road, Jianhua District, Qiqihar, 161006, China
| | - Chuan-Yu Qin
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Qiqihar Medical University, 37 Zhonghua West Road, Jianhua District, Qiqihar, 161006, China
| | - Xiao-Tong Wang
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Qiqihar Medical University, 37 Zhonghua West Road, Jianhua District, Qiqihar, 161006, China
| | - Sheng-Long Shi
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Qiqihar Medical University, 37 Zhonghua West Road, Jianhua District, Qiqihar, 161006, China
| | - Hui-Lin Liu
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Qiqihar Medical University, 37 Zhonghua West Road, Jianhua District, Qiqihar, 161006, China.
| | - Jia-Wei Wang
- Department of Radiology, Tongjiang People's Hospital, Tongjiang City, 156400, China
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9
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Fernández-Peregrina E, Garcia-Garcia HM, Sans-Rosello J, Sanz-Sanchez J, Kotronias R, Scarsini R, Echavarria-Pinto M, Tebaldi M, De Maria GL. Angiography-derived versus invasively-determined index of microcirculatory resistance in the assessment of coronary microcirculation: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2022; 99:2018-2025. [PMID: 35366386 DOI: 10.1002/ccd.30174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/18/2022] [Accepted: 03/14/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The index of microvascular resistance (IMR) is an established tool to assess the status of coronary microcirculation. However, the need for a pressure wire and hyperemic agents have limited its routine use and have led to the development of angiography-derived pressure-wire-free methods (angiography-derived IMR [IMRAngio]). In this review and meta-analysis, we aim to assess the global diagnosis accuracy of IMRAngio versus IMR. METHODS A systematic review of the literature was performed. Studies directly evaluating IMRAngio versus IMR were considered eligible. Pooled values of diagnostic test and summary receiver operator curve were calculated. RESULTS Seven studies directly comparing IMRAngio versus IMR were included (687 patients; 807 vessels). Pooled sensitivity, specificity, +likelihood ratio (LR), and -LR were 82%, 83%, 4.5, and 0.26 respectively. Pooled accuracy was 83% while pooled positive predictive value and negative predictive value were 76% and 85%, respectively. Comparable results were obtained when analyzing by clinical scenario (acute and nonacute coronary syndromes). CONCLUSION IMRAngio shows a good diagnostic performance for the prediction of abnormal IMR.
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Affiliation(s)
- Estefania Fernández-Peregrina
- Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA.,Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Hector M Garcia-Garcia
- Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Jordi Sans-Rosello
- Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA.,Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Jorge Sanz-Sanchez
- Departamento de Cardiología Intervencionista, Hospital de La Fe, Valencia, Spain.,Centro de Investigacion Biomedica en Red (CIBERCV), Madrid, Spain
| | - Rafail Kotronias
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | - Roberto Scarsini
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Mauro Echavarria-Pinto
- Facultad de Medicina, Hospital General ISSSTE Querétano, Universidad Autónoma de Querétano, Santiago de Querétano, Mexico
| | - Matteo Tebaldi
- Cardiovascular Institute, Azienda Ospedaliera Univertaria S. Anna, Ferrara, Italy
| | - Giovanni L De Maria
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
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10
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Bilak JM, Alam U, Miller CA, McCann GP, Arnold JR, Kanagala P. Microvascular Dysfunction in Heart Failure with Preserved Ejection Fraction: Pathophysiology, Assessment, Prevalence and Prognosis. Card Fail Rev 2022; 8:e24. [PMID: 35846985 PMCID: PMC9274364 DOI: 10.15420/cfr.2022.12] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/03/2022] [Indexed: 11/04/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) currently accounts for approximately half of all new heart failure cases in the community. HFpEF is closely associated with chronic lifestyle-related diseases, such as obesity and type 2 diabetes, and clinical outcomes are worse in those with than without comorbidities. HFpEF is pathophysiologically distinct from heart failure with reduced ejection fraction, which may explain, in part, the disparity of treatment options available between the two heart failure phenotypes. The mechanisms underlying HFpEF are complex, with coronary microvascular dysfunction (MVD) being proposed as a potential key driver in its pathophysiology. In this review, the authors highlight the evidence implicating MVD in HFpEF pathophysiology, the diagnostic approaches for identifying MVD (both invasive and non-invasive) and the prevalence and prognostic significance of MVD.
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Affiliation(s)
- Joanna M Bilak
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield HospitalLeicester, UK
| | - Uazman Alam
- Liverpool University Hospitals NHS Foundation TrustLiverpool, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Institute of Human Development, University of ManchesterManchester, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of LiverpoolLiverpool, UK
| | - Christopher A Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science CentreManchester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield HospitalLeicester, UK
| | - Jayanth R Arnold
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield HospitalLeicester, UK
| | - Prathap Kanagala
- Liverpool University Hospitals NHS Foundation TrustLiverpool, UK
- Liverpool Centre for Cardiovascular Sciences, Faculty of Health and Life SciencesLiverpool, UK
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11
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Mangiacapra F, Viscusi MM, Verolino G, Paolucci L, Nusca A, Melfi R, Ussia GP, Grigioni F. Invasive Assessment of Coronary Microvascular Function. J Clin Med 2021; 11:jcm11010228. [PMID: 35011968 PMCID: PMC8745537 DOI: 10.3390/jcm11010228] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 01/01/2023] Open
Abstract
The critical role of the coronary microvascular compartment and its invasive functional assessment has become apparent in light of the significant proportion of patients presenting signs and symptoms of myocardial ischemia, despite the absence of epicardial disease, or after the adequate treatment of it. However, coronary microvascular dysfunction (CMD) represents a diagnostic challenge because of the small dimensions of the coronary microvasculature, which prevents direct angiographic visualization. Several diagnostic tools are now available for the invasive assessment of the coronary microvascular function, which, in association with the physiological indices used to investigate the epicardial department, may provide a comprehensive evaluation of the coronary circulation as a whole. Recent evidence suggests that the physiology-guided management of CMD, although apparently costly and time-consuming, may offer a net clinical benefit in terms of symptom improvement among patients with angina and ischemic heart disease. However, despite the results of several observational studies, the prognostic effect of the physiology-driven management of CMD within this population is currently a matter of debate, and therefore represents an unmet clinical need that urgently deserves further investigation.
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12
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Minten L, McCutcheon K, Jentjens S, Vanhaverbeke M, Segers VFM, Bennett J, Dubois C. The coronary and microcirculatory measurements in patients with aortic valve stenosis study: rationale and design. Am J Physiol Heart Circ Physiol 2021; 321:H1106-H1116. [PMID: 34676781 DOI: 10.1152/ajpheart.00541.2021] [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] [Indexed: 01/09/2023]
Abstract
Although concomitant coronary artery disease (CAD) is frequent in patients with severe aortic stenosis (AS), hemodynamic assessment of CAD severity in patients undergoing valve replacement for severe AS is challenging. Myocardial hypertrophic remodeling interferes with coronary blood flow and may influence the values of fractional flow reserve (FFR) and nonhyperemic pressure ratios (NHPRs). The aim of the current study is to investigate the effect of the AS and its treatment on current indices used for evaluation of CAD. We will compare intracoronary hemodynamics before, immediately after, and 6 mo after aortic valve replacement (AVR) when it is expected that microvascular function has improved. Furthermore, we will compare FFR and resting full-cycle ratio (RFR) with myocardial perfusion single-photon emission-computed tomography (SPECT) as indicators of myocardial ischemia in patients with AS and CAD. One-hundred consecutive patients with AS and intermediate CAD will be prospectively included. Patients will undergo pre-AVR SPECT and intracoronary hemodynamic assessment at baseline, immediately after valve replacement [if transcatheter AVR (TAVR) is chosen], and 6 mo after AVR. The primary end point is the change in FFR 6 mo after AVR. Secondary end points include the acute change of FFR after TAVR, the diagnostic accuracy of FFR versus RFR compared with SPECT for the assessment of ischemia, changes in microvascular function as assessed by the index of microcirculatory resistance (IMR), and the effect of these changes on FFR. The present study will evaluate intracoronary hemodynamic parameters before, immediately after, and 6 mo after AVR in patients with AS and intermediate coronary stenosis. The understanding of the impact of AVR on the assessment of FFR, NHPR, and microvascular function may help guide the need for revascularization in patients with AS and CAD planned for AVR.
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Affiliation(s)
- Lennert Minten
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Cardiovascular Medicine, University Hospitals Leuven, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Keir McCutcheon
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Cardiovascular Medicine, University Hospitals Leuven, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Sander Jentjens
- Department of Nuclear Medicine, University Hospitals Leuven, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Maarten Vanhaverbeke
- Department of Cardiovascular Medicine, University Hospitals Leuven, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Vincent F M Segers
- Laboratory of PhysioPharmacology, University of Antwerp, Antwerp, Belgium.,Department of Cardiology, University Hospital Antwerp, Edegem, Belgium
| | - Johan Bennett
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Cardiovascular Medicine, University Hospitals Leuven, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Christophe Dubois
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Cardiovascular Medicine, University Hospitals Leuven, Universitair Ziekenhuis Leuven, Leuven, Belgium
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13
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Coronary physiologic assessment based on angiography and intracoronary imaging. J Cardiol 2021; 79:71-78. [PMID: 34384666 DOI: 10.1016/j.jjcc.2021.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 01/20/2023]
Abstract
Despite the current evidence supporting clinical benefits of fractional flow reserve (FFR), its uptake in the cardiac catheterization laboratory has been slow due to procedural cost and increased time with the need for maximum hyperemia. Recently, novel physiological indices derived from coronary angiography and intracoronary imaging have emerged to overcome issues with a wire-based FFR. Angiography-based FFR can be measured without vessel instrumentation and has shown excellent diagnostic performance using wire-based FFR as the reference standard. Thus, angiography-based FFR may facilitate coronary functional assessment before and after percutaneous coronary intervention (PCI). Angiography-based index of microcirculatory resistance (IMR) is another new computational index for assessing the coronary microcirculation. Although angiography-derived IMR remains in an early phase of development and requires further validation, its less-invasive nature may help broaden the adoption of microvascular functional assessment in various conditions such as myocardial infarction and cardiac allograft vasculopathy. Lastly, computational FFR based on intravascular ultrasound and optical coherence tomography allows detailed lesion assessment from both morphological and functional standpoints. Given a growing interest in physiology-guided PCI optimization strategies, intravascular imaging-based FFR may become the main assessment tool to confirm successful PCI.
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14
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Li Y, Zhang X, Dai Q, Ma G. Coronary flow reserve and microcirculatory resistance in patients with coronary tortuosity and without atherosclerosis. J Int Med Res 2020; 48:300060520955060. [PMID: 32954929 PMCID: PMC7509742 DOI: 10.1177/0300060520955060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective Coronary tortuosity may affect epicardial coronary arterial blood flow. This study aimed to investigate the effect of coronary tortuosity on coronary flow reserve and the coronary microcirculation in patients without apparent coronary atherosclerosis. Methods Prospective patients (n = 8, 3 men, mean age: 58 ± 6.0 years) with coronary tortuosity and without apparent coronary atherosclerosis were enrolled. Coronary tortuosity was defined by the finding of ≥three bends (defined as a ≥45° change in vessel direction) along the main trunk of the left anterior descending artery or left circumflex artery. Coronary flow reserve and the index of microcirculatory resistance were measured by the thermodilution technique. Results A total of eight coronary arteries with coronary tortuosity were analyzed. The mean fractional flow reserve was 0.98 ± 0.007. The mean coronary flow reserve was 1.5 ± 0.3, which is much lower than that in the normal coronary artery as reported in the literature. The mean index of microcirculatory resistance was 26.7 ± 2.3, which is much higher than that in the normal coronary artery. Conclusions Coronary tortuosity is associated with decreased coronary flow reserve and an increased index of microcirculatory resistance. Trial registration: This study is registered at the Chinese Clinical Trial Registry, NCT No: ChiCTR2000033671
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Affiliation(s)
- Yang Li
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Xiaoguo Zhang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Qiming Dai
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Genshan Ma
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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15
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Decreased resting coronary flow and impaired endothelial function in patients with vasospastic angina. Coron Artery Dis 2020; 30:291-296. [PMID: 30702507 DOI: 10.1097/mca.0000000000000721] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Coronary endothelial and circulatory dysfunction plays important roles in the pathogenesis of vasospastic angina (VSA). However, a complete understanding of the entire coronary circulation including microvasculature in patients with VSA is lacking. PATIENTS AND METHODS A total of 32 patients without obstructive coronary artery disease in the left descending coronary artery, who underwent an intracoronary acetylcholine (ACh) provocation test for diagnosis of VSA, were enrolled prospectively. A positive diagnosis of the ACh test was defined as total/subtotal coronary artery narrowing accompanied by chest pain and/or ischemic ECG changes. Angina frequency and severity at baseline, and 1 and 3 months were recorded. Coronary circulation was evaluated invasively using a thermodilution method by obtaining the mean transit time (Tmn) at rest and hyperemia, coronary flow reserve, and index of microcirculatory resistance. Systemic endothelial function was assessed by the reactive hyperemia index. RESULTS There were 14 (44%) and 18 (56%) patients with and without a positive ACh provocation test. The baseline characteristics did not differ significantly between the two groups. Patients with VSA had a significantly lower reactive hyperemia index compared with those without VSA (1.70±0.33 vs. 2.12±0.53, P=0.02). Coronary flow reserve, index of microcirculatory resistance, and hyperemic Tmn were not different between the two groups, whereas resting Tmn was significantly longer in patients with VSA (1.20±0.44 vs. 0.71±0.37, P=0.002). Although the frequency and severity of angina improved from baseline to 1 and 3 months in patients with both positive and negative ACh tests, there was no difference between the two groups. CONCLUSION Patients with VSA had decreased resting coronary flow and impaired endothelial function.
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16
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Index of Microcirculatory Resistance Measured during Intracoronary Adenosine-Induced Hyperemia. J Interv Cardiol 2020; 2020:4829647. [PMID: 32508541 PMCID: PMC7243016 DOI: 10.1155/2020/4829647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/09/2020] [Accepted: 03/19/2020] [Indexed: 11/24/2022] Open
Abstract
Background The index of microcirculatory resistance is an invasive measure of coronary microvascular function that has to be calculated during maximal hyperemia, classically achieved with intravenous adenosine (IV). The aim of this study was to evaluate the use of intracoronary (IC) adenosine for the calculation of IMR. Methods and Results 31 patients with stable coronary artery disease were included in the study. Coronary pressure and thermodilution measurements were obtained at rest and during maximal hyperemia using a pressure-temperature sensor-tipped coronary guidewire. Duplicate measurements were performed using first IC and then IV adenosine. Dispersion of transit times was comparable for IC and IV adenosine. IMR values based on IC vs IV adenosine showed a high level of agreement and an intraclass correlation coefficient of 0.90. Applying an upper normal limit of 25, misclassification of IMR using IC adenosine was seen in just one patient in whom IC adenosine resulted in a lower value. A simplified procedure based on a single bolus dose of saline did not change the level of agreement or the rate of misclassification. Conclusions We found an excellent agreement between IMR values measured during hyperemia induced by IC as compared to IV adenosine. The use of IC adenosine may facilitate invasive assessment of microvascular function and is potentially time- and cost-saving with less patient discomfort as compared to IV infusion. The trail is registered with NCT03369184.
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17
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Changes in Index of Microcirculatory Resistance during PCI in the Left Anterior Descending Coronary Artery in Relation to Total Length of Implanted Stents. J Interv Cardiol 2019; 2019:1397895. [PMID: 31866770 PMCID: PMC6913317 DOI: 10.1155/2019/1397895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/04/2019] [Accepted: 10/14/2019] [Indexed: 11/18/2022] Open
Abstract
Aim To investigate the relationship between stent length and changes in microvascular resistance during PCI in stable coronary artery disease (CAD). Methods and Results We measured fractional flow reserve (FFR), index of microcirculatory resistance (IMR), and coronary flow reserve (CFR) before and after stenting in 42 consecutive subjects with stable coronary artery undergoing PCI with stent in the LAD. Patients that had very long stent length (38–78 mm) had lower FFR before stenting than patients that had long (23–37 mm) and moderate (12–22 mm) stent length (0.59 (±0.16), 0.70 (±0.12), and 0.75 (±0.07); p=0.002). FFR improved after stenting and more so in subjects with very long stent length compared to long and moderate stent length (0.27 (s.d ± 16), 0.15 (s.d ± 0.12), and 0.12 (s.d ± 0.07); p for interaction = 0.013). Corrected IMR (IMRcorr) increased after stenting in subjects who had very long stent length, whereas IMRcorr was lower after stenting in subjects who had long or moderate stent length (4.6 (s.d. ± 10.7), −1.4 (s.d. ± 9,9), and −4.2 (s.d. ± 7.8); p for interaction = 0.009). Conclusions Changes in IMR during PCI in the LAD in stable CAD seem to be related to total length of stents implanted, possibly influencing post-PCI FFR. Larger studies are needed to confirm the relationship.
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18
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Yang HM, Yoon MH, Lim HS, Seo KW, Choi BJ, Choi SY, Hwang GS, Tahk SJ. Lipid-Core Plaque Assessed by Near-Infrared Spectroscopy and Procedure Related Microvascular Injury. Korean Circ J 2019; 49:1010-1018. [PMID: 31456364 PMCID: PMC6813158 DOI: 10.4070/kcj.2019.0072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/23/2019] [Accepted: 06/11/2019] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives Microvascular damage due to distal embolization during percutaneous coronary intervention (PCI) is an important cause of periprocedural myocardial infarction. We assessed the lipid-core plaque using near-infrared spectroscopy (NIRS) and microvascular dysfunction invasively with the index of microcirculatory resistance (IMR) and evaluated their relationship. Methods This study is pilot retrospective observational study. We analyzed 39 patients who performed NIRS before and after PCI, while fractional flow reserve, thermo-dilution coronary flow reserve (CFR) and IMR were measured after PCI. The maximum value of lipid core burden index (LCBI) for any of the 4-mm segments at the culprit lesion (culprit LCBI4mm) was calculated at the culprit lesion. We divided the patients into 2 groups using a cutoff of culprit LCBI4mm ≥500. Results Mean pre-PCI LCBI was 333±196 and mean post-PCI IMR was 20±14 U. Post-PCI IMR was higher (15.6±7.3 vs. 42.6±17.6 U, p<0.001) and post-PCI CFR was lower (3.7±2.2 vs. 2.1±1.0, p=0.029) in the high LCBI group. Pre-PCI LCBI was positively correlated with post-PCI IMR (ρ=0.358, p=0.025) and negatively correlated with post-PCI CFR (ρ=−0.494, p=0.001). The incidence of microvascular dysfunction (IMR ≥25 U) was higher in the high LCBI group (9.4% vs. 85.7%, p<0.001). However, there were no significant differences in the incidences of creatine Kinase-MB (9.4% vs. 14.3%, p=0.563) and troponin-I elevation (12.5% vs. 14.3%, p=1.000). Conclusions A large lipid-core plaque at the ‘culprit’ lesion is observed higher incidence of post-PCI microvascular dysfunction after PCI. Prospective study with adequate subject numbers will be needed.
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Affiliation(s)
- Hyoung Mo Yang
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Myeong Ho Yoon
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea.
| | - Hong Seok Lim
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Kyoung Woo Seo
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Byoung Joo Choi
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - So Yeon Choi
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Gyo Seung Hwang
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Seung Jea Tahk
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
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19
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Díez-Delhoyo F, Gutiérrez-Ibañes E, Sanz-Ruiz R, Vázquez-Álvarez ME, González Saldívar H, Rivera Juárez A, Sarnago F, Martínez-Sellés M, Bermejo J, Soriano J, Elízaga J, Fernández-Avilés F. Prevalence of Microvascular and Endothelial Dysfunction in the Nonculprit Territory in Patients With Acute Myocardial Infarction. Circ Cardiovasc Interv 2019; 12:e007257. [DOI: 10.1161/circinterventions.118.007257] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Felipe Díez-Delhoyo
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.D.-D., E.G.-I., R.S.-R., M.E.V.-A., H.G.-S., A.R.-J., F.S., M.M.-S., J.B., J.S., J.E., F.F.-A.)
- Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain (F.D.-D., E.G.-I., R.S.-R., M.E.V.-A., H.G.-S., A.R.-J., F.S., J.S., J.E.)
| | - Enrique Gutiérrez-Ibañes
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.D.-D., E.G.-I., R.S.-R., M.E.V.-A., H.G.-S., A.R.-J., F.S., M.M.-S., J.B., J.S., J.E., F.F.-A.)
- Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain (F.D.-D., E.G.-I., R.S.-R., M.E.V.-A., H.G.-S., A.R.-J., F.S., J.S., J.E.)
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain (E.G.-I)
| | - Ricardo Sanz-Ruiz
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.D.-D., E.G.-I., R.S.-R., M.E.V.-A., H.G.-S., A.R.-J., F.S., M.M.-S., J.B., J.S., J.E., F.F.-A.)
| | - María Eugenia Vázquez-Álvarez
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.D.-D., E.G.-I., R.S.-R., M.E.V.-A., H.G.-S., A.R.-J., F.S., M.M.-S., J.B., J.S., J.E., F.F.-A.)
- Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain (F.D.-D., E.G.-I., R.S.-R., M.E.V.-A., H.G.-S., A.R.-J., F.S., J.S., J.E.)
| | - Hugo González Saldívar
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.D.-D., E.G.-I., R.S.-R., M.E.V.-A., H.G.-S., A.R.-J., F.S., M.M.-S., J.B., J.S., J.E., F.F.-A.)
- Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain (F.D.-D., E.G.-I., R.S.-R., M.E.V.-A., H.G.-S., A.R.-J., F.S., J.S., J.E.)
| | - Allan Rivera Juárez
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.D.-D., E.G.-I., R.S.-R., M.E.V.-A., H.G.-S., A.R.-J., F.S., M.M.-S., J.B., J.S., J.E., F.F.-A.)
- Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain (F.D.-D., E.G.-I., R.S.-R., M.E.V.-A., H.G.-S., A.R.-J., F.S., J.S., J.E.)
| | - Fernando Sarnago
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.D.-D., E.G.-I., R.S.-R., M.E.V.-A., H.G.-S., A.R.-J., F.S., M.M.-S., J.B., J.S., J.E., F.F.-A.)
- Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain (F.D.-D., E.G.-I., R.S.-R., M.E.V.-A., H.G.-S., A.R.-J., F.S., J.S., J.E.)
| | - Manuel Martínez-Sellés
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.D.-D., E.G.-I., R.S.-R., M.E.V.-A., H.G.-S., A.R.-J., F.S., M.M.-S., J.B., J.S., J.E., F.F.-A.)
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, Spain (M.M.-S., J.B., F.F.-A.)
| | - Javier Bermejo
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.D.-D., E.G.-I., R.S.-R., M.E.V.-A., H.G.-S., A.R.-J., F.S., M.M.-S., J.B., J.S., J.E., F.F.-A.)
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, Spain (M.M.-S., J.B., F.F.-A.)
| | - Javier Soriano
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.D.-D., E.G.-I., R.S.-R., M.E.V.-A., H.G.-S., A.R.-J., F.S., M.M.-S., J.B., J.S., J.E., F.F.-A.)
- Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain (F.D.-D., E.G.-I., R.S.-R., M.E.V.-A., H.G.-S., A.R.-J., F.S., J.S., J.E.)
| | - Jaime Elízaga
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.D.-D., E.G.-I., R.S.-R., M.E.V.-A., H.G.-S., A.R.-J., F.S., M.M.-S., J.B., J.S., J.E., F.F.-A.)
- Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain (F.D.-D., E.G.-I., R.S.-R., M.E.V.-A., H.G.-S., A.R.-J., F.S., J.S., J.E.)
| | - Francisco Fernández-Avilés
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.D.-D., E.G.-I., R.S.-R., M.E.V.-A., H.G.-S., A.R.-J., F.S., M.M.-S., J.B., J.S., J.E., F.F.-A.)
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, Spain (M.M.-S., J.B., F.F.-A.)
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20
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Wang K, Zhang J, Zhang N, Shen Y, Wang L, Gu R, Xu B, Ji Y. Combined Primary PCI with Multiple Thrombus Burden Reduction Therapy Improved Cardiac Function in Patients with Acute Anterior Myocardial Infarction. Int Heart J 2018; 60:27-36. [PMID: 30464128 DOI: 10.1536/ihj.18-064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
High thrombus burden induced slow-flow and no-reflow during primary percutaneous coronary intervention (PCI) and is associated with a poor prognosis. We aimed to investigate whether a combined thrombus burden reduction therapy during primary PCI, could improve microcirculation and enhance cardiac function in the long-term.Anterior wall STEMI patients with high thrombus burden were randomly assigned to receive a combined thrombus burden reduction therapy or thrombus aspiration alone. The primary end points included the percentage of patients with TMPG (TIMI myocardial perfusion grade) 3, STR (ST-segment resolution) above 70%, the index of microcirculatory resistance (IMR) and left ventricular ejection fraction (LVEF) difference.Twenty-two patients in the combined interventional group and 24 in the control group completed 1-year follow-up. The percentages of patients with TMPG 3 (68.2% versus 33.3%, P = 0.006) and STR above 70% (63.6% versus 25%, P = 0.016) were significantly higher in the combined group. IMR was significantly lower in the combined interventional group (31.50 ± 13.39 U versus 62.72 ± 22.80 U, P = 0.002). At 3 months and 1 year, the overall LVEF value was better in the combined interventional group (42.1% versus 40.0%, P = 0.049; 41.9% versus 39.8%, P = 0.042), respectively. The IMR value was negatively correlated with the EF value at 3 months (r = -0.145, P = 0.013) and 1 year (r = -0.333, P = 0.031).A combined thrombus burden reduction therapy during primary PCI can safely reduce thrombus burden, improve myocardial tissue perfusion, and improve cardiac function among STEMI patients with high thrombus burden. IMR might be a good predictor for post-myocardial infarction cardiac function.
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Affiliation(s)
- Kun Wang
- Department of Cardiology, Drum Tower Hospital of Nanjing Medical University
| | - Jingmei Zhang
- Department of Cardiology, Drum Tower Hospital of Nanjing Medical University
| | - Ning Zhang
- Department of Cardiology, Drum Tower Hospital of Nanjing Medical University
| | - Yu Shen
- Department of Cardiology, Drum Tower Hospital of Nanjing Medical University
| | - Lian Wang
- Department of Cardiology, Drum Tower Hospital of Nanjing Medical University
| | - Rong Gu
- Department of Cardiology, Drum Tower Hospital of Nanjing Medical University
| | - Biao Xu
- Department of Cardiology, Drum Tower Hospital of Nanjing Medical University
| | - Yong Ji
- Key laboratory of Cardiovascular & Cerebrovascular Medicine, School of Pharmacy, Nanjing Medical University
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21
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Long-term prognostic value of invasive and non-invasive measures early after heart transplantation. Int J Cardiol 2018; 260:31-35. [PMID: 29622448 DOI: 10.1016/j.ijcard.2018.01.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 01/13/2018] [Accepted: 01/16/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Invasively assessed coronary microvascular resistance early after heart transplantation predicts worse long-term outcome; however, little is known about the relationship between microvascular resistance, left ventricular function and outcomes in this setting. METHODS A total of 100 cardiac transplant recipients had fractional flow reserve (FFR) and the index of microcirculatory resistance (IMR) measured in the left anterior descending artery and echocardiographic assessment of left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) at 1 year after heart transplantation. The primary endpoint was the composite of death and retransplantation occurring beyond the first post-operative year. RESULTS The mean FFR, IMR, LVEF, and GLS values at 1 year were 0.87 ± 0.06, 21.3 ± 17.3, 60.4 ± 5.4%, and 14.2 ± 2.4%, respectively. FFR and IMR had no significant correlation with LVEF and GLS. During a mean follow-up of 6.7 ± 4.2 years, the primary endpoint occurred in 24 patients (24.0%). By ROC curve analysis, IMR = 19.3 and GLS = 13.3% were the best cutoff values for predicting death or retransplantation. Cumulative event-free survival was significantly lower in patients with higher IMR (log-rank p = 0.02) and lower GLS (log-rank p < 0.001). Cumulative event-free survival can be further stratified by the combination of IMR and GLS (long-rank p < 0.001). By multivariable Cox proportional hazards model, higher IMR and lower GLS were independently associated with long-term death or retransplantation (elevated IMR, hazard ratio = 2.50, p = 0.04 and reduced GLS, hazard ratio = 3.79, p = 0.003, respectively). CONCLUSION Invasively assessed IMR does not correlate with GLS at 1 year after heart transplantation. IMR and GLS determined at 1 year may be used as independent predictors of late death or retransplantation.
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22
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Kobayashi Y, Lee JM, Fearon WF, Lee JH, Nishi T, Choi DH, Zimmermann FM, Jung JH, Lee HJ, Doh JH, Nam CW, Shin ES, Koo BK. Three-Vessel Assessment of Coronary Microvascular Dysfunction in Patients With Clinical Suspicion of Ischemia. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005445. [DOI: 10.1161/circinterventions.117.005445] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 10/23/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Yuhei Kobayashi
- From the Division of Cardiovascular Medicine, Stanford University, CA (Y.K., W.F.F., T.N., D.-H.C.); Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea (J.H.L.); Department of Cardiology, Catharina Hospital Eindhoven, the Netherlands (F.M.Z.); Department of Medicine, Seoul National University Hospital,
| | - Joo Myung Lee
- From the Division of Cardiovascular Medicine, Stanford University, CA (Y.K., W.F.F., T.N., D.-H.C.); Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea (J.H.L.); Department of Cardiology, Catharina Hospital Eindhoven, the Netherlands (F.M.Z.); Department of Medicine, Seoul National University Hospital,
| | - William F. Fearon
- From the Division of Cardiovascular Medicine, Stanford University, CA (Y.K., W.F.F., T.N., D.-H.C.); Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea (J.H.L.); Department of Cardiology, Catharina Hospital Eindhoven, the Netherlands (F.M.Z.); Department of Medicine, Seoul National University Hospital,
| | - Jang Hoon Lee
- From the Division of Cardiovascular Medicine, Stanford University, CA (Y.K., W.F.F., T.N., D.-H.C.); Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea (J.H.L.); Department of Cardiology, Catharina Hospital Eindhoven, the Netherlands (F.M.Z.); Department of Medicine, Seoul National University Hospital,
| | - Takeshi Nishi
- From the Division of Cardiovascular Medicine, Stanford University, CA (Y.K., W.F.F., T.N., D.-H.C.); Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea (J.H.L.); Department of Cardiology, Catharina Hospital Eindhoven, the Netherlands (F.M.Z.); Department of Medicine, Seoul National University Hospital,
| | - Dong-Hyun Choi
- From the Division of Cardiovascular Medicine, Stanford University, CA (Y.K., W.F.F., T.N., D.-H.C.); Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea (J.H.L.); Department of Cardiology, Catharina Hospital Eindhoven, the Netherlands (F.M.Z.); Department of Medicine, Seoul National University Hospital,
| | - Frederik M. Zimmermann
- From the Division of Cardiovascular Medicine, Stanford University, CA (Y.K., W.F.F., T.N., D.-H.C.); Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea (J.H.L.); Department of Cardiology, Catharina Hospital Eindhoven, the Netherlands (F.M.Z.); Department of Medicine, Seoul National University Hospital,
| | - Ji-Hyun Jung
- From the Division of Cardiovascular Medicine, Stanford University, CA (Y.K., W.F.F., T.N., D.-H.C.); Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea (J.H.L.); Department of Cardiology, Catharina Hospital Eindhoven, the Netherlands (F.M.Z.); Department of Medicine, Seoul National University Hospital,
| | - Hyun-Jung Lee
- From the Division of Cardiovascular Medicine, Stanford University, CA (Y.K., W.F.F., T.N., D.-H.C.); Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea (J.H.L.); Department of Cardiology, Catharina Hospital Eindhoven, the Netherlands (F.M.Z.); Department of Medicine, Seoul National University Hospital,
| | - Joon-Hyung Doh
- From the Division of Cardiovascular Medicine, Stanford University, CA (Y.K., W.F.F., T.N., D.-H.C.); Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea (J.H.L.); Department of Cardiology, Catharina Hospital Eindhoven, the Netherlands (F.M.Z.); Department of Medicine, Seoul National University Hospital,
| | - Chang-Wook Nam
- From the Division of Cardiovascular Medicine, Stanford University, CA (Y.K., W.F.F., T.N., D.-H.C.); Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea (J.H.L.); Department of Cardiology, Catharina Hospital Eindhoven, the Netherlands (F.M.Z.); Department of Medicine, Seoul National University Hospital,
| | - Eun-Seok Shin
- From the Division of Cardiovascular Medicine, Stanford University, CA (Y.K., W.F.F., T.N., D.-H.C.); Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea (J.H.L.); Department of Cardiology, Catharina Hospital Eindhoven, the Netherlands (F.M.Z.); Department of Medicine, Seoul National University Hospital,
| | - Bon-Kwon Koo
- From the Division of Cardiovascular Medicine, Stanford University, CA (Y.K., W.F.F., T.N., D.-H.C.); Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea (J.H.L.); Department of Cardiology, Catharina Hospital Eindhoven, the Netherlands (F.M.Z.); Department of Medicine, Seoul National University Hospital,
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23
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Jiang L, Yao H, Liang ZG. Postoperative Assessment of Myocardial Function and Microcirculation in Patients with Acute Coronary Syndrome by Myocardial Contrast Echocardiography. Med Sci Monit 2017; 23:2324-2332. [PMID: 28514327 PMCID: PMC5443357 DOI: 10.12659/msm.901233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Postoperative myocardial function and microcirculation of acute coronary syndrome (ACS) was assessed by myocardial contrast echocardiography (MCE). MATERIAL AND METHODS Eighty-nine ACS patients treated with percutaneous coronary intervention (PCI) were detected by MCE and two-dimensional ultrasonography before and a month later after PCI respectively. Their myocardial perfusion was evaluated by myocardial contrast score (MSC) and contrast score index (CSI); cross-sectional area of microvessel (A), average myocardial microvascular impairment (β), and myocardial blood flow (MBF) were analyzed by cardiac ultrasound quantitative analysis (CUSQ), and fractional flow reserve (FFR) change was observed. Left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD), and left ventricular end-systolic dimension (LVESD) were observed; the index of microcirculatory resistance (IMR), FFR, and coronary flow reserve (CFR) were detected to evaluate coronary microcirculation. RESULTS None of the 89 patients experienced no-reflow. Patients with normal myocardial perfusion mostly had normal or slightly decreased ventricular wall motion after PCI. A month after the operation, there was an increase in A, β, MBF, LVEF, E/A, IMR, FFR, and CFR (all P<0.05), while LVEDD, LVESD, diastolic gallop A peak, E/Ea, E/Ea×S, and Tei decreased (all P<0.05). LVEF and IMR were in positive correlations with A. LVEF, IMR, FFR and CFR were positively correlated with b and MBF (both r>0, P<0.05), while E/Ea×Sa and Tei were negatively correlated with b and MBF (r<0, P<0.05). CONCLUSIONS MCE can safely assess post-PCI myocardial function and microcirculation of ASC.
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Affiliation(s)
- Li Jiang
- Department of Hematology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China (mainland)
| | - Hong Yao
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Zhao-Guang Liang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
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24
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Myojo M, Ando J, Uehara M, Daimon M, Watanabe M, Komuro I. Feasibility of Extracorporeal Shock Wave Myocardial Revascularization Therapy for Post-Acute Myocardial Infarction Patients and Refractory Angina Pectoris Patients. Int Heart J 2017; 58:185-190. [PMID: 28320996 DOI: 10.1536/ihj.16-289] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Extracorporeal shockwave myocardial revascularization (ESMR) is one of the new treatment options for refractory angina pectoris (RAP), and some studies have indicated its effectiveness. A single-arm prospective trial to assess the feasibility of ESMR using Cardiospec for patients with post-acute myocardial infarction (AMI) and RAP was designed and performed. The patients were treated with 9 sessions of ESMR to the ischemic areas for 9 weeks. The feasibility measures included echocardiography; cardiac magnetic resonance imaging; troponin T, creatine kinase-MB (CK-MB), and brain natriuretic peptide testing; and a Seattle Angina Questionnaire (SAQ) survey. Three post-AMI patients and 3 RAP patients were enrolled. The post-AMI patients had already undergone revascularization with percutaneous coronary intervention (PCI) in the acute phase. In two patients, adverse events requiring admission occurred: one a lumbar disc hernia in a post-AMI patient and the other congestive heart failure resulting in death in an RAP patient. No apparent elevations in CK-MB and troponin T levels during the trial were observed. Echocardiography revealed no remarkable changes of ejection fraction; however, septal E/E' tended to decrease after treatments (11.6 ± 4.8 versus 9.2 ± 2.8, P = 0.08). Concerning the available SAQ scores for two RAP patients, one patient reported improvements in angina frequency and treatment satisfaction and the other reported improvements in physical limitations and angina stability. In this feasibility study, ESMR seems to be a safe treatment for both post-AMI patients and RAP patients. The efficacy of ESMR for post-AMI patients remains to be evaluated with additional studies.
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Affiliation(s)
- Masahiro Myojo
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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25
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Bürker BS, Gullestad L, Gude E, Relbo Authen A, Grov I, Hol PK, Andreassen AK, Arora S, Dew MA, Fiane AE, Haraldsen IR, Malt UF, Andersson S. Cognitive function after heart transplantation: Comparing everolimus-based and calcineurin inhibitor-based regimens. Clin Transplant 2017; 31. [PMID: 28185318 DOI: 10.1111/ctr.12927] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Studies have shown conflicting results concerning the occurrence of cognitive impairment after successful heart transplantation (HTx). Another unresolved issue is the possible differential impact of immunosuppressants on cognitive function. In this study, we describe cognitive function in a cohort of HTx recipients and subsequently compare cognitive function between subjects on either everolimus- or calcineurin inhibitor (CNI)-based immunosuppression. METHODS Cognitive function, covering attention, processing speed, executive functions, memory, and language functions, was assessed with a neuropsychological test battery. Thirty-seven subjects were included (everolimus group: n=20; CNI group: n=17). The extent of cerebrovascular pathology was assessed with magnetic resonance imaging. RESULTS About 40% of subjects had cognitive impairment, defined as performance at least 1.5 standard deviations below normative mean in one or several cognitive domains. Cerebrovascular pathology was present in 33.3%. There were no statistically significant differences between treatment groups across cognitive domains. CONCLUSIONS Given the high prevalence of cognitive impairment in the sample, plus the known negative impact of cognitive impairment on clinical outcome, our results indicate that cognitive assessment should be an integrated part of routine clinical follow-up after HTx. However, everolimus- and CNI-based immunosuppressive regimens did not show differential impacts on cognitive function.
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Affiliation(s)
- Britta S Bürker
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Research and Education, Oslo University Hospital - Rikshospitalet, Oslo, Norway.,Department of Psychosomatic Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Lars Gullestad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Anne Relbo Authen
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Ingelin Grov
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Per K Hol
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,The Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Arne K Andreassen
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Satish Arora
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Arnt E Fiane
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiothoracic Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Ira R Haraldsen
- Department of Psychosomatic Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Ulrik F Malt
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Research and Education, Oslo University Hospital - Rikshospitalet, Oslo, Norway
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26
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Nijjer S, Davies J. Physiologic Assessment in the Cardiac Catheterization Laboratory. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Sukhjinder Nijjer
- Hammersmith Hospital; Imperial College Healthcare NHS Trust; London UK
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27
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Lee JM, Kim CH, Koo BK, Hwang D, Park J, Zhang J, Tong Y, Jeon KH, Bang JI, Suh M, Paeng JC, Cheon GJ, Na SH, Ahn JM, Park SJ, Kim HS. Integrated Myocardial Perfusion Imaging Diagnostics Improve Detection of Functionally Significant Coronary Artery Stenosis by
13
N-ammonia Positron Emission Tomography. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.004768. [DOI: 10.1161/circimaging.116.004768] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/21/2016] [Indexed: 12/25/2022]
Abstract
Background—
Recent evidence suggests that the diagnostic accuracy of myocardial perfusion imaging is improved by quantifying stress myocardial blood flow (MBF) in absolute terms. We evaluated a comprehensive quantitative
13
N-ammonia positron emission tomography (
13
NH
3
-PET) diagnostic panel, including stress MBF, coronary flow reserve (CFR), and relative flow reserve (RFR) in conjunction with relative perfusion defect (PD) assessments to better detect functionally significant coronary artery stenosis.
Methods and Results—
A total of 130 patients (307 vessels) with coronary artery disease underwent both
13
NH
3
-PET and invasive coronary angiography with fractional flow reserve (FFR) measurement. Diagnostic accuracy, optimal cut points, and discrimination indices of respective
13
NH
3
-PET quantitative measures were compared, with FFR as standard reference. The capacity to discern disease with stepwise addition of stress MBF, CFR, and RFR to qualitatively assessed relative PD was also gauged, using the category-free net reclassification index. All quantitative measures showed significant correlation with FFR (PET-derived CFR,
r
=0.388; stress MBF,
r
=0.496; and RFR,
r
=0.780; all
P
<0.001). Optimal respective cut points for FFR ≤0.8 and ≤0.75 were 1.99 and 1.84 mL/min per g for stress MBF and 2.12 and 2.00 for PET-derived CFR. Discrimination indices of quantitative measures that correlated with FFR ≤0.8 were all significantly higher than that of relative PD (area under the curve: 0.626, 0.730, 0.806, and 0.897 for relative PD, CFR, stress MBF, and RFR, respectively; overall comparison
P
<0.001). The capacity for functionally significant coronary stenosis was incrementally improved by the successive addition of CFR (net reclassification index=0.629), stress MBF (net reclassification index=0.950), and RFR (net reclassification index=1.253; all
P
<0.001) to relative PD.
Conclusions—
Integrating quantitative
13
NH
3
-PET measures with qualitative myocardial perfusion assessment provides superior diagnostic accuracy and improves the capacity to detect functionally significant coronary artery stenosis.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifiers: NCT01621438 and NCT01366404.
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Affiliation(s)
- Joo Myung Lee
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Chee Hae Kim
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Bon-Kwon Koo
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Doyeon Hwang
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Jonghanne Park
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Jinlong Zhang
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Yaliang Tong
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Ki-Hyun Jeon
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Ji-In Bang
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Minseok Suh
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Jin Chul Paeng
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Gi Jeong Cheon
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Sang-Hoon Na
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Jung-Min Ahn
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Seung-Jung Park
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Hyo-Soo Kim
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
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Lee JM, Layland J, Jung JH, Lee HJ, Echavarria-Pinto M, Watkins S, Yong AS, Doh JH, Nam CW, Shin ES, Koo BK, Ng MK, Escaned J, Fearon WF, Oldroyd KG. Integrated physiologic assessment of ischemic heart disease in real-world practice using index of microcirculatory resistance and fractional flow reserve: insights from the International Index of Microcirculatory Resistance Registry. Circ Cardiovasc Interv 2016; 8:e002857. [PMID: 26499500 DOI: 10.1161/circinterventions.115.002857] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The index of microcirculatory resistance (IMR) is a quantitative and specific index for coronary microcirculation. However, the distribution and determinants of IMR have not been fully investigated in patients with ischemic heart disease (IHD). METHODS AND RESULTS Consecutive patients who underwent elective measurement of both fractional flow reserve (FFR) and IMR were enrolled from 8 centers in 5 countries. Patients with acute myocardial infarction were excluded. To adjust for the influence of collateral flow, IMR values were corrected with Yong's formula (IMRcorr). High IMR was defined as greater than the 75th percentile in each of the major coronary arteries. FFR≤0.80 was defined as an ischemic value. 1096 patients with 1452 coronary arteries were analyzed (mean age 61.1, male 71.2%). Mean FFR was 0.84 and median IMRcorr was 16.6 U (Q1, Q3 12.4 U, 23.0 U). There was no correlation between IMRcorr and FFR values (r=0.01, P=0.62), and the categorical agreement of FFR and IMRcorr was low (kappa value=-0.04, P=0.10). There was no correlation between IMRcorr and angiographic % diameter stenosis (r=-0.03, P=0.25). Determinants of high IMR were previous myocardial infarction (odds ratio [OR] 2.16, 95% confidence interval [CI] 1.24-3.74, P=0.01), right coronary artery (OR 2.09, 95% CI 1.54-2.84, P<0.01), female (OR 1.67, 95% CI 1.18-2.38, P<0.01), and obesity (OR 1.80, 95% CI 1.31-2.49, P<0.01). Determinants of FFR ≤0.80 were left anterior descending coronary artery (OR 4.31, 95% CI 2.92-6.36, P<0.01), angiographic diameter stenosis ≥50% (OR 5.16, 95% CI 3.66-7.28, P<0.01), male (OR 2.15, 95% CI 1.38-3.35, P<0.01), and age (per 10 years, OR 1.21, 95% CI 1.01-1.46, P=0.04). CONCLUSIONS IMR showed no correlation with FFR and angiographic lesion severity, and the predictors of high IMR value were different from those for ischemic FFR value. Therefore, integration of IMR into FFR measurement may provide additional insights regarding the relative contribution of macro- and microvascular disease in patients with ischemic heart disease. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02186093.
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Affiliation(s)
- Joo Myung Lee
- From the Department of Medicine, Seoul National University Hospital, Seoul, South Korea (J.M.L., J.-H.J., H.-J.L., B.-K.K.); Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (J.L., S.W., K.G.O.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.W., K.G.O.); Servicio de Cardiología, Hospital Clinico San Carlos, Faculty of Medicine Complutense University of Madrid, Madrid, Spain (M.E.-P., J.E.); Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (M.E.-P., J.E.); Department of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (A.S.Y., W.F.F.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.-H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea (C.-W.N.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea (E.-S.S.); Institute on Aging, Seoul National University, Seoul, South Korea (B.K.K.); and Departments of Cardiology, Royal Prince Alfred and Concord Hospitals and University of Sydney, Sydney, Australia (M.K.N.)
| | - Jamie Layland
- From the Department of Medicine, Seoul National University Hospital, Seoul, South Korea (J.M.L., J.-H.J., H.-J.L., B.-K.K.); Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (J.L., S.W., K.G.O.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.W., K.G.O.); Servicio de Cardiología, Hospital Clinico San Carlos, Faculty of Medicine Complutense University of Madrid, Madrid, Spain (M.E.-P., J.E.); Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (M.E.-P., J.E.); Department of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (A.S.Y., W.F.F.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.-H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea (C.-W.N.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea (E.-S.S.); Institute on Aging, Seoul National University, Seoul, South Korea (B.K.K.); and Departments of Cardiology, Royal Prince Alfred and Concord Hospitals and University of Sydney, Sydney, Australia (M.K.N.)
| | - Ji-Hyun Jung
- From the Department of Medicine, Seoul National University Hospital, Seoul, South Korea (J.M.L., J.-H.J., H.-J.L., B.-K.K.); Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (J.L., S.W., K.G.O.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.W., K.G.O.); Servicio de Cardiología, Hospital Clinico San Carlos, Faculty of Medicine Complutense University of Madrid, Madrid, Spain (M.E.-P., J.E.); Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (M.E.-P., J.E.); Department of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (A.S.Y., W.F.F.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.-H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea (C.-W.N.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea (E.-S.S.); Institute on Aging, Seoul National University, Seoul, South Korea (B.K.K.); and Departments of Cardiology, Royal Prince Alfred and Concord Hospitals and University of Sydney, Sydney, Australia (M.K.N.)
| | - Hyun-Jung Lee
- From the Department of Medicine, Seoul National University Hospital, Seoul, South Korea (J.M.L., J.-H.J., H.-J.L., B.-K.K.); Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (J.L., S.W., K.G.O.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.W., K.G.O.); Servicio de Cardiología, Hospital Clinico San Carlos, Faculty of Medicine Complutense University of Madrid, Madrid, Spain (M.E.-P., J.E.); Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (M.E.-P., J.E.); Department of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (A.S.Y., W.F.F.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.-H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea (C.-W.N.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea (E.-S.S.); Institute on Aging, Seoul National University, Seoul, South Korea (B.K.K.); and Departments of Cardiology, Royal Prince Alfred and Concord Hospitals and University of Sydney, Sydney, Australia (M.K.N.)
| | - Mauro Echavarria-Pinto
- From the Department of Medicine, Seoul National University Hospital, Seoul, South Korea (J.M.L., J.-H.J., H.-J.L., B.-K.K.); Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (J.L., S.W., K.G.O.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.W., K.G.O.); Servicio de Cardiología, Hospital Clinico San Carlos, Faculty of Medicine Complutense University of Madrid, Madrid, Spain (M.E.-P., J.E.); Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (M.E.-P., J.E.); Department of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (A.S.Y., W.F.F.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.-H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea (C.-W.N.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea (E.-S.S.); Institute on Aging, Seoul National University, Seoul, South Korea (B.K.K.); and Departments of Cardiology, Royal Prince Alfred and Concord Hospitals and University of Sydney, Sydney, Australia (M.K.N.)
| | - Stuart Watkins
- From the Department of Medicine, Seoul National University Hospital, Seoul, South Korea (J.M.L., J.-H.J., H.-J.L., B.-K.K.); Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (J.L., S.W., K.G.O.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.W., K.G.O.); Servicio de Cardiología, Hospital Clinico San Carlos, Faculty of Medicine Complutense University of Madrid, Madrid, Spain (M.E.-P., J.E.); Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (M.E.-P., J.E.); Department of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (A.S.Y., W.F.F.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.-H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea (C.-W.N.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea (E.-S.S.); Institute on Aging, Seoul National University, Seoul, South Korea (B.K.K.); and Departments of Cardiology, Royal Prince Alfred and Concord Hospitals and University of Sydney, Sydney, Australia (M.K.N.)
| | - Andy S Yong
- From the Department of Medicine, Seoul National University Hospital, Seoul, South Korea (J.M.L., J.-H.J., H.-J.L., B.-K.K.); Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (J.L., S.W., K.G.O.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.W., K.G.O.); Servicio de Cardiología, Hospital Clinico San Carlos, Faculty of Medicine Complutense University of Madrid, Madrid, Spain (M.E.-P., J.E.); Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (M.E.-P., J.E.); Department of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (A.S.Y., W.F.F.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.-H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea (C.-W.N.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea (E.-S.S.); Institute on Aging, Seoul National University, Seoul, South Korea (B.K.K.); and Departments of Cardiology, Royal Prince Alfred and Concord Hospitals and University of Sydney, Sydney, Australia (M.K.N.)
| | - Joon-Hyung Doh
- From the Department of Medicine, Seoul National University Hospital, Seoul, South Korea (J.M.L., J.-H.J., H.-J.L., B.-K.K.); Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (J.L., S.W., K.G.O.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.W., K.G.O.); Servicio de Cardiología, Hospital Clinico San Carlos, Faculty of Medicine Complutense University of Madrid, Madrid, Spain (M.E.-P., J.E.); Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (M.E.-P., J.E.); Department of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (A.S.Y., W.F.F.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.-H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea (C.-W.N.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea (E.-S.S.); Institute on Aging, Seoul National University, Seoul, South Korea (B.K.K.); and Departments of Cardiology, Royal Prince Alfred and Concord Hospitals and University of Sydney, Sydney, Australia (M.K.N.)
| | - Chang-Wook Nam
- From the Department of Medicine, Seoul National University Hospital, Seoul, South Korea (J.M.L., J.-H.J., H.-J.L., B.-K.K.); Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (J.L., S.W., K.G.O.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.W., K.G.O.); Servicio de Cardiología, Hospital Clinico San Carlos, Faculty of Medicine Complutense University of Madrid, Madrid, Spain (M.E.-P., J.E.); Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (M.E.-P., J.E.); Department of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (A.S.Y., W.F.F.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.-H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea (C.-W.N.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea (E.-S.S.); Institute on Aging, Seoul National University, Seoul, South Korea (B.K.K.); and Departments of Cardiology, Royal Prince Alfred and Concord Hospitals and University of Sydney, Sydney, Australia (M.K.N.)
| | - Eun-Seok Shin
- From the Department of Medicine, Seoul National University Hospital, Seoul, South Korea (J.M.L., J.-H.J., H.-J.L., B.-K.K.); Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (J.L., S.W., K.G.O.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.W., K.G.O.); Servicio de Cardiología, Hospital Clinico San Carlos, Faculty of Medicine Complutense University of Madrid, Madrid, Spain (M.E.-P., J.E.); Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (M.E.-P., J.E.); Department of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (A.S.Y., W.F.F.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.-H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea (C.-W.N.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea (E.-S.S.); Institute on Aging, Seoul National University, Seoul, South Korea (B.K.K.); and Departments of Cardiology, Royal Prince Alfred and Concord Hospitals and University of Sydney, Sydney, Australia (M.K.N.)
| | - Bon-Kwon Koo
- From the Department of Medicine, Seoul National University Hospital, Seoul, South Korea (J.M.L., J.-H.J., H.-J.L., B.-K.K.); Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (J.L., S.W., K.G.O.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.W., K.G.O.); Servicio de Cardiología, Hospital Clinico San Carlos, Faculty of Medicine Complutense University of Madrid, Madrid, Spain (M.E.-P., J.E.); Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (M.E.-P., J.E.); Department of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (A.S.Y., W.F.F.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.-H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea (C.-W.N.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea (E.-S.S.); Institute on Aging, Seoul National University, Seoul, South Korea (B.K.K.); and Departments of Cardiology, Royal Prince Alfred and Concord Hospitals and University of Sydney, Sydney, Australia (M.K.N.).
| | - Martin K Ng
- From the Department of Medicine, Seoul National University Hospital, Seoul, South Korea (J.M.L., J.-H.J., H.-J.L., B.-K.K.); Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (J.L., S.W., K.G.O.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.W., K.G.O.); Servicio de Cardiología, Hospital Clinico San Carlos, Faculty of Medicine Complutense University of Madrid, Madrid, Spain (M.E.-P., J.E.); Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (M.E.-P., J.E.); Department of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (A.S.Y., W.F.F.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.-H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea (C.-W.N.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea (E.-S.S.); Institute on Aging, Seoul National University, Seoul, South Korea (B.K.K.); and Departments of Cardiology, Royal Prince Alfred and Concord Hospitals and University of Sydney, Sydney, Australia (M.K.N.)
| | - Javier Escaned
- From the Department of Medicine, Seoul National University Hospital, Seoul, South Korea (J.M.L., J.-H.J., H.-J.L., B.-K.K.); Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (J.L., S.W., K.G.O.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.W., K.G.O.); Servicio de Cardiología, Hospital Clinico San Carlos, Faculty of Medicine Complutense University of Madrid, Madrid, Spain (M.E.-P., J.E.); Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (M.E.-P., J.E.); Department of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (A.S.Y., W.F.F.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.-H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea (C.-W.N.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea (E.-S.S.); Institute on Aging, Seoul National University, Seoul, South Korea (B.K.K.); and Departments of Cardiology, Royal Prince Alfred and Concord Hospitals and University of Sydney, Sydney, Australia (M.K.N.)
| | - William F Fearon
- From the Department of Medicine, Seoul National University Hospital, Seoul, South Korea (J.M.L., J.-H.J., H.-J.L., B.-K.K.); Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (J.L., S.W., K.G.O.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.W., K.G.O.); Servicio de Cardiología, Hospital Clinico San Carlos, Faculty of Medicine Complutense University of Madrid, Madrid, Spain (M.E.-P., J.E.); Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (M.E.-P., J.E.); Department of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (A.S.Y., W.F.F.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.-H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea (C.-W.N.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea (E.-S.S.); Institute on Aging, Seoul National University, Seoul, South Korea (B.K.K.); and Departments of Cardiology, Royal Prince Alfred and Concord Hospitals and University of Sydney, Sydney, Australia (M.K.N.)
| | - Keith G Oldroyd
- From the Department of Medicine, Seoul National University Hospital, Seoul, South Korea (J.M.L., J.-H.J., H.-J.L., B.-K.K.); Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (J.L., S.W., K.G.O.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.W., K.G.O.); Servicio de Cardiología, Hospital Clinico San Carlos, Faculty of Medicine Complutense University of Madrid, Madrid, Spain (M.E.-P., J.E.); Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (M.E.-P., J.E.); Department of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (A.S.Y., W.F.F.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.-H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea (C.-W.N.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea (E.-S.S.); Institute on Aging, Seoul National University, Seoul, South Korea (B.K.K.); and Departments of Cardiology, Royal Prince Alfred and Concord Hospitals and University of Sydney, Sydney, Australia (M.K.N.)
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Kobayashi Y, Fearon WF, Honda Y, Tanaka S, Pargaonkar V, Fitzgerald PJ, Lee DP, Stefanick M, Yeung AC, Tremmel JA. Effect of Sex Differences on Invasive Measures of Coronary Microvascular Dysfunction in Patients With Angina in the Absence of Obstructive Coronary Artery Disease. JACC Cardiovasc Interv 2016; 8:1433-1441. [PMID: 26404195 DOI: 10.1016/j.jcin.2015.03.045] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/01/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study investigated sex differences in coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR) in patients with angina in the absence of obstructive coronary artery disease. BACKGROUND Coronary microvascular dysfunction is associated with worse long-term outcomes, especially in women. Coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR) are 2 methods of assessing the coronary microcirculation. METHODS We prospectively enrolled 117 women and 40 men with angina in the absence of obstructive coronary artery disease. We performed CFR, IMR, fractional flow reserve, and quantitative coronary angiography in the left anterior descending artery. Coronary flow was assessed with a thermodilution method by obtaining mean transit time (Tmn) (an inverse correlate to absolute flow) at rest and hyperemia. RESULTS All patients had minimal atherosclerosis by quantitative coronary angiography (% diameter stenosis: 23.2 ± 12.3%), and epicardial disease was milder in women (fractional flow reserve: 0.88 ± 0.04 vs. 0.87 ± 0.04; p = 0.04). IMR was similar between the sexes (20.7 ± 9.8 vs. 19.1 ± 8.0; p = 0.45), but CFR was lower in women (3.8 ± 1.6 vs. 4.8 ± 1.9; p = 0.004). This was primarily due to a shorter resting Tmn in women (p = 0.005), suggesting increased resting coronary flow, whereas hyperemic Tmn was identical (p = 0.79). In multivariable analysis, female sex was an independent predictor of lower CFR and shorter resting Tmn. CONCLUSIONS Despite similar microvascular function in women and men by IMR, CFR is lower in women. This discrepancy appears to be due to differences in resting coronary flow between the sexes. The effect of sex differences should be considered in interpretation of physiological indexes using resting coronary flow.
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Affiliation(s)
- Yuhei Kobayashi
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - William F Fearon
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - Yasuhiro Honda
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - Shigemitsu Tanaka
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - Vedant Pargaonkar
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - Peter J Fitzgerald
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - David P Lee
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - Marcia Stefanick
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - Alan C Yeung
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - Jennifer A Tremmel
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California.
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van de Sande DAJP, Breuer MAW, Kemps HMC. Utility of Exercise Electrocardiography in Pre-participation Screening in Asymptomatic Athletes: A Systematic Review. Sports Med 2016; 46:1155-64. [DOI: 10.1007/s40279-016-0501-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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31
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LeBlanc AJ, Hoying JB. Adaptation of the Coronary Microcirculation in Aging. Microcirculation 2016; 23:157-67. [DOI: 10.1111/micc.12264] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023]
Affiliation(s)
- Amanda J. LeBlanc
- Department of Physiology; Cardiovascular Innovation Institute; University of Louisville; Louisville Kentucky USA
| | - James B. Hoying
- Department of Physiology; Cardiovascular Innovation Institute; University of Louisville; Louisville Kentucky USA
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32
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Berry C, Corcoran D, Hennigan B, Watkins S, Layland J, Oldroyd KG. Fractional flow reserve-guided management in stable coronary disease and acute myocardial infarction: recent developments. Eur Heart J 2015; 36:3155-64. [PMID: 26038588 PMCID: PMC4816759 DOI: 10.1093/eurheartj/ehv206] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/09/2015] [Accepted: 05/03/2015] [Indexed: 01/10/2023] Open
Abstract
Coronary artery disease (CAD) is a leading global cause of morbidity and mortality, and improvements in the diagnosis and treatment of CAD can reduce the health and economic burden of this condition. Fractional flow reserve (FFR) is an evidence-based diagnostic test of the physiological significance of a coronary artery stenosis. Fractional flow reserve is a pressure-derived index of the maximal achievable myocardial blood flow in the presence of an epicardial coronary stenosis as a ratio to maximum achievable flow if that artery were normal. When compared with standard angiography-guided management, FFR disclosure is impactful on the decision for revascularization and clinical outcomes. In this article, we review recent developments with FFR in patients with stable CAD and recent myocardial infarction. Specifically, we review novel developments in our understanding of CAD pathophysiology, diagnostic applications, prognostic studies, clinical trials, and clinical guidelines.
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Affiliation(s)
- Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - David Corcoran
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - Barry Hennigan
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | | | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
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Echavarría-Pinto M, Serruys PW, Garcia-Garcia HM, Broyd C, Cerrato E, Macaya C, Escaned J. Use of intracoronary physiology indices in acute coronary syndromes. Interv Cardiol 2015. [DOI: 10.2217/ica.15.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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34
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Thermodilutional Confirmation of Coronary Microvascular Dysfunction in Patients With Recurrent Angina After Successful Percutaneous Coronary Intervention. Can J Cardiol 2015; 31:989-97. [DOI: 10.1016/j.cjca.2015.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 03/01/2015] [Accepted: 03/02/2015] [Indexed: 12/27/2022] Open
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35
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Kobayashi Y, Tremmel JA. The relationship between fractional flow reserve and index of microcirculatory resistance: be careful with whom you associate. Catheter Cardiovasc Interv 2015; 85:593-4. [PMID: 25702909 DOI: 10.1002/ccd.25850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/18/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Yuhei Kobayashi
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California
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36
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Corcoran D, Berry C, Oldroyd K. Current frontiers in the clinical research of coronary physiology. Interv Cardiol 2015. [DOI: 10.2217/ica.14.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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37
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Faccini A, Agricola E, Oppizzi M, Margonato A, Galderisi M, Sabbadini MG, Franchini S, Camici PG. Coronary Microvascular Dysfunction in Asymptomatic Patients Affected by Systemic Sclerosis – Limited vs. Diffuse Form –. Circ J 2015; 79:825-9. [DOI: 10.1253/circj.cj-14-1114] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Alessia Faccini
- Vita-Salute San Raffaele University and San Raffaele Scientific Institute
| | - Eustachio Agricola
- Vita-Salute San Raffaele University and San Raffaele Scientific Institute
| | - Michele Oppizzi
- Vita-Salute San Raffaele University and San Raffaele Scientific Institute
| | - Alberto Margonato
- Vita-Salute San Raffaele University and San Raffaele Scientific Institute
| | | | | | - Stefano Franchini
- Vita-Salute San Raffaele University and San Raffaele Scientific Institute
| | - Paolo G Camici
- Vita-Salute San Raffaele University and San Raffaele Scientific Institute
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Drenjancevic I, Koller A, Selthofer-Relatic K, Grizelj I, Cavka A. Assessment of coronary hemodynamics and vascular function. Prog Cardiovasc Dis 2014; 57:423-30. [PMID: 25460847 DOI: 10.1016/j.pcad.2014.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Coronary blood flow closely matches to metabolic demands of heart and myocardial oxygen consumption and is conditioned by function of coronary resistance vessels. The microvascular endothelium of coronary resistance vessels is exposed to a spatially and temporally regulated input from cardiomyocytes and the haemodynamic forces of the cardiac cycle. Functional measurements of coronary pressure and flow are important approaches that provide complementary information on the function of coronary vessel function that could not be assessed by the methods utilized for the anatomic characterization of coronary disease, such as coronary angiography. The goal of this paper is to review the methodologies for assessment of coronary vascular function and haemodynamics which are utilized in research and to discuss their potential applicability in the clinical settings.
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Affiliation(s)
- Ines Drenjancevic
- Faculty of Medicine Osijek, University of Osijek, Department of Physiology and Immunology, Osijek, Croatia.
| | - Akos Koller
- Department of Physiology and Gerontology, Medical School and Szentagothai Research Centre, University of Pecs, Hungary, Department of Pathophysiology, Semmelweis University, Budapest, Hungary, Department of Physiology New York Medical College, Valhalla NY 10595, USA; Walhala University NW, USA
| | - Kristina Selthofer-Relatic
- Faculty of Medicine Osijek, University of Osijek, Dept of Internal Medicine, Osijek, Croatia; Clinical Hospital Center Osijek, Clinic for Internal Diseases, Osijek, Croatia
| | - Ivana Grizelj
- Faculty of Medicine Osijek, University of Osijek, Department of Physiology and Immunology, Osijek, Croatia
| | - Ana Cavka
- Faculty of Medicine Osijek, University of Osijek, Department of Physiology and Immunology, Osijek, Croatia
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Facing the complexity of ischaemic heart disease with intracoronary pressure and flow measurements. Curr Opin Cardiol 2014; 29:564-70. [DOI: 10.1097/hco.0000000000000110] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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