1
|
Mohammed AA, Li S, Zhang H, Abdu FA, Mohammed AQ, Zhang W, Al-Hashedi EM, Xu Y, Che W. Prognostic impact of coronary microvascular dysfunction in patients with atrial fibrillation. Microvasc Res 2024; 154:104685. [PMID: 38593952 DOI: 10.1016/j.mvr.2024.104685] [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: 01/30/2024] [Revised: 03/30/2024] [Accepted: 04/04/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) is frequently observed in atrial fibrillation (AF), the most commonly sustained arrhythmia. Nevertheless, an in-depth prognostic significance of CMD in AF is lacking. We aimed to provide insight into the predictive impact of CMD assessed by a novel non-invasive coronary angiography-derived index of microcirculatory resistance (caIMR) for major adverse events (MACE) in AF patients. METHOD This study included patients with AF who underwent invasive coronary angiography due to suspected cardiac ischemia and did not exhibit obstructive epicardial coronary artery disease (≤50 % stenosis). The caIMR was prospectively evaluated, and the optimal cutoff value for predicting MACE was determined through ROC analysis. RESULT A total of 463 patients with AF were enrolled. During a median of 33 months of follow-up, 111 (23.97 %) patients had MACE endpoints. The best caIMR cutoff value was 39.28. In patients with MACE, both the mean caIMR and the prevalence of elevated caIMR (caIMR>39.28) were significantly higher compared to those without MACE. An elevated caIMR was linked to a higher risk of MACE (log-rank P < 0.001) and emerged as an independent predictor of clinical outcomes (HR: 4.029; 95 % CI: 2.529-6.418; P < 0.001). In addition, the risk of MACE was higher in high caIMR patients with non-paroxysmal AF (log-rank P < 0.001) and no catheter ablation (log-rank P < 0.001). CONCLUSION Elevated caIMR is common and showed a vital independent prognostic significance in AF patients. In addition to well-known risk factors, assessment of microvascular function can be a feasible approach for early prevention and a therapeutic target in AF patients.
Collapse
Affiliation(s)
- Ayman A Mohammed
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Department of Internal Medicine, Faculty of Medicine and Health Science, Taiz University, Yemen
| | - Siqi Li
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hengbin Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fuad A Abdu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Abdul-Quddus Mohammed
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wen Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ekhlas Mahmoud Al-Hashedi
- Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University Xi'an, Shaanxi, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenliang Che
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Department of Cardiology, Shanghai Tenth People's Hospital Chongming branch, Shanghai, China.
| |
Collapse
|
2
|
Madsen S, Kjaerulff MLG, Ejlersen JA, Ranghøj Nielsen BR, Jakobsen L, Sörensen J, Tolbod LP, Gormsen LC. Guiding early revascularization using [15O]H2O positron emission tomography myocardial perfusion imaging: impact of atrial fibrillation. Eur Heart J Cardiovasc Imaging 2024; 25:958-967. [PMID: 38376457 DOI: 10.1093/ehjci/jeae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/20/2023] [Accepted: 02/03/2024] [Indexed: 02/21/2024] Open
Abstract
AIMS Myocardial perfusion imaging (MPI) using [15O]H2O positron emission tomography (PET) is used to guide the selection of patients with angina for invasive angiography and possible revascularization. Our study evaluated (i) whether atrial fibrillation (AF) reduces global hyperaemic myocardial blood flow (MBF) and (ii) whether [15O]H2O PET MPI effectively guides revascularization procedures for patients with ongoing AF. METHODS AND RESULTS We prospectively recruited 346 patients with angina and persistent or paroxysmal AF referred for baseline/hyperaemic [15O]H2O PET MPI. The primary outcome was revascularization within 3 months of MPI. In the analyses, patients were divided into four groups based on whether they had ongoing AF or sinus rhythm (SR) and whether they had previously documented coronary artery disease (CAD) or not. Thus, four groups were compared: SR-noCAD, AF-noCAD, SR-CAD, and AF-CAD. Hyperaemic MBF was affected by both ongoing AF and prior CAD [MBF (mL/min/g): 2.82 (SR-noCAD) vs. 2.12 (AF-noCAD) vs. 2.22 (SR-CAD) vs. 1.80 (AF-CAD), two-way analysis of variance P < 0.0001]. In multiple linear regression, ongoing AF was independently associated with reduced hyperaemic MBF. Every 0.1 mL/min/g decrease in hyperaemic MBF was associated with a 23% increase in odds of early revascularization. Receiver operating characteristic (ROC) analysis of vessel-specific hyperaemic MBF to predict early revascularization yielded the following areas under the ROC curve: SR-noCAD: 0.95 (P < 0.0001); AF-noCAD: 0.79 (P < 0.0001); SR-CAD: 0.78 (P < 0.0001); and AF-CAD: 0.88 (P < 0.0001). CONCLUSION Ongoing AF is associated with 19-25% reduced global hyperaemic MBF as measured by [15O]H2O MPI PET. Regardless, vessel-specific hyperaemic MBF still predicts early revascularization in patients with AF.
Collapse
Affiliation(s)
- Simon Madsen
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, Aarhus N DK-8200, Denmark
| | - Mette Louise Gram Kjaerulff
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, Aarhus N DK-8200, Denmark
| | - June Anita Ejlersen
- Department of Physiology and Nuclear Medicine, Regional Hospital Viborg, Viborg, Denmark
| | | | - Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Jens Sörensen
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, Aarhus N DK-8200, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard, 998200 Aarhus N, Denmark
| | - Lars Poulsen Tolbod
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, Aarhus N DK-8200, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard, 998200 Aarhus N, Denmark
| | - Lars Christian Gormsen
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, Aarhus N DK-8200, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard, 998200 Aarhus N, Denmark
| |
Collapse
|
3
|
Takahashi M, Arai T, Kimura T, Hojo R, Hiraoka M, Fukamizu S. Relationship between coronary blood flow and improvement of cardiac function after catheter ablation for persistent atrial fibrillation. J Interv Card Electrophysiol 2023; 66:2063-2070. [PMID: 37043092 DOI: 10.1007/s10840-023-01542-8] [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: 01/19/2023] [Accepted: 03/27/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND The relationship between coronary blood flow during atrial fibrillation (AF) and improvement of cardiac function after catheter ablation (CA) for persistent AF (PeAF) is not prominent; this study was conducted to evaluate this relationship. METHODS This was a retrospective case-control study. Eighty-five patients with PeAF (resting heart rate < 100 bpm) and heart failure with reduced ejection fraction (left ventricular ejection fraction (LVEF) < 40%) who had undergone coronary angiography within 1 week before CA were included. All patients could maintain a sinus rhythm for > 6 months after CA. The primary outcome was improvement of cardiac function with an LVEF cutoff value of > 50% during sinus rhythm 6 months after CA. RESULTS In the LVEF improvement group (N = 57), patients were younger, with a higher baseline diastolic blood pressure and lower baseline brain natriuretic peptide level than the no LVEF improvement group (N = 28). Heart rate at baseline and 6 months after CA and AF duration did not differ between the two groups. Thrombolysis in myocardial infarction frame count parameters was significantly higher in the LVEF improvement (P < 0.001) than in the no LVEF improvement group. Multivariate logistic regression analysis revealed mean thrombolysis in myocardial infarction frame count as an independent factor for LVEF improvement (odds ratio, 1.72 (95% confidence interval 1.17-2.54); P = 0.006). CONCLUSION Coronary blood flow in patients with PeAF is strongly associated with improved left ventricular systolic function after the restoration of sinus rhythm by CA for PeAF and heart failure with reduced ejection fraction.
Collapse
Affiliation(s)
- Masao Takahashi
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan.
| | - Tomoyuki Arai
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Takashi Kimura
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Rintaro Hojo
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | | | - Seiji Fukamizu
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| |
Collapse
|
4
|
Black N, Mohammad F, Saraf K, Morris G. Endothelial function and atrial fibrillation: A missing piece of the puzzle? J Cardiovasc Electrophysiol 2021; 33:109-116. [PMID: 34674346 DOI: 10.1111/jce.15277] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/14/2021] [Accepted: 10/18/2021] [Indexed: 12/15/2022]
Abstract
Endothelial dysfunction, a term used to describe both the physical damage and dysregulated physiology of this endothelial lining, is an increasingly recognized pathophysiological state shared by many cardiovascular diseases. Historically, the role of endothelial dysfunction in atrial fibrillation (AF) was thought to be limited to mediating atrial thromboembolism. However, there is emerging evidence that endothelial dysfunction both promotes and maintains atrial arrhythmic substrate, predicts adverse outcomes, and identifies patients at high risk of recurrence following cardioversion and ablation therapy. Treatments targeted at improving endothelial function also represent a promising new therapeutic paradigm in AF. This review summarizes the current understanding of endothelial function in AF.
Collapse
Affiliation(s)
- Nicholas Black
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Fahad Mohammad
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Karan Saraf
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Gwilym Morris
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK.,Manchester Heart Centre, Manchester Academic Health Science Centre, Manchester University Foundation Trust, Manchester, UK
| |
Collapse
|
5
|
Impaired coronary flow reserve evaluated by phase-contrast cine magnetic resonance imaging in patients with atrial fibrillations. Heart Vessels 2021; 36:775-781. [PMID: 33484290 DOI: 10.1007/s00380-020-01759-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
Myocardial perfusion and perfusion reserve are diminished in patients with atrial fibrillation (AF). Phase-contrast (PC) cine magnetic resonance imaging (MRI) of the coronary sinus serves as a non-invasive means of quantifying coronary flow reserve (CFR) without any radioactive tracer. The present study aimed to evaluate the utility of PC cine MRI of the coronary sinus for assessing decreased CFR in patients with AF. We studied 362 patients with known or suspected coronary artery disease (CAD) [age 72 ± 9 years; 267 (74%) male; 90 (25%) had AF] and 20 age- and gender-matched control subjects [age 72 ± 9 years, 14 (70%) male]. Using a 1.5-T MR scanner and cardiac coils, blood flow of the coronary sinus (CBF) was quantified by PC cine MRI. CFR was calculated as CBF during adenosine triphosphate infusion divided by CBF at rest. CFR was significantly lower in patients with AF than in those without AF among all patients (n = 362) (2.45 ± 0.42 vs. 2.71 ± 0.58, p < 0.001), in patients with known CAD (n = 155) (2.40 ± 0.46 vs. 2.72 ± 0.58, p = 0.002), and in those with suspected CAD (n = 207) (2.49 ± 0.40 vs. 2.72 ± 0.59, p = 0.007). Significant differences in CFR were found between controls and patients without AF (3.12 ± 0.52 vs. 2.71 ± 0.58, p < 0.001). AF was independently associated with CFR in both known CAD patients [β = - 0.248, 95% confidence interval (CI): - 0.561 to - 0.119, p = 0.003) and suspected CAD patients (β = - 0.154, 95% CI - 0.353 to - 0.034, p = 0.018). The presence of AF was related to impaired CFR in both known and suspected CAD patients. PC cine MRI of the coronary sinus can be useful for detecting impaired CFR in patients with AF.
Collapse
|
6
|
Maaniitty T, Knuuti J, Saraste A. 15O-Water PET MPI: Current Status and Future Perspectives. Semin Nucl Med 2020; 50:238-247. [PMID: 32284110 DOI: 10.1053/j.semnuclmed.2020.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Myocardial perfusion imaging with 15O-water positron emission tomography (PET) is a validated tool for quantitative measurement of myocardial blood flow (MBF) and myocardial flow reserve (MFR). Current scanner and software technology enable quantification of global and regional MBF in clinical PET myocardial perfusion imaging studies. Reduced stress MBF or MFR measured by 15O-water PET accurately detects hemodynamically significant coronary artery stenosis defined by intracoronary fractional flow reserve (FFR) measurement in patients with suspected obstructive coronary artery disease (CAD). Furthermore, MBF and MFR provide prognostic information on mortality and risk of myocardial infarction. Clinical experience in some centers indicates that clinical application of 15O-water PET in evaluation of CAD is feasible and guides management decisions on revascularization. This review discusses basic concepts of measuring MBF with 15O-water PET and reviews clinical studies on its application in evaluation of obstructive CAD.
Collapse
Affiliation(s)
- Teemu Maaniitty
- Turku PET Centre, University of Turku, Turku, Finland; Department of Clinical Physiology, Nuclear Medicine and PET, Turku University Hospital, Turku, Finland.
| | - Juhani Knuuti
- Turku PET Centre, University of Turku, Turku, Finland; Department of Clinical Physiology, Nuclear Medicine and PET, Turku University Hospital, Turku, Finland
| | - Antti Saraste
- Turku PET Centre, University of Turku, Turku, Finland; Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| |
Collapse
|
7
|
Vatasescu R, Bogdan S, Deaconu A. Coronary Microcirculation and Arrhythmias: The Two Faces of a Janus. Microcirculation 2020. [DOI: 10.1007/978-3-030-28199-1_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
8
|
Kaya A, Keskin M, Tatlisu MA, Uzman O, Borklu E, Cinier G, Yildirim E, Kayapinar O. Atrial Fibrillation: A Novel Risk Factor for No-Reflow Following Primary Percutaneous Coronary Intervention. Angiology 2019; 71:175-182. [DOI: 10.1177/0003319719840589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
There is a lack of evidence regarding the association of atrial fibrillation (AF) and no-reflow (NR) phenomenon in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (pPCI). A total of 2452 patients with STEMI who underwent pPCI were retrospectively investigated. After exclusions, 370 (14.6%) patients were in the AF group and 2095 (85.4%) were in the No-AF group. Patients with a thrombolysis in myocardial infarction flow rate <3 were defined as having NR. Patients in the AF group were older and had higher 3-vessel disease rates (24.1% vs 18.9%; P = .021) and lower left ventricular ejection fraction (45.4 [11.7] vs 48.7 [10.5%]; P < .001). No-reflow rates were higher in the AF group than in the No-AF group (29.1% vs 11.8%; P < .001). According to multivariable analysis, AF (odds ratio: 1.81, 95% confidence interval: 1.63-2.04, P < .001), age, Killip class, anterior myocardial infarction, diabetes mellitus, chronic kidney disease, stent length, and smoking were independent predictors of NR following pPCI. Atrial fibrillation is a quite common arrhythmia in patients with STEMI. Atrial fibrillation was found to be an independent predictor of NR in the current study. This effect of AF on coronary flow rate might be considered as an important risk factor in STEMI.
Collapse
Affiliation(s)
- Adnan Kaya
- Cardiology, Duzce University School of Medicine, Duzce, Turkey
| | - Muhammed Keskin
- Cardiology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | | | - Osman Uzman
- Cardiology, Dr Siyami Ersek Cardiovascular Surgery Hospital, Istanbul, Turkey
| | - Edibe Borklu
- Cardiology, Dr Siyami Ersek Cardiovascular Surgery Hospital, Istanbul, Turkey
| | - Goksel Cinier
- Cardiology, Dr Siyami Ersek Cardiovascular Surgery Hospital, Istanbul, Turkey
| | - Ersin Yildirim
- Cardiology, Dr Siyami Ersek Cardiovascular Surgery Hospital, Istanbul, Turkey
| | - Osman Kayapinar
- Cardiology, Duzce University School of Medicine, Duzce, Turkey
| |
Collapse
|
9
|
Byrne C, Hasbak P, Kjær A, Thune JJ, Køber L. Myocardial perfusion during atrial fibrillation in patients with non-ischaemic systolic heart failure: a cross-sectional study using Rubidium-82 positron emission tomography/computed tomography. Eur Heart J Cardiovasc Imaging 2019; 20:233-240. [PMID: 29992262 DOI: 10.1093/ehjci/jey089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/12/2018] [Indexed: 11/14/2022] Open
Abstract
Aims Patients with non-ischaemic systolic heart failure often have reduced myocardial blood flow without significant coronary atherosclerosis. Likewise, patients with atrial fibrillation (AF) have reduced myocardial perfusion during AF compared with sinus rhythm. The aim of this study was to explore whether there is an additive negative effect of AF during scan on the myocardial perfusion in patients with non-ischaemic systolic heart failure. Methods and results We included 27 young healthy controls and 114 patients with non-ischaemic systolic heart failure to a Rubidium-82 positron emission tomography/computed tomography perfusion scan (23 with AF during scan). To obtain the myocardial flow reserve (MFR = stress flow/rest flow), patients were scanned at rest and during adenosine-induced stress. Among patients, those with AF were older [years: 73; interquartile range (IQR) 65-78 vs. 67; IQR 60-74; P = 0.03] and more were men (87% vs. 62%; P = 0.02). Distribution of sex in controls did not differ from either patient group. Patients with AF had significantly lower MFR than patients without [MFR: 1.87; 95% confidence interval (CI) 1.58-2.22 vs. 2.50; 95% CI 2.06-2.86; percent difference: -21.5%; P = 0.01]. MFR remained significantly lower in the group with AF (estimate -24.2%; 95% CI -39.6% to -4.8%; P = 0.02) in an adjusted multivariable regression analysis. Further, patients had lower MFR compared with controls: 3.46; 95% CI 3.03-3.94; P < 0.0001. Additionally, coronary vascular resistance was highest in patients with AF and lowest in controls. Conclusion Patients with systolic heart failure had lower flow reserve than healthy controls and even lower MFR if they had AF during scan.
Collapse
Affiliation(s)
- Christina Byrne
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet 9841, Blegdansvej 9, Copenhagen, Denmark.,Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Copenhagen University Hospital Rigshospitalet, 4011, Blegdamsvej 9, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen, Denmark
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Copenhagen University Hospital Rigshospitalet, 4011, Blegdamsvej 9, Copenhagen, Denmark
| | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Copenhagen University Hospital Rigshospitalet, 4011, Blegdamsvej 9, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen, Denmark
| | - Jens Jakob Thune
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital Bispebjerg Hospital, Ebba Lunds Vej 44, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet 9841, Blegdansvej 9, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen, Denmark
| |
Collapse
|
10
|
White RD, Kirsch J, Bolen MA, Batlle JC, Brown RK, Eberhardt RT, Hurwitz LM, Inacio JR, Jin JO, Krishnamurthy R, Leipsic JA, Rajiah P, Shah AB, Singh SP, Villines TC, Zimmerman SL, Abbara S. ACR Appropriateness Criteria® Suspected New-Onset and Known Nonacute Heart Failure. J Am Coll Radiol 2018; 15:S418-S431. [DOI: 10.1016/j.jacr.2018.09.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/07/2018] [Indexed: 12/21/2022]
|
11
|
Yuan SM. Cardiomyopathy in the pediatric patients. Pediatr Neonatol 2018; 59:120-128. [PMID: 29454680 DOI: 10.1016/j.pedneo.2017.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/16/2017] [Accepted: 05/09/2017] [Indexed: 10/18/2022] Open
Abstract
Pediatric cardiomyopathies are a group of myocardial diseases with complex taxonomies. Cardiomyopathy can occur in children at any age, and it is a common cause of heart failure and heart transplantation in children. The incidence of pediatric cardiomyopathy is increasing with time. They may be associated with variable comorbidities, which are most often arrhythmia, heart failure, and sudden death. Medical imaging technologies, including echocardiography, cardiac magnetic resonance, and nuclear cardiology, are helpful in reaching a diagnosis of cardiomyopathy. Nevertheless, endomyocardial biopsy is the final diagnostic method of diagnosis. Patients warrant surgical operations, such as palliative operations, bridging operations, ventricular septal maneuvers, and heart transplantation, if pharmaceutical therapies are ineffective. Individual therapeutic regimens due to pediatric characteristics, genetic factors, and pathogenesis may improve the effects of treatment and patients' survival.
Collapse
Affiliation(s)
- Shi-Min Yuan
- Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian Province, People's Republic of China.
| |
Collapse
|
12
|
Byrne C, Hasbak P, Kjaer A, Thune JJ, Køber L. Myocardial perfusion in patients with non-ischaemic systolic heart failure and type 2 diabetes: a cross-sectional study using Rubidium-82 PET/CT. Int J Cardiovasc Imaging 2017; 34:993-1001. [DOI: 10.1007/s10554-017-1295-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/22/2017] [Indexed: 11/29/2022]
|
13
|
Bravo PE, Di Carli MF, Dorbala S. Role of PET to evaluate coronary microvascular dysfunction in non-ischemic cardiomyopathies. Heart Fail Rev 2017; 22:455-464. [PMID: 28577279 PMCID: PMC6214157 DOI: 10.1007/s10741-017-9628-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Coronary microvascular dysfunction (CMD) can result from structural and functional abnormalities at the intramural and small coronary vessel level affecting coronary blood flow autoregulation and consequently leading to impaired coronary flow reserve. CMD often co-exists with epicardial coronary artery disease but is also commonly seen in patients with various forms of heart disease, including dilated, hypertrophic, and infiltrative cardiomyopathies. CMD can go unnoticed without any symptoms, or manifest as angina, and/or dyspnea, and contribute to the development of heart failure, and even sudden death especially when co-existing with myocardial fibrosis. However, whether CMD in non-ischemic cardiomyopathy is a cause or an effect of the underlying cardiomyopathic process, or whether it can be potentially modifiable with specific therapies, remains incompletely understood.
Collapse
Affiliation(s)
- Paco E Bravo
- Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, 70 Francis Street, Shapiro 5th Floor, Room 128, Boston, MA, 02115, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- The Noninvasive Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, MA, USA
- Departments of Medicine (Cardiology) and Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Cardiac Amyloidosis Program, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Heart & Vascular Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Marcelo F Di Carli
- Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, 70 Francis Street, Shapiro 5th Floor, Room 128, Boston, MA, 02115, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- The Noninvasive Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, MA, USA
- Departments of Medicine (Cardiology) and Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Cardiac Amyloidosis Program, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Heart & Vascular Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, 70 Francis Street, Shapiro 5th Floor, Room 128, Boston, MA, 02115, USA.
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
- The Noninvasive Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, MA, USA.
- Departments of Medicine (Cardiology) and Radiology, Brigham and Women's Hospital, Boston, MA, USA.
- Cardiac Amyloidosis Program, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
- Heart & Vascular Center, Brigham and Women's Hospital, Boston, MA, USA.
| |
Collapse
|
14
|
Manuguerra R, Callegari S, Corradi D. Inherited Structural Heart Diseases With Potential Atrial Fibrillation Occurrence. J Cardiovasc Electrophysiol 2015; 27:242-52. [PMID: 26519209 DOI: 10.1111/jce.12872] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/06/2015] [Accepted: 10/08/2015] [Indexed: 12/16/2022]
Abstract
Inherited cardiac diseases inducing structural remodeling of the myocardium sometimes develop arrhythmias of various kinds. Among these rhythm disturbances, atrial fibrillation is well known to frequently worsen the prognosis of the primary disorder by increasing morbidity and mortality, especially because of a higher rate of heart failure. In this manuscript, we have reviewed the literature on the most important inherited structural cardiac diseases in whose clinical history atrial fibrillation may occur fairly often.
Collapse
Affiliation(s)
- Roberta Manuguerra
- Department of Biomedical, Biotechnological, and Translational Sciences (S.Bi.Bi.T.), Unit of Pathology, University of Parma, Parma, Italy
| | - Sergio Callegari
- Azienda Unità Sanitaria Locale, Unit of Cardiology, Parma, Italy
| | - Domenico Corradi
- Department of Biomedical, Biotechnological, and Translational Sciences (S.Bi.Bi.T.), Unit of Pathology, University of Parma, Parma, Italy
| |
Collapse
|
15
|
Elabbassi W, Chowdhury MA, Liska B, Hatala R. Clinical profile and angiographic findings among patients with atrial fibrillation presenting for selective coronary angiography. Health (London) 2014. [DOI: 10.4236/health.2014.61007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
16
|
Luo C, Wu X, Huang Z, Du Z, Hao Y, Hu C, Huang Y, Gao X. Documentation of impaired coronary blood flow by TIMI frame count method in patients with atrial fibrillation. Int J Cardiol 2013; 167:1176-80. [DOI: 10.1016/j.ijcard.2012.03.118] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 02/02/2012] [Accepted: 03/12/2012] [Indexed: 11/28/2022]
|
17
|
Patel MR, White RD, Abbara S, Bluemke DA, Herfkens RJ, Picard M, Shaw LJ, Silver M, Stillman AE, Udelson J. 2013 ACCF/ACR/ASE/ASNC/SCCT/SCMR appropriate utilization of cardiovascular imaging in heart failure: a joint report of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Foundation Appropriate Use Criteria Task Force. J Am Coll Cardiol 2013; 61:2207-31. [PMID: 23500216 DOI: 10.1016/j.jacc.2013.02.005] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
18
|
Kochiadakis GE, Kallergis EM. Impact of Atrial Fibrillation on Coronary Blood Flow: A Systematic Review. J Atr Fibrillation 2012; 5:458. [PMID: 28496766 DOI: 10.4022/jafib.458] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 08/01/2012] [Accepted: 09/04/2012] [Indexed: 11/10/2022]
Abstract
Patients with atrial fibrillation (AF) frequently present with symptoms suggestive of myocardial isch- aemia, even in the absence of significant CAD, that seem to be attributable to abnormalities of myocardial perfusion and perfusion reserve. According to the results of recent human and previous experimen- tal studies the increase in coronary artery blood flow during AF is smaller, while the coronary vascular resistance during the arrhythmia does not decrease as much as we would expect, suggesting a mismatch between coronary blood flow and myocardial metabolic demand. AF itself diminishes coronary flow reserve, especially in the subendocardial layer, partly as a result of the increase in the myocardial com- ponent of coronary vascular resistance, and it is possible that irregular ventricular rhythm may play an important role. The mismatch of coronary blood flow and myocardial metabolic demand, especially in view of the severe reduction in coronary flow reserve, may have deleterious consequences that are not limited to patients with CAD.
Collapse
|
19
|
Croteau E, Gascon S, Bentourkia M, Langlois R, Rousseau JA, Lecomte R, Bénard F. [11C]Acetate rest-stress protocol to assess myocardial perfusion and oxygen consumption reserve in a model of congestive heart failure in rats. Nucl Med Biol 2011; 39:287-94. [PMID: 22079038 DOI: 10.1016/j.nucmedbio.2011.07.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 07/23/2011] [Accepted: 07/26/2011] [Indexed: 10/15/2022]
Abstract
UNLABELLED This study describes an [(11)C]acetate rest-stress method to obtain an indirect estimate of myocardial blood flow (MBF) and myocardial oxygen consumption (MVO(2)) in rats. Doxorubicin cardiotoxicity was used to test the usefulness of this approach for the assessment of congestive heart failure. METHODS [(11)C]Acetate rest-stress studies have been used in clinical research to assess the capacity of the coronary arteries to respond to stress. In this article, we used this approach to assess the cardiotoxicity of doxorubicin in a rat model. The method was first validated in a group of healthy rats and then used to follow the effect of doxorubicin chemotherapy on cardiac function. The effect of doxorubicin on myocardial perfusion and oxygen consumption reserve was measured at rest and under dobutamine stimulation. RESULTS Validation of the protocol showed a good correlation between the MBF and MVO(2) (r(2)=.68). The doxorubicin-treated group showed a significant (P=.04) decrease in cardiovascular perfusion reserve at 1.3±0.2 compared with the control animals at 1.6±0.2. Similar results were obtained for the MVO(2) reserve (treated 1.8±0.4 vs. controls 2.3±0.3; P=.02). CONCLUSIONS We describe an [(11)C]acetate PET rest-stress protocol for the assessment of congestive heart failure in rats and its application to the follow-up of cardiotoxicity under doxorubicin chemotherapy. This is a rapid and reliable approach to the measurement of cardiac perfusion and oxygen consumption reserve that could be applied to the development of new strategies to reduce the cardiotoxicity of anthracycline.
Collapse
Affiliation(s)
- Etienne Croteau
- Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke and Sherbrooke Molecular Imaging Center, Étienne-LeBel Clinical Research Center, CHUS, Sherbrooke, QC, Canada.
| | | | | | | | | | | | | |
Collapse
|
20
|
Fang W, Zhang J, He ZX. Myocardial ischemia in patients with dilated cardiomyopathy. Nucl Med Commun 2010; 31:981-4. [DOI: 10.1097/mnm.0b013e32833f393f] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
21
|
|
22
|
Smit MD, Tio RA, Slart RHJA, Zijlstra F, Van Gelder IC. Myocardial perfusion imaging does not adequately assess the risk of coronary artery disease in patients with atrial fibrillation. Europace 2009; 12:643-8. [PMID: 20022875 DOI: 10.1093/europace/eup404] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
AIMS The role of coronary artery disease (CAD) in atrial fibrillation (AF) is poorly investigated. This study investigated the value of myocardial perfusion single-photon emission computed tomography (SPECT) in the assessment of risk of CAD in patients with a history of AF. METHODS AND RESULTS Out of consecutive patients without previous coronary angiogram or history of CAD referred for SPECT, patients with a history of AF (n = 129) were compared with age- and gender-matched controls (n = 124). Primary endpoint was positive SPECT, i.e. unambiguous signs of ischaemia. There was no significant difference with regard to positive SPECT outcome between AF patients and controls (14 patients, 11% vs. 21 patients, 17%; P = 0.16). Coronary angiography (CAG) performed after SPECT demonstrated a higher yield of positive SPECT regarding significant CAD in control patients (10 out of 15 patients, 67%) than in AF patients (2 out of 13 patients, 15%; P = 0.006). CONCLUSION Positive SPECT outcome was similar in patients with AF and in controls. Nevertheless, in AF patients a positive SPECT outcome was less often related to significant CAD in those patients who subsequently underwent CAG. These results emphasize the need for new non-invasive techniques to adequately assess the risk of significant CAD in AF patients.
Collapse
Affiliation(s)
- Marcelle D Smit
- Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | | | | | | | | |
Collapse
|