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Li J, Ma C, Sun H, Li F, She Y, Yi T. Effect of quantitative parameters of contrast-enhanced ultrasound on the long-term prognosis of patients with chronic coronary syndrome. J Thorac Dis 2023; 15:6806-6812. [PMID: 38249916 PMCID: PMC10797379 DOI: 10.21037/jtd-23-1267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/16/2023] [Indexed: 01/23/2024]
Abstract
Background Ultrasound is one of the most commonly used examination methods in patients with coronary artery disease (CAD) and is valuable in evaluating patient prognosis. Although contrast-enhanced ultrasound (CEUS) can assess more in depth the vascular lesions of patients, there is still a lack of relevant research on the value of quantitative parameters of CEUS in predicting the long-term prognosis of patients with chronic coronary syndrome (CCS), thus, we designed this study. Methods From January 2016 to December 2017, a total of 473 patients with CCS admitted to Yueyang People's Hospital were retrospectively enrolled. The patients were followed up for five years. According to whether the patients had major adverse cardiovascular events (MACE), patients were divided into the MACE group (n=113) and the control group (n=360). The CEUS was performed to detect the myocardial perfusion status. The value of quantitative parameters of CEUS in predicting the MACE in patients with CCS was analyzed using the receiver operating characteristic (ROC) curve. Results Peak intensity of contrast agent at platform stage, rising rate of microbubble reperfusion, and left ventricular ejection fraction (LVEF) were found to be valuable in predicting the risk of MACE in patients with CCS. Among them, the peak intensity of contrast agent at platform stage had the highest predictive value, and the area under the curve (AUC) was 0.860 [95% confidence interval (CI): 0.827-0.894, P<0.001]. Multivariate logistics regression analysis showed that the peak intensity of contrast agent at platform stage <4.54 dB and rising rate of microbubble reperfusion <0.275 s were independent risk factors of MACE in patients with CCS. The relative risks were 12.238 (95% CI: 6.632-22.585) and 5.724 (95% CI: 3.149-10.405), respectively. Conclusions Quantitative parameters of CEUS can be used as predictors of MACE in patients with CCS, and strengthening the management of such high-risk patients may be beneficial to reduce the incidence of MACE.
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Affiliation(s)
- Jia Li
- Cardiovascular Ultrasound Room, Qinghai Provincial People’s Hospital, Xining, China
| | - Chunyan Ma
- Department of Ultrasound, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China
| | - Haixia Sun
- Cardiovascular Ultrasound Room, Qinghai Provincial People’s Hospital, Xining, China
| | - Fang Li
- Cardiovascular Ultrasound Room, Qinghai Provincial People’s Hospital, Xining, China
| | - Yao She
- Department of Ultrasound, Yueyang People’s Hospital, Yueyang, China
| | - Tianhong Yi
- Department of Ultrasound, Yueyang People’s Hospital, Yueyang, China
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Li H, Gao Y, Lin Y. Progress in molecular mechanisms of coronary microvascular dysfunction. Microcirculation 2023; 30:e12827. [PMID: 37608689 DOI: 10.1111/micc.12827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/23/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023]
Abstract
Coronary microvascular dysfunction is a high-risk factor for many cardiovascular events. However, because of multiple risk factors and limited understanding about its underlying pathophysiological mechanisms, it was easily misdiagnosed. Therefore, its clinical diagnosis and treatment were greatly restricted. Coronary microcirculation refers to microvessels that play an important role in the physiological regulation of myocardial perfusion and regulating blood flow distribution, fulfilling myocardial metabolic needs and moderating peripheral vascular resistance. In coronary microvascular dysfunction, vascular endothelial celldamage is a critical link. The main feature of early coronary microvascular dysfunction is the impairment of endothelial cell proliferation, adhesion, migration, apoptosis, and secretion. Moreover, coronary microvascular dysfunction risk factors include hyperglycemia, lipid metabolism disorders, ischemia-reperfusion injury, aging, and hypertension, similar to coronary atherosclerosis. There are various mechanisms by which these risk factors harm endothelial function and cause microcirculatory disturbances. Therefore, we reviewed coronary microvascular dysfunction's risk factors and pathogenesis in this article.
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Affiliation(s)
- Hao Li
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Yuping Gao
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Yuanyuan Lin
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
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Datta P, Nath S, Pathade AG, Yelne S. Unveiling the Enigma: Exploring the Intricate Link Between Coronary Microvascular Dysfunction and Takotsubo Cardiomyopathy. Cureus 2023; 15:e44552. [PMID: 37790001 PMCID: PMC10544771 DOI: 10.7759/cureus.44552] [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: 08/18/2023] [Accepted: 09/01/2023] [Indexed: 10/05/2023] Open
Abstract
This review article delves into the intricate and evolving relationship between coronary microvascular dysfunction (CMD) and takotsubo cardiomyopathy (TCM), two intriguing cardiovascular conditions increasingly recognised for their potential interplay. We examine their characteristics, shared pathophysiological mechanisms, diagnostic challenges, and management strategies. Emerging evidence suggests a link between microvascular dysfunction and the development of TCM, leading to a deeper exploration of their connection. Accurate diagnosis of both conditions becomes essential, as microvascular dysfunction may modify TCM outcomes. We underscore the significance of understanding this connection for improved patient care, emphasising the need for tailored interventions when CMD and TCM coexist. Collaborative research and heightened clinical awareness are advocated to advance our comprehension of this relationship. Through interdisciplinary efforts, we aim to refine diagnostic precision, develop targeted therapies, and enhance patient outcomes in cardiovascular medicine.
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Affiliation(s)
- Pragyamita Datta
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | | | - Aniket G Pathade
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Seema Yelne
- Nursing, Shalinitai Meghe College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Liu J, Wang Y, Zhang J, Li X, Tan L, Huang H, Dai Y, Shang Y, Shen Y. Dynamic evolution of left ventricular strain and microvascular perfusion assessed by speckle tracking echocardiography and myocardial contrast echocardiography in diabetic rats: Effect of dapagliflozin. Front Cardiovasc Med 2023; 10:1109946. [PMID: 36910521 PMCID: PMC9996187 DOI: 10.3389/fcvm.2023.1109946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Background This experimental study aimed to determine the dynamic changes in myocardial strain and microvascular perfusion in diabetic rats by comprehensive echocardiography while evaluating the effect of dapagliflozin (DAPA). Materials and methods Male Sprague-Dawley rats (n = 128) were randomly divided into four groups based on the presence or absence of a high-fat diet and streptozotocin-induced diabetes with or without DAPA treatment (n = 32/group). Serial conventional ultrasound, two-dimensional speckle tracking echocardiography (2D-STE) and myocardial contrast echocardiography (MCE) were performed at 2, 4, 6, and 8 weeks, and left ventricular global longitudinal strain (GLS), myocardial blood flow velocity (MBFV), myocardial blood flow (MBF), and myocardial blood volume (MBV) were determined. All animals were sacrificed immediately after the last echo measurement for histopathological assessment. Results Despite similar conventional Doppler-echo indexes among the groups at 2, 4, 6, and 8 weeks (p > 0.05), left ventricular GLS, MBFV, MBF, and MBV were decreased at 8 weeks in diabetic rats (p < 0.05) as detected by both 2D-STE and MCE. These indexes were significantly improved at 6 and 8 weeks after treatment with DAPA for diabetic rats (p < 0.05), reaching similar values observed in non-diabetic controls. DAPA treatment was associated with increased myocardial vacuolization and microvessel density and reduced interstitial fibrosis in diabetic rats. Conclusions Combined 2D-STE and MCE is sensitive for detecting left ventricular deformity and impaired microvascular perfusion in prediabetes and the early stage of diabetes mellitus. DAPA exerts a beneficial effect on protecting myocardial perfusion in diabetic rats.
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Affiliation(s)
- Juan Liu
- Department of Ultrasound, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yixuan Wang
- Department of Cardiovascular Medicine, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jun Zhang
- Department of Ultrasound, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xin Li
- Department of Ultrasound, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Lin Tan
- Department of Ultrasound, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Haiyun Huang
- Department of Ultrasound, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yang Dai
- Department of Cardiovascular Medicine, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yongning Shang
- Department of Ultrasound, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ying Shen
- Department of Cardiovascular Medicine, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Zhang J, Ma M, Li H, Pu Z, Liu H, Huang T, Cheng H, Gong Y, Chu Y, Wang Z, Jiang J, Xia L. Early diagnosis of coronary microvascular dysfunction by myocardial contrast stress echocardiography. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:7845-7858. [PMID: 37161175 DOI: 10.3934/mbe.2023339] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Coronary microvascular dysfunction (CMD) is one of the basic mechanisms of myocardial ischemia. Myocardial contrast echocardiography (MCE) is a bedside technique that utilises microbubbles which remain entirely within the intravascular space and denotes the status of microvascular perfusion within that region. Some pilot studies suggested that MCE may be used to diagnose CMD, but without further validation. This study is aimed to investigate the diagnostic performance of MCE for the evaluation of CMD. MCE was performed at rest and during adenosine triphosphate stress. ECG triggered real-time frames were acquired in the apical 4-chamber, 3-chamber, 2-chamber, and long-axis imaging planes. These images were imported into Narnar for further processing. Eighty-two participants with suspicion of coronary disease and absence of significant epicardial lesions were prospectively investigated. Thermodilution was used as the gold standard to diagnose CMD. CMD was present in 23 (28%) patients. Myocardial blood flow reserve (MBF) was assessed using MCE. CMD was defined as MBF reserve < 2. The MCE method had a high sensitivity (88.1%) and specificity (95.7%) in the diagnosis of CMD. There was strong agreement with thermodilution (Kappa coefficient was 0.727; 95% CI: 0.57-0.88, p < 0.001). However, the correlation coefficient (r = 0.376; p < 0.001) was not high.
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Affiliation(s)
- Jucheng Zhang
- Department of Clinical Engineering, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou 310009, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou 310009, China
| | - Minwen Ma
- Department of Clinical Engineering, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou 310009, China
| | - Huajun Li
- Department of Cardiology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou 310009, China
| | - Zhaoxia Pu
- Department of Cardiology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou 310009, China
| | - Haipeng Liu
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Tianhai Huang
- Department of Clinical Engineering, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou 310009, China
| | - Huan Cheng
- Key Laboratory for Biomedical Engineering of Ministry of Education, Institute of Biomedical Engineering, Zhejiang University, Hangzhou 310027, China
| | - Yinglan Gong
- Institute of Wenzhou, Zhejiang University, Wenzhou 325036, China
| | - Yonghua Chu
- Department of Clinical Engineering, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou 310009, China
| | - Zhikang Wang
- Department of Clinical Engineering, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou 310009, China
| | - Jun Jiang
- Department of Cardiology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou 310009, China
| | - Ling Xia
- Key Laboratory for Biomedical Engineering of Ministry of Education, Institute of Biomedical Engineering, Zhejiang University, Hangzhou 310027, China
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