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Verdoia M, Rognoni A. Coronary Physiology: Modern Concepts for the Guidance of Percutaneous Coronary Interventions and Medical Therapy. J Clin Med 2023; 12:2274. [PMID: 36983275 PMCID: PMC10057250 DOI: 10.3390/jcm12062274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023] Open
Abstract
Recent evidence on ischemia, rather than coronary artery disease (CAD), representing a major determinant of outcomes, has led to a progressive shift in the management of patients with ischemic heart disease. According to most recent guidelines, myocardial revascularization strategies based on anatomical findings should be progressively abandoned in favor of functional criteria for the guidance of PCI. Thus, emerging importance has been assigned to the assessment of coronary physiology in order to determine the ischemic significance of coronary stenoses. However, despite several indexes and tools that have been developed so far, the existence of technical and clinical conditions potentially biasing the functional evaluation of the coronary tree still cause debates regarding the strategy of choice. The present review provides an overview of the available methods and the most recent acquirements for the invasive assessment of ischemia, focusing on the most widely available indexes, fractional flow reserve (FFR) and instant-wave free ratio (iFR), in addition to emerging examples, as new approaches to coronary flow reserve (CFR) and microvascular resistance, aiming at promoting the knowledge and application of those "full physiology" principles, which are generally advocated to allow a tailored treatment and the achievement of the largest prognostic benefits.
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Affiliation(s)
- Monica Verdoia
- Nuovo Ospedale Degli Infermi, Azienda Sanitaria Locale Biella, 13900 Biella, Italy
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Hagen MW, Louey S, Alaniz SM, Brown L, Lindner JR, Jonker SS. Coronary conductance in the normal development of sheep during the perinatal period. Physiol Rep 2022; 10:e15523. [PMID: 36461657 PMCID: PMC9718948 DOI: 10.14814/phy2.15523] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 12/04/2022]
Abstract
Birth is associated with substantial shifts in cardiovascular physiology. Little is known about coronary vascular adaptations during this period. We used fetal and neonatal lambs to measure coronary function at late gestation (92% of term) and shortly after birth (5-6 days postnatal age). In each animal we measured unanesthetized myocardial perfusion and oxygen delivery using a circumflex artery flow probe. We used inflatable occluders and adenosine to determine coronary conductance and flow reserve. In a subset of animals, we used myocardial contrast echocardiography (MCE, anesthetized) to assess its utility as a tool for studying changes in regional myocardial perfusion in normal development. Separate age-matched animals were instrumented with aortic and coronary sinus sampling catheters to determine myocardial oxygen extraction (unanesthetized). With an average of 17 days of developmental time separating our neonatal and fetal cohorts we found that heart-to-body weight ratio was significantly greater in neonates than fetuses. In resting animals, we found significant decreases in weight-normalized perfusion of, and oxygen delivery to, neonatal relative to fetal myocardium. Similar results were seen when measuring baseline MCE-derived perfusion. Pressure-flow relationship studies revealed lower baseline and maximal coronary conductance in neonates than fetuses, with similar coronary flow reserve between groups. There was greater oxygen extraction in neonates than fetuses. Combined analysis of oxygen extraction with coronary flow suggested greater oxygen consumption by the fetal than neonatal myocardium. We conclude that, during the immediate perinatal period, cardiac growth outpaces coronary microvascular growth resulting in lower capacity for microvascular perfusion in the early neonate.
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Affiliation(s)
- Matthew W. Hagen
- Center for Developmental HealthOregon Health & Science UniversityPortlandOregonUSA,Knight Cardiovascular Institute, Oregon Health & Science UniversityPortlandOregonUSA
| | - Samantha Louey
- Center for Developmental HealthOregon Health & Science UniversityPortlandOregonUSA,Knight Cardiovascular Institute, Oregon Health & Science UniversityPortlandOregonUSA
| | - Sarah M. Alaniz
- Center for Developmental HealthOregon Health & Science UniversityPortlandOregonUSA
| | - Laura Brown
- Department of PediatricsPerinatal Research CenterUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Jonathan R. Lindner
- Knight Cardiovascular Institute, Oregon Health & Science UniversityPortlandOregonUSA
| | - Sonnet S. Jonker
- Center for Developmental HealthOregon Health & Science UniversityPortlandOregonUSA,Knight Cardiovascular Institute, Oregon Health & Science UniversityPortlandOregonUSA
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Mourmoura E, Chaté V, Couturier K, Laillet B, Vial G, Rigaudiere JP, Morio B, Malpuech-Brugère C, Azarnoush K, Demaison L. Body adiposity dictates different mechanisms of increased coronary reactivity related to improved in vivo cardiac function. Cardiovasc Diabetol 2014; 13:54. [PMID: 24572210 PMCID: PMC3996056 DOI: 10.1186/1475-2840-13-54] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 02/19/2014] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Saturated fatty acid-rich high fat (HF) diets trigger abdominal adiposity, insulin resistance, type 2 diabetes and cardiac dysfunction. This study was aimed at evaluating the effects of nascent obesity on the cardiac function of animals fed a high-fat diet and at analyzing the mechanisms by which these alterations occurred at the level of coronary reserve. MATERIALS AND METHODS Rats were fed a control (C) or a HF diet containing high proportions of saturated fatty acids for 3 months. Thereafter, their cardiac function was evaluated in vivo using a pressure probe inserted into the cavity of the left ventricle. Their heart was isolated, perfused iso-volumetrically according to the Langendorff mode and the coronary reserve was evaluated by determining the endothelial-dependent (EDV) and endothelial-independent (EIV) vasodilatations in the absence and presence of endothelial nitric oxide synthase and cyclooxygenase inhibitors (L-NAME and indomethacin). The fatty acid composition of cardiac phospholipids was then evaluated. RESULTS Although all the HF-fed rats increased their abdominal adiposity, some of them did not gain body weight (HF- group) compared to the C group whereas other ones had a higher body weight (HF+). All HF rats displayed a higher in vivo cardiac activity associated with an increased EDV. In the HF- group, the improved EDV was due to an increase in the endothelial cell vasodilatation activity whereas in the HF+ group, the enhanced EDV resulted from an improved sensitivity of coronary smooth muscle cells to nitric oxide. Furthermore, in the HF- group the main pathway implicated in the EDV was the NOS pathway while in the HF+ group the COX pathway. CONCLUSIONS Nascent obesity-induced improvement of cardiac function may be supported by an enhanced coronary reserve occurring via different mechanisms. These mechanisms implicate either the endothelial cells activity or the smooth muscle cells sensitivity depending on the body adiposity of the animals.
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Affiliation(s)
- Evangelia Mourmoura
- Université Joseph Fourier, Laboratoire de Bioénergétique Fondamentale et Appliquée, BP 53, Grenoble F-38041, France
- U1055 INSERM, Grenoble F-38041, France
| | - Valérie Chaté
- Université Joseph Fourier, Laboratoire de Bioénergétique Fondamentale et Appliquée, BP 53, Grenoble F-38041, France
- U1055 INSERM, Grenoble F-38041, France
| | - Karine Couturier
- Université Joseph Fourier, Laboratoire de Bioénergétique Fondamentale et Appliquée, BP 53, Grenoble F-38041, France
- U1055 INSERM, Grenoble F-38041, France
| | - Brigitte Laillet
- INRA, UMR 1019 Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand, France
- Clermont Université, Université d’Auvergne, UMR 1019 Nutrition Humaine, Clermont-Ferrand, France
| | - Guillaume Vial
- INSERM UMR-1060, Laboratoire CarMeN, Université Lyon 1, INRA USC1362, INSA de Lyon, Facultés de médecine Rockefeller et Charles Merieux Lyon-Sud, Lyon F-69003, France
| | - Jean-Paul Rigaudiere
- INRA, UMR 1019 Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand, France
- Clermont Université, Université d’Auvergne, UMR 1019 Nutrition Humaine, Clermont-Ferrand, France
| | - Béatrice Morio
- INSERM UMR-1060, Laboratoire CarMeN, Université Lyon 1, INRA USC1362, INSA de Lyon, Facultés de médecine Rockefeller et Charles Merieux Lyon-Sud, Lyon F-69003, France
| | - Corinne Malpuech-Brugère
- INRA, UMR 1019 Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand, France
- Clermont Université, Université d’Auvergne, UMR 1019 Nutrition Humaine, Clermont-Ferrand, France
| | - Kasra Azarnoush
- Heart surgery Department, G. Montpied Hospital, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Luc Demaison
- Université Joseph Fourier, Laboratoire de Bioénergétique Fondamentale et Appliquée, BP 53, Grenoble F-38041, France
- U1055 INSERM, Grenoble F-38041, France
- INRA, UMR 1019 Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand, France
- Clermont Université, Université d’Auvergne, UMR 1019 Nutrition Humaine, Clermont-Ferrand, France
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