Influence of increased heart rate and aortic pressure on resting indices of functional coronary stenosis severity

The modification by aortic pressure and stroke volume of the response in cardiac performance to increases in heart rate (interval-force relationship) has not been previously studied. To investigate this interaction, 30 adrenergically blocked anesthetized dogs on right heart bypass were studied. At constant low aortic pressure and stroke volume, increasing heart rate (over the entire range 60-180) is associated with a continuously increasing stroke power, decreasing systolic ejection period, and an unchanging left ventricular end-diastolic pressure and circumference. At increased aortic pressure or stroke volume at low rates (60-120), increases in heart rate were associated with an increased performance. However, at increased aortic pressure or stroke volume at high rates (120-180), increases in heart rate were associated with a leveling or decrease in performance. Thus, an increase in aortic pressure or stroke volume results in an accentuation of the improvement in cardiac performance observed with increases in heart rate, but this response is limited to a low heart rate range. Therefore, the hemodynamic response to given increases in heart rate is critically dependent on aortic pressure and stroke volume.

Download Full-text

Analysis of thallium-201 single-photon emission computed tomography after intravenous dipyridamole using different quantitative measures of coronary stenosis severity and receiver operator characteristic curves

American Heart Journal ◽

10.1016/0002-8703(92)90921-h ◽

1992 ◽

Vol 124 (1) ◽

pp. 65-74 ◽

Cited By ~ 2

Author(s):

Jeffrey J. Popma ◽

Gregory J. Dehmer ◽

Brandy S. Walker ◽

Theodore R. Simon ◽

Thomas C. Smitherman

Keyword(s):

Coronary Stenosis ◽

Single Photon ◽

Photon Emission ◽

Thallium 201 ◽

Emission Computed Tomography ◽

Receiver Operator Characteristic ◽

Single Photon Emission ◽

Stenosis Severity ◽

Single Photon Emission Computed ◽

Photon Emission Computed Tomography

Download Full-text

Myocardial blood flow reserve is determined by not only coronary stenosis severity but also coronary risk factors in patients with suspected coronary artery disease

Journal of Nuclear Cardiology ◽

10.1016/j.nuclcard.2004.12.172 ◽

2005 ◽

Vol 12 (2) ◽

pp. S75-S75

Author(s):

T TSUKAMOTO ◽

K MORITA ◽

M NAYA ◽

C KATOH ◽

Y KUGE ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Stenosis ◽

Suspected Coronary Artery Disease ◽

Coronary Risk Factors ◽

Coronary Risk ◽

Flow Reserve ◽

Stenosis Severity ◽

Artery Disease ◽

Myocardial Blood Flow Reserve

Download Full-text

Abstract 15758: Relationship Between Physiological Coronary Artery Stenosis Severity Assessed by Fractional Flow Reserve and Optical Coherence Tomography Findings in Stable Angina Pectoris

Circulation ◽

10.1161/circ.132.suppl_3.15758 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Tetsumin Lee ◽

Tadashi Murai ◽

Yoshihisa Kanaji ◽

Eisuke Usui ◽

Makoto Araki ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Coronary Artery ◽

Angina Pectoris ◽

Stable Angina ◽

Coronary Stenosis ◽

Coronary Artery Stenosis ◽

Stable Angina Pectoris ◽

Fractional Flow ◽

Flow Reserve ◽

Stenosis Severity

Backgrounds: The aim of the present study is to investigate the relationship between physiological coronary artery stenosis severity and lesion instability by Optical Coherence Tomography (OCT) in patients with stable angina pectoris (SAP). Methods and Results: We investigated 198 culprit lesions of 180 SAP patients who underwent OCT imaging and fractional flow reserve (FFR) measurement before PCI procedure. Physiological coronary stenosis severity was assessed by FFR analysis, and lesions were divided into two groups on the basis of FFR values; severe stenosis group (group S): FFR <0.75 (n=78, 39%), moderate stenosis group (group M): FFR ≥0.75 (n=120, 61%) according to the previous study. Thin-capped fibroatheroma (TCFA) was defined as lipid-rich plaque (lipid arc ≥90°) with fibrous cap thickness <70μm. The median FFR values in total lesions, group S, and group M were 0.77 (interquartile range [IQR]: 0.69—0.83), 0.65 (0.57—0.72), and 0.81 (0.78—0.87), respectively. There were no significant differences in patient characteristics expect for the frequency of previous myocardial infarction (S: 15%, M: 38%, P <0.01) and previous PCI (S: 29%, M: 60%, P <0.01). In angiographic analysis, there were significant differences in the frequency of culprit lesion location in LAD (S: 72%, M: 49%, P <0.01), minimum lumen diameter (S: 1.07±0.36 mm, M: 1.35±0.32 mm, P <0.01), % diameter stenosis (S: 58.9 % [53.1—70.8], M: 52.8 % [47.7—57.5], P <0.01), and lesion length (S: 13.7 mm [10.6—17.5], M: 11.5 mm [9.2—14.5], P = 0.02) between the two groups. In OCT analysis, there were significant differences in the lipid arc (S: 200° [160—232], M: 168° [143—211], P <0.01), CT (S: 110 μm [63—157], M: 140 μm [93—197], P <0.01), and frequency of TCFA (S: 27%, M: 9%, P <0.01) between the two groups. Subgroup analysis of LAD lesions showed similar results between the two groups. Conclusions: Lesions of physiologically severe coronary stenosis in SAP were associated with lesion instability assessed by OCT. These findings may challenge the concept that lesions responsible for acute coronary syndromes are mild in most cases provided that plaque rupture of TCFA evenly results in coronary events in the wide range of stenosis severity in patients with SAP.

Download Full-text

Abstract P189: Factors Associated With Stenosis on Invasive Coronary Angiography for Persons Living With Human Immunodeficiency Virus (PLWH): The HIV Electronic Comprehensive Cohort of CVD Complications (HIVE-4CVD)

Circulation ◽

10.1161/circ.137.suppl_1.p189 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Andrew Furman ◽

Robert Riestenberg ◽

Anna Pawlowski ◽

Daniel Schneider ◽

Donald M Lloyd-Jones ◽

...

Keyword(s):

Viral Load ◽

Coronary Angiography ◽

Coronary Stenosis ◽

Clinical Care ◽

Invasive Coronary Angiography ◽

Hiv Viral Load ◽

Cvd Risk ◽

Significant Difference ◽

Stenosis Severity ◽

Significant Coronary Stenosis

Background: Persons living with HIV (PLWH) have greater risks for atherosclerotic cardiovascular disease (ASCVD) than uninfected persons. However, data are sparse regarding HIV-specific factors associated with coronary atherosclerosis. Methods: HIVE-4CVD is an electronic data repository of demographic and clinical data collected during the routine clinical care of 5041 PLWH and 10082 uninfected controls frequency matched on age, sex, race, zip code, and clinic location receiving care at Northwestern Medicine from 1/1/2000 to 5/17/2017. Using validated natural language extraction algorithms, we analyzed data on coronary stenosis severity for the 286 PLWH and 266 uninfected controls in HIVE-4CVD who underwent coronary angiography. Stenosis severity was recorded as the highest percentage of stenosis noted for each patient in each artery (LAD, LCx, RCA). Multivariable logistic regression models adjusted for demographics and CVD risk factors were used to evaluate odds of significant (≥50%) coronary stenosis (1) for PLWH versus uninfected controls and (2) across different levels of HIV viremia and immune suppression among PLWH. Results: Of the 286 PLWH and 266 uninfected controls undergoing coronary angiography, 205 (55.4%) PLWH vs. 165 (44.6%) uninfected controls had diagnoses of myocardial infarction (p=0.02). The location and severity of coronary stenoses did not differ significantly for PLWH vs. uninfected controls; mean maximal overall stenosis and mean maximal LAD, RCA, and LCx stenoses were 52.3% vs. 50.2% (p=0.52), 44.5% vs. 42.3% (p=0.48), 37.0% vs. 36.1% (p=0.78) and 31.4% vs. 31.6% (p=0.95) respectively. There was no significant difference in odds of having significant coronary stenosis for PLWH vs. uninfected controls (multivariable-adjusted OR 1.15, 95% CI 0.79-1.70). Among PLWH, peak HIV viral load was associated with borderline significantly greater odds of ≥50% coronary stenosis after adjustment for demographics, CVD risk factors, and HIV therapies (OR 1.07 per 10-fold greater peak HIV viral load, 95% CI 1.00-1.14, p=0.04), but lower Nadir CD4+ T cell count (<200 vs. ≥200 cells/mm 3 ) was not (OR 1.05, 95% CI 0.74-1.48, p=0.79). Conclusions: There was no consistent or significant difference in severity of coronary artery stenosis among PLWH and uninfected controls undergoing invasive coronary angiography in the course of routine clinical care. Higher peak HIV viral load is associated with borderline significantly greater odds of having significant coronary stenosis among PLWH undergoing invasive coronary angiography.

Download Full-text

Fractional flow reserve

State of the Art Surgical Coronary Revascularization ◽

10.1093/med/9780198758785.003.0017 ◽

2021 ◽

pp. 63-67

Author(s):

Giovanni Ciccarelli ◽

Emanuele Barbato ◽

Bernard De Bruyne

Keyword(s):

Blood Flow ◽

Myocardial Blood Flow ◽

Fractional Flow Reserve ◽

Coronary Stenosis ◽

Coronary Intervention ◽

Aortic Pressure ◽

Fractional Flow ◽

Coronary Pressure ◽

Flow Reserve ◽

Percutaneous Coronary

Fractional flow reserve is an index of the physiological significance of a coronary stenosis, defined as the ratio of maximal myocardial blood flow in the presence of the stenosis to the theoretically normal maximal myocardial blood flow (i.e. in the absence of the stenosis). This flow ratio can be calculated from the ratio of distal coronary pressure to central aortic pressure during maximal hyperaemia. More practically, fractional flow reserve indicates to what extent the epicardial segment can be responsible for myocardial ischaemia and, accordingly, fractional flow reserve quantifies the expected perfusion benefit from revascularization by percutaneous coronary intervention. Very limited evidence exists on the role on fractional flow reserve for bypass grafts.

Download Full-text

Effect of exercise conditioning on coronary resistance

Journal of Applied Physiology ◽

10.1152/jappl.1982.53.3.631 ◽

1982 ◽

Vol 53 (3) ◽

pp. 631-636 ◽

Cited By ~ 17

Author(s):

I. Y. Liang ◽

H. L. Stone

Keyword(s):

Heart Rate ◽

Aortic Pressure ◽

Treadmill Running ◽

Atrial Pacing ◽

Adrenergic Blockade ◽

Coronary Resistance ◽

Implanted Electrodes ◽

Daily Exercise ◽

Before And After ◽

The Relationship

Diastolic coronary resistance (DCR) was determined in seven conscious dogs in the untrained state and after 4–5 wk of daily exercise conditioning (partial training). The conditioning regime consisted of treadmill running 5 days/wk. The dogs were instrumented to measure aortic pressure and left circumflex coronary flow during atrial pacing with implanted electrodes. Heart rate was varied from the resting value to 240 beats/min before and after adrenergic blockade with propranolol (beta B, 1 mg/kg) or phentolamine (alpha B, 1 mg/kg); myocardial oxygen consumption (MVO2) was measured in three dogs under the same condition in both the untrained (UT) and partially trained (PT) condition. DCR decreased with increasing heart rate [from 4.75 +/- 0.56 (SE) to 2.48 +/- 0.22 Torr . ml-1 . min at 240 beats/min]; alpha B reduced DCR, whereas beta B increased DCR. In the PT condition, DCR decreased to 4.02 +/- 0.40 Torr . ml-1 . min at rest and was decreased to 1.82 +/- 0.16 Torr . ml-1 . min at 240 beats/min (P less than 0.05 compared with UT). alpha-Adrenergic and beta-adrenergic blockade in the PT condition resulted in parallel reduction in DCR compared with the UT condition. MVO2 was unaffected by either PT or adrenergic blockade but increased as heart rate increased with atrial pacing. These data suggest a change in caliber of the coronary resistance vessel because of the parallel shift in the relationship between DCR and heart rate.

Download Full-text