Impact of Targeted Therapies for Coronary Microvascular Dysfunction as Assessed by the Index of Microcirculatory Resistance

2020 ◽  
Author(s):  
James Xu ◽  
Sidney Lo ◽  
Craig P. Juergens ◽  
Dominic Y. Leung
Keyword(s):  
Targeted Therapies ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Index Of Microcirculatory Resistance

scholarly journals Coronary Flow Reserve in Patients With Prior Spontaneous Coronary Artery Dissection and Recurrent Angina

2020 ◽  
Vol 9 (16) ◽  
Author(s):  
Tara Sedlak ◽  
Andrew Starovoytov ◽  
Karin Humphries ◽  
Jacqueline Saw
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Flow ◽  
Fibromuscular Dysplasia ◽  
Microvascular Dysfunction ◽  
Artery Dissection ◽  
Coronary Microvascular Dysfunction ◽  
Coronary Artery Dissection ◽  
Flow Reserve ◽  
Index Of Microcirculatory Resistance

Background A significant proportion of patients with spontaneous coronary artery dissection (SCAD) have ongoing chronic chest pain despite healing of their dissection. We sought to determine whether coronary microvascular dysfunction contributes to post‐SCAD chronic chest pain by performing coronary reactivity testing in the cardiac catheterization laboratory. Methods and Results Eighteen patients consented to coronary reactivity testing at least 3 months post‐SCAD. Coronary flow reserve (CFR) and index of microcirculatory resistance were measured in the previously affected SCAD artery and 1 non‐SCAD artery. CFR <2.5 was defined as diagnostic of coronary microvascular dysfunction. An abnormal index of microcirculatory resistance was defined as >25 units. Seventeen women underwent coronary reactivity testing (1 had chronic dissection and was excluded). All presented with myocardial infarction and 2 underwent coronary stenting during the initial SCAD event. Fibromuscular dysplasia was present in 70.6% upon screening renal, iliac, and cerebrovascular arteries. Twelve patients (70.6%) had CFR <2.5 and 13 (76.5%) had an index of microcirculatory resistance >25 in at least 1 artery. There was no difference in the frequency of a low CFR measurement between SCAD and non‐SCAD arteries. Conclusions Among patients with chronic chest pain after an SCAD event, >70% had coronary microvascular dysfunction as indicated by abnormal CFR or index of microcirculatory resistance in at least 1 coronary artery on invasive coronary reactivity testing. Presence of coronary microvascular dysfunction in both SCAD and non‐SCAD arteries suggests that underlying microvascular abnormalities from vasculopathies such as coronary fibromuscular dysplasia may be the underlying etiology.

scholarly journals Coronary Microvascular Dysfunction in Takotsubo Syndrome Assessed by Angiography-Derived Index of Microcirculatory Resistance: A Pressure-Wire-Free Tool

2021 ◽  
Vol 10 (19) ◽  
pp. 4331
Author(s):  
Jordi Sans-Roselló ◽  
Estefanía Fernández-Peregrina ◽  
Albert Duran-Cambra ◽  
Jose Carreras-Mora ◽  
Alessandro Sionis ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Troponin T ◽  
Systolic Dysfunction ◽  
Microvascular Dysfunction ◽  
Left Ventricular Ejection ◽  
Coronary Microvascular Dysfunction ◽  
Cardiac Troponin T ◽  
Takotsubo Syndrome ◽  
Pressure Wire ◽  
Index Of Microcirculatory Resistance

Background: Coronary microvascular dysfunction (CMD) has been proposed as a key mechanism in Takotsubo syndrome (TTS). The non-hyperaemic angiography-derived index of microcirculatory resistance (NH-IMRangio) has been validated as a pressure-wire-free tool for the assessment of coronary microvasculature. We aimed to study the presence of CMD in TTS patients and its association with levels of cardiac biomarkers and systolic dysfunction patterns. Methods: We recruited 181 consecutive patients admitted for TTS who underwent cardiac angiography at a tertiary center from January 2014 to January 2021. CMD was defined as an NH-IMRangio ≥ 25. Plasma levels of NT-proBNP, high-sensitive cardiac troponin T (hs-cTnT) and the left ventricular ejection fraction (LVEF) by echocardiography were measured at admission. Results: Mean age was 75.3 years, 83% were women and median LVEF was 45%. All patients presented CMD (NH-IMRangio ≥ 25) in at least one epicardial coronary artery. The left anterior descending artery (LAD) showed higher median NH-IMRangio values than left circumflex (LCx) and right coronary arteries (RCA) (44.6 vs. 31.3 vs. 36.1, respectively; p < 0.001). NH-IMRangio values differed among ventricular contractility patterns in the LAD and RCA (p = 0.0152 and 0.0189, respectively) with the highest values in the mid-ventricular + apical and mid-ventricular + basal patterns. NT-proBNP levels, but not high-sensitive cardiac troponin T (hs-cTnT), were correlated with both the degree and the extent of CMD in patients with TTS. Lower LVEF was also associated with higher NH-IMRangio values. Conclusions: CMD is highly prevalent in patients admitted for TTS and is associated with both a higher degree of systolic dysfunction and higher BNP levels, but not troponin.

Coronary microvascular dysfunction

2020 ◽  
Vol 68 (2) ◽  
Author(s):  
Vincenzo Sucato ◽  
Giuseppina Novo ◽  
Antonino Saladino ◽  
Salvatore Evola ◽  
Alfredo R. Galassi
Keyword(s):  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction

scholarly journals Epicardial adipose tissue differentiates in patients with and without coronary microvascular dysfunction

2021 ◽  
Author(s):  
Ihab Mahmoud ◽  
Iryna Dykun ◽  
Luisa Kärner ◽  
Stefanie Hendricks ◽  
Matthias Totzeck ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Regression Analysis ◽  
Epicardial Adipose Tissue ◽  
Obstructive Coronary Artery Disease ◽  
Age Groups ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Local Inflammation ◽  
And Gender ◽  
Fat Depot

Abstract Background/Objectives Coronary microvascular dysfunction (CMD) is a common disorder, leading to symptoms similar to obstructive coronary artery disease and bears important prognostic implications. Local inflammation is suggested to promote development of CMD. Epicardial adipose tissue (EAT) is a local visceral fat depot surrounding the heart and the coronary arteries, modifying the inflammatory environment of the heart. We compared EAT in patients with and without CMD. Methods We retrospectively included consecutive patients undergoing diagnostic coronary angiography as well as transthoracic echocardiography between March and October 2016. EAT thickness was defined as space between the epicardial wall of the myocardium and the visceral layer of the pericardium and EAT index was calculated as EAT thickness/body surface area. Logistic regression analysis was used to determine the association of EAT index with the presence of CMD. Results Overall, 399 patients (mean age 60.2 ± 14.0 years, 46% male) were included. EAT thickness was significantly higher in patients with CMD compared to patients without CMD (EAT thickness 4.4 ± 1.8 vs. 4.9 ± 2.4 mm, p = 0,048 for patients without and with CMD, respectively). In univariate regression analysis, EAT index was associated with a 30% higher frequency of CMD (odds ratio [95% confidence interval]: 1.30 [1.001–1.69], p = 0.049). Effect sizes remained stable upon adjustment for body mass index (BMI, 1.30 [1.003–1.70], p = 0.048), but were attenuated when ancillary adjusting for age and gender (1.17 [0.90–1.54, p = 0.25). The effect was more pronounced in patients >65 years of age and independent of BMI and sex (1.85 [1.14–3.00], p = 0.013). Conclusion EAT thickness is independently associated with CMD and can differentiate between patients with and without CMD especially in older age groups. Our results support the hypothesis that modulation of local inflammation by epicardial fat is involved in the development of CMD.

scholarly journals Coronary microvascular dysfunction is associated with degree of anaemia in end‐stage renal disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ashwin Radhakrishnan ◽  
Luke C. Pickup ◽  
Anna M. Price ◽  
Jonathan P. Law ◽  
Kirsty C. McGee ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Renal Disease ◽  
Kidney Transplant ◽  
End Stage Renal Disease ◽  
Microvascular Dysfunction ◽  
Left Ventricular ◽  
Coronary Microvascular Dysfunction ◽  
Transplant Candidates ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Coronary microvascular dysfunction (CMD) is common in end-stage renal disease (ESRD) and is an adverse prognostic marker. Coronary flow velocity reserve (CFVR) is a measure of coronary microvascular function and can be assessed using Doppler echocardiography. Reduced CFVR in ESRD has been attributed to factors such as diabetes, hypertension and left ventricular hypertrophy. The contributory role of other mediators important in the development of cardiovascular disease in ESRD has not been studied. The aim of this study was to examine the prevalence of CMD in a cohort of kidney transplant candidates and to look for associations of CMD with markers of anaemia, bone mineral metabolism and chronic inflammation. Methods Twenty-two kidney transplant candidates with ESRD were studied with myocardial contrast echocardiography, Doppler CFVR assessment and serum multiplex immunoassay analysis. Individuals with diabetes, uncontrolled hypertension or ischaemic heart disease were excluded. Results 7/22 subjects had CMD (defined as CFVR < 2). Demographic, laboratory and echocardiographic parameters and serum biomarkers were similar between subjects with and without CMD. Subjects with CMD had significantly lower haemoglobin than subjects without CMD (102 g/L ± 12 vs. 117 g/L ± 11, p = 0.008). There was a positive correlation between haemoglobin and CFVR (r = 0.7, p = 0.001). Similar results were seen for haematocrit. In regression analyses, haemoglobin was an independent predictor of CFVR (β = 0.041 95% confidence interval 0.012–0.071, p = 0.009) and of CFVR < 2 (odds ratio 0.85 95% confidence interval 0.74–0.98, p = 0.022). Conclusions Among kidney transplant candidates with ESRD, there is a high prevalence of CMD, despite the absence of traditional risk factors. Anaemia may be a potential driver of microvascular dysfunction in this population and requires further investigation.

Silent severe myocardial ischemia in a past illicit drug user imaged with myocardial perfusion scintigraphy

Perfusion ◽  
2021 ◽  
pp. 026765912110281
Author(s):  
Chrissa Sioka ◽  
Georgios Georgiou ◽  
Christos Katsouras ◽  
Konstantinos Pappas ◽  
Dimitris-Nikiforos Kiortsis ◽  
...  
Keyword(s):  
Drug Use ◽  
Myocardial Perfusion ◽  
Myocardial Ischemia ◽  
Illicit Drugs ◽  
Illicit Drug ◽  
Microvascular Dysfunction ◽  
Illicit Drug Use ◽  
Coronary Microvascular Dysfunction ◽  
Illicit Drug User ◽  
Cardiac Symptoms

Patients with illicit drug use may have deleterious acute and chronic cardiac effects. We present a case of a 42-year-old man, former alcohol and various illicit drugs user, who was admitted to the psychiatric unit for management of psychosis. Because of his previous drug and alcohol history, a cardiological evaluation was performed which revealed silent severe myocardial ischemia detected by myocardial perfusion imaging (MPI). The myocardial ischemia was attributed to coronary microvascular dysfunction, occurring several years after quitting the illicit drugs. This study highlights the potential myocardial ischemia that may occur in patients with previous alcohol and illicit drug use, and the role of MPI, a non-invasive test that can provide important information regarding the myocardial status of such patients, even without obvious cardiac symptoms or findings.

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