Microvascular Resistance Reserve for Assessment of Coronary Microvascular Function

2021 ◽  
Vol 78 (15) ◽  
pp. 1541-1549
Author(s):  
Bernard De Bruyne ◽  
Nico H.J. Pijls ◽  
Emanuele Gallinoro ◽  
Alessandro Candreva ◽  
Stephane Fournier ◽  
...  
2006 ◽  
Vol 13 (5) ◽  
pp. 389-396 ◽  
Author(s):  
RAJAN PRAKASH ◽  
JAMES D. MINTZ ◽  
DAVID W. STEPP

2000 ◽  
Vol 9 (3) ◽  
pp. A162
Author(s):  
R.A.P. Skyrme-Jones ◽  
H.M.O. Farouque ◽  
J.L. Kealey ◽  
M.J. Zhang ◽  
I.T. Meredith

Cardiology ◽  
2014 ◽  
Vol 129 (1) ◽  
pp. 20-24 ◽  
Author(s):  
Rossella Parrinello ◽  
Alfonso Sestito ◽  
Antonino Di Franco ◽  
Giulio Russo ◽  
Angelo Villano ◽  
...  

Author(s):  
Filippo Crea ◽  
Gaetano A. Lanza ◽  
Paolo G. Camici

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ali Ahmad ◽  
Michel Corban ◽  
Takumi Toya ◽  
Frederik H Verbrugge ◽  
Jaskanwal D Sara ◽  
...  

Introduction: Coronary microvascular dysfunction (CMD) is prevalent in symptomatic patients with no obstructive coronary artery disease. We postulated that exercise capacity and cardiac output augmentation in response to exercise are linked to coronary microvascular function in this patient population. Methods: Fifty-one consecutive patients with unexplained cardiac exertion symptoms, non-obstructive coronary artery disease on angiography (<50% stenosis), and normal left ventricular ejection fraction (>50%) who underwent concurrent clinically indicated coronary reactivity testing and invasive cardiopulmonary exercise testing (CPEX) were included. Microvascular function was assessed by coronary flow reserve (CFR; hyperemic/resting flow) in response to intracoronary adenosine injection. Cardiac output (CO) was calculated at rest and peak exercise using Fick’s formula. CO limitation was defined as a measured (peak CO - resting CO) <80% than the expected [6*absolute ΔVO 2 (Peak VO 2 -Rest VO 2 ) increase in CO in L/min]. The relationship between CFR, maximal exercise capacity, and CO augmentation at peak exercise was explored. Results: Patients were 56.6±10.5 years old and 73% were females. CFR had a modest positive correlation with measured increase in CO (r=0.42; P=0.003) ( Fig 1A ), and with maximal ergometric exercise capacity [in Watts/Kg] (Pearson’s r=0.33, P=0.02) ( Fig 1B ). Patients with, vs. without impaired cardiac limitations during exercise, had significantly lower CFR levels (2.6±0.5 vs 3.1±0.7; P=0.01) ( Fig 2 ). Conclusion: Impaired coronary microvascular function is associated with lower peak exercise capacity and reduced cardiac output augmentation in response to exercise, underscoring the functional ramification of CMD in symptomatic patients.


Author(s):  
Paolo G. Camici ◽  
Ornella Rimoldi

Beside obstructive disease of the epicardial coronary arteries dysfunction of the coronary microvasculature has emerged in the past 20 years as an additional mechanism of myocardial ischaemia. The coronary microvasculature cannot be directly visualized in vivo, therefore, both invasive and non-invasive techniques, have been developed to assess parameters that depend directly on coronary microvascular function. Studies at the microcirculatory level entail the use of vasodilators to obtain near-maximal vasodilation. The ratio of the maximal increase of blood flow above its resting value the coronary flow reserve (CFR) allows to gain an insight into the integrated circulatory function. The diagnostic accuracy of imaging techniques can be exploited to detect impairments of myocardial perfusion in asymptomatic subjects with cardiovascular risk factors. The assessment of the coronary microvascular function has provided novel details on the pathophysiological role of coronary microvascular dysfunction in the development of myocardial ischaemia bearing also important prognostic implications.


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