scholarly journals TCT-240 Coronary Microvascular Dysfunction in Takotsubo Cardiomyopathy Assessed by Angiography-Derived Index of Microcirculatory Resistance, a Pressure Wire–Free Tool

2021 ◽  
Vol 78 (19) ◽  
pp. B97-B98
Author(s):  
Estefanía Fernández Peregrina ◽  
Jordi Sans-Rosello ◽  
Albert Duran-Cambra ◽  
Jose Carreras-Mora ◽  
Jesús Álvarez-García ◽  
...  
Keyword(s):  
Takotsubo Cardiomyopathy ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Pressure Wire ◽  
Index Of Microcirculatory Resistance

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.

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 Long-Term Clinical Outcomes in Patients With an Acute ST-Segment-Elevation Myocardial Infarction Stratified by Angiography-Derived Index of Microcirculatory Resistance

2021 ◽  
Vol 8 ◽  
Author(s):  
Rafail A. Kotronias ◽  
Dimitrios Terentes-Printzios ◽  
Mayooran Shanmuganathan ◽  
Federico Marin ◽  
Roberto Scarsini ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Primary Endpoint ◽  
Rank Test ◽  
Coronary Microvascular Dysfunction ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Log Rank Test ◽  
St Segment ◽  
Pressure Wire ◽  
Index Of Microcirculatory Resistance

Aims: Despite the prognostic value of coronary microvascular dysfunction (CMD) in patients with ST-segment-elevation myocardial infarction (STEMI), its assessment with pressure-wire-based methods remains limited due to cost, technical and procedural complexities. The non-hyperaemic angiography-derived index of microcirculatory resistance (NH IMRangio) has been shown to reliably predict microvascular injury in patients with STEMI. We investigated the prognostic potential of NH IMRangio as a pressure-wire and adenosine-free tool.Methods and Results: NH IMRangio was retrospectively derived on the infarct-related artery at completion of primary percutaneous coronary intervention (pPCI) in 262 prospectively recruited STEMI patients. Invasive pressure-wire-based assessment of the index of microcirculatory resistance (IMR) was performed. The combination of all-cause mortality, resuscitated cardiac arrest and new heart failure was the primary endpoint. NH IMRangio showed good diagnostic performance in identifying CMD (IMR &gt; 40U); AUC 0.78 (95%CI: 0.72–0.84, p &lt; 0.0001) with an optimal cut-off at 43U. The primary endpoint occurred in 38 (16%) patients at a median follow-up of 4.2 (2.0–6.5) years. On survival analysis, NH IMRangio &gt; 43U (log-rank test, p &lt; 0.001) was equivalent to an IMR &gt; 40U(log-rank test, p = 0.02) in predicting the primary endpoint (hazard ratio comparison p = 0.91). NH IMRangio &gt; 43U was an independent predictor of the primary endpoint (adjusted HR 2.13, 95% CI: 1.01–4.48, p = 0.047).Conclusion: NH IMRangio is prognostically equivalent to invasively measured IMR and can be a feasible alternative to IMR for risk stratification in patients presenting with STEMI.

scholarly journals Takotsubo Cardiomyopathy: One More Angiographic Evidence of Microvascular Dysfunction

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Marco Loffi ◽  
Andrea Santangelo ◽  
Martin Kozel ◽  
Viktor Kocka ◽  
Tomas Budesinsky ◽  
...  
Keyword(s):  
Myocardial Perfusion ◽  
Coronary Arteries ◽  
Takotsubo Cardiomyopathy ◽  
Coronary Flow ◽  
Microvascular Dysfunction ◽  
Control Group ◽  
Coronary Microvascular Dysfunction ◽  
Microvascular Angina ◽  
Timi Frame Count ◽  
Angiographic Evidence

Background. Takotsubo cardiomyopathy (TC) aetiology has not been completely understood yet. One proposed pathogenic mechanism was coronary microvascular dysfunction (MVD). This study compared coronary flow and myocardial perfusion in patients with TC, microvascular angina (MVA), and a control group (CG). Methods. Out of 42 consecutive patients presented to our centre with TC from 2013 to 2017; we retrospectively selected 27 patients. We compared them with a sex- and age-matched group of 27 MVA cases and 27 patients with normal coronary arteries (CG). The flow was evaluated in the three coronary arteries as TIMI flow and TIMI frame count (TFC). Myocardial perfusion was studied with Blush-Score and Quantitative Blush Evaluator (QuBE). Results. TFC, in TC, revealed flow impairment in the three arteries compared to the CG (left anterior descending artery (LAD): 22±8, 15±4; p=0.001) (right coronary artery: 12±4, 10±3; p=0,025) (left circumflex: 14±4, CG 11±3; p=0,006). QuBE showed myocardial perfusion impairment in the LAD territory in TC comparing with both the CG (8,9 (7,2–11,5) versus 11,4 (10–15,7); p=0,008) and the MVA group (8,9 (7,2–11,5) versus 13,5 (10–16); p=0,006). Conclusions. Our study confirmed that coronary flow is impaired in TC, reflecting a MVD. Myocardial perfusion defect was detected only in the LAD area.

Coronary Microvascular Dysfunction Assessed by Pressure Wire and CMR After STEMI Predicts Long-Term Outcomes

2021 ◽  
Author(s):  
Roberto Scarsini ◽  
Mayooran Shanmuganathan ◽  
Giovanni Luigi De Maria ◽  
Alessandra Borlotti ◽  
Rafail A. Kotronias ◽  
...  
Keyword(s):  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Long Term Outcomes ◽  
Pressure Wire
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