Stress echocardiography: diagnostic and prognostic values and specific clinical subsets

2016 ◽  
Author(s):  
Luc A. Pierard ◽  
Lauro Cortigiani
Keyword(s):  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Stress Echocardiography ◽  
Left Ventricular ◽  
Myocardial Imaging ◽  
Prognostic Information ◽  
Hypertensive Patients ◽  
Exercise Electrocardiography ◽  
Flow Reserve ◽  
Inducible Ischaemia

Stress echocardiography is a widely used method for assessing coronary artery disease, due to its high diagnostic and prognostic value. While inducible ischaemia predicts an unfavourable outcome, its absence is associated with a low risk of future cardiac events. The method provides superior diagnostic and prognostic information than standard exercise electrocardiography and perfusion myocardial imaging in specific clinical subsets, such as women, hypertensive patients, and patients with left bundle branch block. Stress echocardiography allows effective risk assessment also in the diabetic population. The evaluation of coronary flow reserve of the left anterior descending artery by transthoracic Doppler adds diagnostic and prognostic information to that of standard stress test. Stress echocardiography is indicated in the cases when exercise electrocardiography is unfeasible, uninterpretable or gives ambiguous result, and when ischaemia during the test is frequently a false-positive response, as in hypertensive patients, women, and patients with left ventricular hypertrophy. Viability detection represents another application of stress echocardiography. The documentation of a large amount of viable myocardium predicts improved ejection fraction, reverse remodelling, and improved outcome following revascularization in patients with ischaemic cardiomyopathy. Moreover, stress echocardiography can aid significantly in clinical decision-making in patients with valvular heart disease through dynamic assessment of primary or secondary mitral regurgitation, transvalvular gradients, and pulmonary artery systolic pressure, as well as before vascular surgery due to the excellent negative predictive value. Finally, stress echocardiography allows effective risk stratification in patients with hypertrophic cardiomyopathy through evaluation of inducible ischaemia, coronary flow reserve, and intraventricular gradient.

Coronary flow reserve in hypertensive patients with appropriate or inappropriate left ventricular mass

2003 ◽  
Vol 21 (11) ◽  
pp. 2183-2188 ◽  
Author(s):  
Maurizio Galderisi ◽  
Giovanni de Simone ◽  
Silvana Cicala ◽  
Luigi De Simone ◽  
Arcangelo D'Errico ◽  
...  
Keyword(s):  
Left Ventricular Mass ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Left Ventricular ◽  
Hypertensive Patients ◽  
Flow Reserve ◽  
Ventricular Mass

Impairment of coronary flow reserve in aortic stenosis

2009 ◽  
Vol 106 (1) ◽  
pp. 113-121 ◽  
Author(s):  
Damien Garcia ◽  
Paolo G. Camici ◽  
Louis-Gilles Durand ◽  
Kim Rajappan ◽  
Emmanuel Gaillard ◽  
...  
Keyword(s):  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Lumped Parameter Model ◽  
Effective Orifice Area ◽  
Sensitivity Index ◽  
Coronary Perfusion ◽  
Flow Reserve ◽  
Wide Range

Coronary flow reserve (CFR) is markedly reduced in patients with severe aortic valve stenosis (AS), but the exact mechanisms underlying this impairment of CFR in AS remain unclear. Reduced CFR is the key mechanism leading to myocardial ischemia symptoms and adverse outcomes in AS patients. The objective of this study was to develop an explicit mathematical model formulated with a limited number of parameters that describes the effect of AS on left coronary inflow patterns and CFR. We combined the mathematical V3 (ventricular-valvular-vascular) model with a new lumped-parameter model of coronary inflow. One thousand Monte-Carlo computational simulations with AS graded from mild up to very severe were performed within a wide range of physiological conditions. There was a good agreement between the CFR values computed with this new model and those measured in 24 patients with isolated AS ( r = 0.77, P < 10−4). A global sensitivity analysis showed that the valve effective orifice area (EOA) was the major physiological determinant of CFR (total sensitivity index = 0.87). CFR was markedly reduced when AS became severe, i.e., when EOA was <1.0 cm2, and was generally exhausted when the EOA was <0.5–0.6 cm2. The reduction of CFR that is associated with AS can be explained by the concomitance of 1) reduced myocardial supply as a result of decreased coronary perfusion pressure, and 2) increased myocardial metabolic demand as a result of increased left ventricular workload.

Stress echocardiography

2011 ◽  
Author(s):  
Lauro Cortigiani ◽  
Eugenio Picano
Keyword(s):  
Stress Echocardiography ◽  
Clinical Decision Making ◽  
Stress Test ◽  
Dynamic Assessment ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Pulmonary Artery Systolic Pressure ◽  
Mitral Insufficiency ◽  
Prognostic Information ◽  
Flow Reserve

Stress echocardiography is a widely used method for assessing coronary artery disease, due to the high diagnostic and prognostic value. While inducible ischaemia predicts an unfavourable outcome, its absence is associated with a low risk of future events. The evaluation of coronary flow reserve by Doppler adds prognostic information to that of standard stress test. Stress echocardiography is indicated in cases when exercise testing is unfeasible, uninterpretable, or gives ambiguous result, and when ischaemia during the test is frequently a false positive response, as in hypertensives, women and patients with left ventricular hypertrophy. Viability detection represents another application of stress echocardiography. The documentation of viable myocardium predicts an improved outcome following revascularization in ischaemic and following resynchronization therapy in idiopathic cardiomyopathy. Moreover, stress echocardiography can aid significantly in clinical decision making in patients with valvular heart disease through dynamic assessment of mitral insufficiency, transvalvular gradients and pulmonary artery systolic pressure. Among the various stress modalities, exercise is safer than pharmacologic stress, in which major complications are three times more frequent with dobutamine than with dipyridamole. Stress echocardiography provides similar accuracy than perfusion scintigraphy but a substantially lower cost, without environmental impact and with no radiation biohazards for the patient.

scholarly journals Left ventricular concentric remodelling and functional impairment in women with ischaemia with no obstructive coronary artery disease and intermediate coronary flow reserve: a report from the WISE-CVD study

2019 ◽  
Vol 20 (8) ◽  
pp. 875-882 ◽  
Author(s):  
Seong-Mi Park ◽  
Janet Wei ◽  
Galen Cook-Wiens ◽  
Michael D Nelson ◽  
Louise Thomson ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Obstructive Coronary Artery Disease ◽  
Left Ventricular ◽  
Flow Reserve ◽  
Group 2 ◽  
Artery Disease ◽  
Group 1

Abstract Aims Women with evidence of ischaemia but no obstructive coronary artery disease (INOCA) often have coronary microvascular dysfunction (CMD). Although invasively measured coronary flow reserve (CFR) is useful for the diagnosis of CMD, intermediate CFR values are often found of uncertain significance. We investigated myocardial flow reserve and left ventricular (LV) structural and functional remodelling in women with suspected INOCA and intermediate CFR. Methods and results Women’s Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study participants who had invasively measured intermediate CFR of 2.0≤ CFR ≤3.0 (n = 125) were included for this analysis. LV strain, peak filling rate (PFR) and myocardial perfusion reserve index (MPRI) were obtained by cardiac magnetic resonance imaging. Participants were divided: (i) Group 1 (n = 66) high MPRI ≥ 1.8, and (ii) Group 2 (n = 59) low MPRI < 1.8. The mean age was 54 ± 12 years and CFR was 2.46 ± 0.27. MPRI was significantly different but CFR did not differ between groups. LV relative wall thickness (RWT) trended higher in Group 2 and circumferential peak systolic strain and early diastolic strain rate were lower (P = 0.039 and P = 0.035, respectively), despite a similar LV ejection fraction and LV mass. PFR was higher in Group 1 and LV RWT was negatively related to PFR (r = −0.296, P = 0.001). Conclusions In women with suspected INOCA and intermediate CFR, those with lower MPRI had a trend towards more adverse remodelling and impaired diastolic LV function compared with those with higher MPRI. CFR was similar between the two groups. These findings provide evidence that both coronary microvessel vasomotion and structural and functional myocardial remodelling contribute to CMD.

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