Abstract 2870: In Women without Obstructive Coronary Artery Disease, Endothelial-Dependent and Non-Endothelial Dependent Coronary Reactivity Dysfunction are Associated with Different Types of Adverse Outcomes. The NHLBI Women’s Ischemia Syndrome Evaluation (WISE).

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Scott Midwall ◽  
R. David Anderson ◽  
Delia Johnson ◽  
Eileen Handberg ◽  
Rhonda Cooper-Dehoff ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Adverse Events ◽  
Obstructive Coronary Artery Disease ◽  
Treatment Strategies ◽  
Adverse Outcomes ◽  
Flow Reserve ◽  
Different Types ◽  
Artery Disease ◽  
Major Adverse Events

Backround: Altered coronary reactivity frequently occurs in women with chest discomfort both with and without obstructive coronary artery disease (CAD). Among those with obstructive CAD, the endothelial-dependent and non-endothelial dependent components of this altered reactivity have been associated with adverse outcomes. The clinical events among those with altered coronary reactivity but without obstructive CAD are not well defined. Methods: We evaluated 169 women with suspected myocardial ischemia who had no obstructive CAD at coronary angiography. Coronary reactivity was assessed by measuring flow reserve (CFR) with adenosine (endothelial-dependent) and change in vessel diameter (DIAM) following acetylcholine (non-endothelial dependent). Women were then followed for major adverse events (death, myocardial infarction, stroke, or hospitalization for heart failure) as well as hospitalization for recurrent angina by annual telephone contact over a median of 6.0 years. Results: Mean age was 54 ± 10 years, 15% were non-white, 37% had abnormal CFR (<2.32), and 47% had abnormal DIAM (no change or constriction). Of the women receiving both coronary reactivity tests, results were concordant in only 52%. Major events occurred in 16% (28/169) of which 5% (8/169) died. An additional 24% (41/169) were hospitalized for worsening angina. Major adverse events were predicted by abnormal CFR (27% vs 10%, p = 0.006) but not abnormal DIAM, while abnormal DIAM, but not CFR, predicted hospitalization for angina. Conclusion: Endothelial-dependent and non-dependent coronary dysfunction coexist in approximately one-half of women tested without angiographic evidence of CAD and appear to predict different types of adverse outcomes during follow-up. These results should foster developement of new diagnostic and treatment strategies targeting both endothelial and non-endothelial (e.g. vascular smooth muscle) dependent coronary dysfunction in women.

Abstract 14277: Serum Nt-prob-type Natriuretic Peptide is Associated With Coronary Microvascular Dysfunction in Patients With Angina and Non-obstructive Coronary Artery Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ali Ahmad ◽  
Jaskanwal D Sara ◽  
Michel T Corban ◽  
Takumi Toya ◽  
Ilke Ozcan ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Natriuretic Peptide ◽  
Obstructive Coronary Artery Disease ◽  
Inverse Correlation ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Flow Reserve ◽  
Artery Disease ◽  
And Gender

Title: Serum NT-proB-type Natriuretic Peptide is associated with Coronary Microvascular Dysfunction in Patients with Angina and Non-obstructive Coronary Artery Disease Authors: Ali Ahmad, MD, Jaskanwal D. Sara, MBChB, Michel T. Corban, MD, Takumi Toya, MD, Ilke Özcan, MD, Lilach O. Lerman, MD PhD, Amir Lerman, MD Introduction: Coronary microvascular dysfunction (CMD) is prevalent in patients with heart failure with preserved ejection fraction. Subclinical ischemia and myocardial fibrosis in CMD might raise filling pressure, a hallmark of HFpEF, which induces secretion of NT-proB-type natriuretic peptide (NTpro-BNP). We sought to explore the relationship between CMD and NT-proBNP. Methods: We studied 698 patients with signs and/or symptoms of ischemia and with non-obstructive CAD (<40% angiographic stenosis) who underwent invasive CMD evaluation and had NT-proBNP checked within 6 weeks. CMD was defined as coronary flow reserve (CFR) (hyperemic flow/baseline flow as measured by the doppler wire) of ≤2.5 in response to intracoronary adenosine injection. Results: Overall mean age was 52.8±12.2 years, and women represented 69% of the patients. Log NT-proBNP showed a modest inverse correlation with CFR (Pearson’s R = -0.22, P<0.0001; Figure 1 ), which remained significant after adjusting for age and gender (Standardized ß coefficient = -0.14; P = 0.001). Patients with CMD had higher levels of NT-proBNP than those without (82 [44-190] vs. 62 (33-130], P <0.0001; Figure 2) . Conclusion: Declining coronary microvascular function is correlated with higher NT-proBNP levels. Patients with CMD had higher levels of NT-proBNP, a marker of elevated LV pressure, contributing to the possible role of CMD in early HFpEF pathophysiology. Keywords: Coronary microvascular dysfunction, NT-proBNP

Abstract 11043: Lipoprotein(a) Cholesterol but not Lipoprotein (a) Mass is Significantly Correlated With Angiographic Coronary Artery Disease and Major Adverse Events

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Linnea Baudhuin ◽  
Sandra Bryant ◽  
Grant Spears ◽  
Stacy Hartman ◽  
Virend Somers ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Adverse Events ◽  
Multivariable Analysis ◽  
Hdl Cholesterol ◽  
Strongly Correlated ◽  
Lipoprotein A ◽  
Increased Risk ◽  
Artery Disease ◽  
Major Adverse Events

Introduction: Elevated plasma levels of lipoprotein(a) [Lp(a)] are associated with increased risk for coronary artery disease (CAD), but the strength of the association and whether it is independent of other risk factors remains controversial. Differences in prospective studies may be partially explained by variability in methods used to measure Lp(a). Methods: We utilized two different analytical methods (electrophoretic and immunologic) to measure Lp(a) and determine the predictive value of Llp(a) in assessing angiographic coronary artery disease (CAD) and association with major adverse events in 500 patients. Results: In univariate analyses, median Lp(a) cholesterol and Lp(a) mass were significantly associated with angiographic CAD. In a multivariable model, Lp(a) cholesterol remained a significant correlate of CAD (OR 1.61, 95% CI 1.13-2.31, P = 0.009) while Lp(a) mass was not (OR 1.18, 95% CI 0.95-1.47, P = 0.14). Additionally, on multivariable analysis, the presence of a detectable amount of Lp(a) cholesterol (> or =2.5 mg/dL) was more strongly correlated with CAD than HDL cholesterol < 40 mg/dL, and, along withLp(a) cholesterol, was strongly correlated with major adverse events (OR 2.08 95% CI 1.22-3.56, P = 0.007 and OR 1.22, 95% CI 1.05-1.42, P = 0.012, respectively). Conclusions: Lp(a) cholesterol measured electrophoretically is independently correlated with angiographic CAD and presence of major adverse events, and may be used as an alternative or supplement to Lp(a) mass analysis.

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.

scholarly journals Radionuclide imaging methods in the diagnosis of microvascular dysfunction in non-obstructive coronary artery disease

2021 ◽  
Vol 26 (12) ◽  
pp. 4746
Author(s):  
A. N. Maltseva ◽  
A. V. Mochula ◽  
K. V. Kopyeva ◽  
E. V. Grakova ◽  
K. V. Zavadovsky
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Single Photon ◽  
Obstructive Coronary Artery Disease ◽  
Photon Emission ◽  
Small Diameter ◽  
Microvascular Dysfunction ◽  
Emission Computed Tomography ◽  
Flow Reserve ◽  
Artery Disease

Non-obstructive coronary artery disease is generally considered as a favorable type of pathology, however, a number of studies indicate that in non-obstructive atherosclerosis, the risk of such cardiovascular events as myocardial infarction, ischemic stroke, sudden cardiac death and decompensated heart failure cannot be completely ruled out. This may be due to microvascular dysfunction. However, due to the small diameter of vessels, none of the imaging techniques used in clinical practice makes it possible to assess microvascular morphology. To date, the most well-established methods for assessing myocardial perfusion are single-photon emission computed tomography (SPECT) and positron emission tomography (PET). The ability to quantify myocardial blood flow and coronary flow reserve allows SPECT and PET to be the methods of choice for non-invasive diagnosis of microvascular dysfunction. This review is devoted to current data on the clinical significance of radionuclide diagnosis of microvascular dysfunction in patients with non-obstructive coronary artery disease.

scholarly journals Combining body mass index with waist circumference to assess coronary microvascular function in patients with non-obstructive coronary artery disease

2021 ◽  
Author(s):  
Ruonan Wang ◽  
Xiang Li ◽  
Shihao Huangfu ◽  
Qi Yao ◽  
Ping Wu ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Waist Circumference ◽  
Obstructive Coronary Artery Disease ◽  
Normal Weight ◽  
Excess Weight ◽  
Coronary Microvascular Dysfunction ◽  
Flow Reserve ◽  
Increased Risk ◽  
Artery Disease

Abstract Background Coronary microvascular dysfunction (CMD) may precede clinically overt coronary artery disease (CAD). Overall and central obesity (CO) are major risk factors for CAD. This study sought to investigate the subclinical significance of body adiposity patterns based on the CMD risk. Methods A total of 128 patients with non-obstructive CAD were prospectively enrolled. Patients were categorized into 4 anthropometric groups: normal weight and non-CO (NWNCO, n = 41), normal weight and CO (NWCO, n = 20), excess weight and non-CO (EWNCO, n = 26), and excess weight and CO (EWCO, n = 41). Patients underwent rest/stress electrocardiography-gated 13N-ammonia positron emission tomography to measure absolute myocardial blood flow (MBF), myocardial flow reserve (MFR), hemodynamic parameters, and cardiac function. Results Resting MBF did not differ between groups (P = .36). Compared with the NWNCO group, hyperemic MBF and MFR were significantly lower in the NWCO and EWCO groups. Notably, patients with NWCO presented the lowest hyperemic MBF and MFR and the highest incidence of CMD. Waist circumference was an independent risk factor for CMD (OR 1.05, 95% CI 1.01 to 1.10, P = .02). Conclusion In patients with non-obstructive CAD, CO may be associated with an increased risk of CMD to better fit the study findings which did not assess management or monitoring of MBF and MFR.

Abstract 6094: Alterations in Blood Flow Reserve Secondary to Decompensated Diabetes Mellitus - Preliminary Results Obtained by Myocardial Contrast Echocardiography

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Natanael V Moraes ◽  
Carolina P Oliveira ◽  
Jeane Tsutsui ◽  
Antônio C Lerário ◽  
Wilson Mathias
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Blood Flow ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Contrast Echocardiography ◽  
Blood Glucose Control ◽  
Diabetic Patients ◽  
Flow Reserve ◽  
Artery Disease

Diabetes mellitus (DM) is one of the most important health problems in developed countries. Poor blood glucose control is known to be associated with clinical symptoms and increased risk for cardiovascular complications. Myocardial contrast echocardiography (MCE) has been demonstrated to be valuable for assessing myocardial blood flow reserve (MBFR) in patients with obstructive coronary artery disease and in those with microcirculatory alterations. We hypothesized that DM would result in impairment of MBFR, as measured by MCE, even in patients without obstructive coronary artery disease. Methods: We studied 30 patients with DM (mean age 55 years, 13 men) and 10 control subjects (mean age 53 years, 5 men) with normal global and regional systolic function. MBFR was determined by quantitative contrast echocardiography during dipyridamol (0.84 mg/Kg) stress using intravenous commercialy available microbubbles contrast (Definity, Bristol-Myers Squibb). Diabetic patients were studied in a decompensated state, with mean glycosylated hemoglobin of 9.0% (ranging from 8.5% to 13.0%). Quantification of peak myocardial intensity (A), microbubble velocity (Beta) and MBFR (peak dipyridamol/baseline AxBeta) were measured off line using Q-Lab software (Philips Medical Imaging). All patients underwent computed tomography coronary angiography (64 slices) which demonstrated no obstructive coronary artery disease. Results: Values of A (dB), Beta (1/s), and AxBeta (dB/s) both at baseline and during dipyridamol stress are described in Table . MBFR was significantly lower in patients with decompensated DM than in control subjects (1.58 versus 2.87; p<0.001). Conclusion: These preliminary results suggest that diabetic patients with poor blood glucose control and no obstructive coronary artery disease have impaired MBFR. MCE may be a useful noninvasive technique for evaluating changes in MBFR in this group of patients.

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