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.

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

Neoangiogenesis after direct intramyocardial implantation of bone marrow-derived stem cells in a patient with severe coronary artery disease ineligible for percutaneous or surgical revascularization

Open Medicine ◽  
2009 ◽  
Vol 4 (3) ◽  
pp. 279-285
Author(s):  
Bugra Harmandar ◽  
Turkan Tansel ◽  
Ertan Onursal ◽  
Nuray Gurses ◽  
Sevgi Besisik ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Severe Coronary Artery Disease ◽  
Canadian Cardiovascular Society Class ◽  
Severe Coronary Artery ◽  
Artery Disease

AbstractBone marrow-derived stem cells (BMSC) may be an alternative for the treatment of patients with severe coronary artery disease ineligible for either percutaneous or surgical revascularization. This case report presents a 65-year-old male patient with untreatable angina pectoris (Canadian Cardiovascular Society Class III) and severe coronary artery disease. A mixture of BMSC containing approximately 3×106 CD34+ cells was directly injected into preoperatively determined ischemic regions of the myocardium by median sternotomy. At baseline, at 3 months, and at 1 year of follow-up, echocardiography (demonstrating wall motions of 16 segments), single-photon emission computed tomography, and coronary angiography (at baseline and at 1 year) were performed to assess myocardial perfusion, left ventricular (LV) function and coronary anatomy. The patient reached Canadian Cardiovascular Society Class I after 6 months of cell implantation. The ejection fraction increased from 34% to 37% at the third month and 40% at 1 year of follow-up. At 1 year of follow-up, preoperatively akinetic mid-base septum and anteroseptal regions progressed to mild hipokinesia and severe hypokinetic mid-base-apical anterior regions and apical lateral-inferior regions became normokinesia. Single-photon emission computed tomography revealed a visible improvement in anterior and lateral segments at 1 year of follow-up. Coronary angiography showed newly developed collateral arteries at 1 year of follow-up. BMSC transplantation in a patient with severe coronary artery disease resulted in increase of LV ejection fraction, an increase of the perfusion of ischemic myocardial regions, and improvement in wall motion defects without any adverse events.

scholarly journals A decision tree model for evaluating the cost effectiveness of Single-Photon Emission-Computed Tomography compared with stress echocardiography for diagnosis of coronary artery disease

2020 ◽  
Author(s):  
Javad Javan-Noughabi ◽  
Aziz Rezapour ◽  
Marjan Hajahmadi ◽  
Vahid Alipour ◽  
Abdosaleh Jafari ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cost Effectiveness ◽  
Coronary Artery ◽  
Stress Echocardiography ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Tree Model ◽  
Artery Disease ◽  
The Cost

Abstract Background Early diagnosis of coronary artery disease is very vital for success in treatment of this disease. However, the appropriate diagnostic modality for diagnosis of coronary artery disease is uncertain. Therefore, we conducted this study to compare the cost-effectiveness of Single-Photon Emission-Computed Tomography (SPECT) versus stress echocardiography for diagnosis of coronary artery disease in Iran.Methods A decision tree model was developed to compare the cost-effectiveness of SPECT versus stress echocardiography. This study was conducted in Tehran, capital of Iran, between April 1, 2017, and September 1, 2018. The cost analysis was conducted from a societal perspective and medical direct costs, nonmedical direct costs and indirect costs were estimated.. Effectiveness was defined as the accurate detection of coronary artery disease and invasive coronary angiography was used as a gold standard. The incremental cost-effectiveness ratio was defined as an additional cost per correct diagnosis.Results SPECT was associated with higher costs and lower effectiveness compared with stress echocardiography. Therefore stress echocardiography is dominant alternative compared to SPECT. The results also indicated that total cost per patient were $970.49 and $781.8 for SPECT and stress echocardiography, respectively. Also, the percent of true positive and true negative responses were %88 and %79 for SPECT and %90 and %92 for stress echocardiography.Conclusions The results of this study indicate that stress echocardiography is the cost-effective modality in the diagnosis of coronary artery disease compared with SPECT. According to the results, it is suggested cardiologists use stress echocardiography instead of SPECT for the diagnosis of coronary artery disease. The result of the current study has significant concepts for decision-making in designing clinical guidelines for the diagnosis of coronary artery disease.

scholarly journals Association of the Extent of Myocardial Ischemia with Outcomes in Patients with Suspected Coronary Artery Disease

2020 ◽  
Author(s):  
Takao Kato ◽  
Mitsuru Momose ◽  
Yukari Uemura ◽  
Masanao Naya ◽  
Naoya Matsumoto ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Single Photon ◽  
Heart Diseases ◽  
Photon Emission ◽  
Suspected Coronary Artery Disease ◽  
Emission Computed Tomography ◽  
Cardiac Events ◽  
Artery Disease

Abstract Background: There is an ongoing controversy regarding the necessity of single-photon emission computed tomography (SPECT) for patients with ischemic heart diseases after the publication of the results of the ISCHEMIA trial. We aimed to evaluate the association of the extent of myocardial ischemia with outcomes in patients with suspected coronary artery disease in Japan.Methods: From the data of 2780 patients with stable angina, who were enrolled prospectively between January 2006 and March 2008 in Japan and had undergone physician-referred non-invasive imaging tests, 1205 patients managed with SPECT were stratified by 10% myocardial ischemia. Major adverse cardiac events (MACEs), including death, myocardial infarction, hospitalization for heart failure, and late revascularization, were followed-up for 1 year. Results: Patients with ≥10% myocardial ischemia (n=173) were older than patients with <10% myocardial ischemia (n=1032) and had a significantly higher 1-year cumulative incidence of MACEs (9.1% vs. 1.2%, P<0.0001). After adjusting for confounders, the risk of ≥10% myocardial ischemia relative to <10% myocardial ischemia for MACEs remained significant (adjusted hazard ratio [95% confidence interval], 2.40 [1.09-5.26], P=0.029).Conclusion: The presence of ≥10% myocardial ischemia was significantly associated with the 1-year risk for MACEs in Japanese patients with suspected coronary artery disease.

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