Microvascular (dys)Function in Stable Coronary Artery Disease: Cross Talk with Epicardial Segments

2018 ◽  
Vol 24 (25) ◽  
pp. 2900-2905
Author(s):  
Lucian Calmac ◽  
Vlad Bataila ◽  
Bogdan Dragoescu ◽  
Cosmin Mihai ◽  
Alexandru Scafa-Udriste ◽  
...  
Keyword(s):  
Coronary Flow ◽  
Stable Coronary Artery Disease ◽  
Microvascular Dysfunction ◽  
Complex Interaction ◽  
Diagnostic Tools ◽  
Pathological State ◽  
Hemodynamic Parameters ◽  
Artery Disease ◽  
Epicardial Stenosis ◽  
Current Guidelines

Myocardial ischemia is the consequence of an unbalance between coronary flow that can be achieved and myocardial metabolic needs. Pathological state of both epicardial and intramyocardial vessels may be responsible for inducing ischemia. However, revascularization decision should be based on the severity of each epicardial lesion that is evaluated. There are different diagnostic tools that may help for the evaluation of each compartment which is based on the measurement of coronary hemodynamics. Pressure-derived indices are recommended by current guidelines for evaluation of epicardial stenosis significance. We assess the complex interaction between hemodynamic parameters in order to understand how different parameters are influenced in the settings of microvascular dysfunction.

scholarly journals Effects of coronary revascularization on global coronary flow reserve in stable coronary artery disease

2018 ◽  
Vol 115 (1) ◽  
pp. 119-129 ◽  
Author(s):  
Tadao Aikawa ◽  
Masanao Naya ◽  
Masahiko Obara ◽  
Osamu Manabe ◽  
Keiichi Magota ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Stable Coronary Artery Disease ◽  
Flow Reserve ◽  
Artery Disease ◽  
The Impact

Abstract Aims Coronary flow reserve (CFR) is an integrated measure of the entire coronary vasculature, and is a powerful prognostic marker in coronary artery disease (CAD). The extent to which coronary revascularization can improve CFR is unclear. This study aimed to evaluate the impact of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) on CFR in patients with stable CAD. Methods and results In a prospective, multicentre observational study, CFR was measured by 15O-water positron emission tomography as the ratio of stress to rest myocardial blood flow at baseline and 6 months after optimal medical therapy (OMT) alone, PCI, or CABG. Changes in the SYNTAX and Leaman scores were angiographically evaluated as indicators of completeness of revascularization. Follow-up was completed by 75 (25 OMT alone, 28 PCI, and 22 CABG) out of 82 patients. The median SYNTAX and Leaman scores, and baseline CFR were 14.5 [interquartile range (IQR): 8–24.5], 5.5 (IQR: 2.5–12.5), and 1.94 (IQR: 1.67–2.66), respectively. Baseline CFR was negatively correlated with the SYNTAX (ρ = −0.40, P < 0.001) and Leaman scores (ρ = −0.33, P = 0.004). Overall, only CABG was associated with a significant increase in CFR [1.67 (IQR: 1.14–1.96) vs. 1.98 (IQR: 1.60–2.39), P < 0.001]. Among patients with CFR <2.0 (n = 41), CFR significantly increased in the PCI [1.70 (IQR: 1.42–1.79) vs. 2.21 (IQR: 1.78–2.49), P = 0.002, P < 0.001 for interaction between time and CFR] and CABG groups [1.28 (IQR: 1.13–1.80) vs. 1.86 (IQR: 1.57–2.22), P < 0.001]. The reduction in SYNTAX or Leaman scores after PCI or CABG was independently associated with the percent increase in CFR after adjusting for baseline characteristics (P = 0.012 and P = 0.011, respectively). Conclusion Coronary revascularization ameliorated reduced CFR in patients with obstructive CAD. The degree of improvement in angiographic CAD burden by revascularization was correlated with magnitude of improvement in CFR.

scholarly journals Diagnostic value of myocardial perfusion CT to detect coexisting microvascular dysfunction in patients with obstructive epicardial coronary disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Hada ◽  
Y Kanaji ◽  
H Ueno ◽  
K Nogami ◽  
T Misawa ◽  
...  
Keyword(s):  
Myocardial Perfusion ◽  
Coronary Flow ◽  
Microvascular Dysfunction ◽  
Diagnostic Value ◽  
Regional Myocardial Blood Flow ◽  
Fractional Flow ◽  
Coronary Syndrome ◽  
Flow Reserve ◽  
Significant Difference ◽  
Epicardial Stenosis

Abstract Background The usefulness of computed tomography myocardial perfusion (CTP) to assess hemodynamically significant coronary artery lesions has been previously reported. However, the diagnostic value of quantitative evaluation of regional absolute coronary flow by CTP to detect microvascular dysfunction remains unknown. Purpose The aim of study is to assess the diagnostic value of preprocedural CTP to detect coexisting microvascular dysfunction with functionally significant epicardial stenosis in patients with chronic coronary syndromes. Methods and results Thirty-three chronic coronary syndrome patients with de novo single functionally significant stenosis (Fractional flow reserve [FFR]&lt;0.80) who underwent noncomplicated PCI were investigated. In CTP analysis, regional myocardial blood flow (MBF) at rest (rest-MBF) and hyperemia (hyperemic-MBF) were evaluated semi-automatically. Clinical characteristics, pressure-temperature sensor-chipped wire-based information and CTP findings were compared between groups with and without microvascular dysfunction defined by the index of microcirculatory resistance (IMR) (IMR≥25, n=17, IMR&lt;25, n=16, respectively). The determinants of coexistence of microvascular dysfunction and functional epicardial stenosis were determined. In invasive wire-based analysis, FFR, coronary flow reserve (CFRwire) and IMR were 0.68 (0.57–0.72), 1.61 (1.00–1.98), and 26.7 (19.3–39.4) respectively. In CTP analysis, rest and hyperemic-MBF and CFR derived from CTP (CFRCTP; calculated as hyperemic-MBF/rest-MBF) were 2.00 (1.31–2.35) ml/min/g, 4.03 (2.11–5.44) ml/min/g, and 2.09 (1.49–2.09) respectively. In the lesions with IMR&gt;25, hyperemic-MBF was significantly lower than that in IMR&lt;25 (3.42 [1.89–4.34] vs 4.50 [3.44–5.99], p=0.031), although there was no significant difference in regional rest-MBF and CFRCTP (1.75 [1.31–2.24] vs 2.05 [1.35–2.46], p=0.439, and 1.83 [1.21–2.11] vs 2.61 [1.91–2.91], p=0.101 respectively). Receiver operating characteristic curve analysis of hyperemic-MBF detecting IMR&gt;25 showed area under the curve of 0.72 (0.54–0.90), sensitivity of 47% and specificity of 94%. Conclusion Quantitative assessment of absolute coronary flow by CTP may help detect coexisting microvascular dysfunction in patients with significant epicardial stenotic lesions. Funding Acknowledgement Type of funding source: None

scholarly journals Relation Between Coronary Tortuosity and Vasomotor Dysfunction in Patients Without Obstructed Coronaries?

2022 ◽  
Vol 8 ◽  
Author(s):  
Tijn P. J. Jansen ◽  
Kyra van Keeken ◽  
Regina E. Konst ◽  
Aukelien Dimitriu-Leen ◽  
Angela H. E. M. Maas ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Flow ◽  
Obstructive Coronary Artery Disease ◽  
Coronary Artery Spasm ◽  
Microvascular Dysfunction ◽  
Flow Reserve ◽  
Index Of Microvascular Resistance ◽  
Artery Disease ◽  
Coronary Tortuosity ◽  
Vasomotor Dysfunction

Background: A large proportion of patients with angina and no obstructive coronary artery disease (ANOCA) has underlying coronary vasomotor dysfunction (CVDys), which can be diagnosed by a coronary function test (CFT). Coronary tortuosity is a common angiographic finding during the CFT. Yet, no data exist on the association between vasomotor dysfunction and coronary tortuosity.Aim: To investigate the association between CVDys and coronary tortuosity in patients with ANOCAMethods: All consecutive ANOCA patients who underwent clinically indicated CFT between February 2019 and November 2020 were included. CFT included acetylcholine spasm testing to diagnose epicardial or microvascular spasm, and adenosine testing to diagnose microvascular dysfunction (MVD). MVD was defined as an index of microvascular resistance (IMR) ≥ 25 and/or coronary flow reserve (CFR) &lt;2.0. Coronary tortuosity, was scored (no, mild, moderate or severe) based on the angles of the curvatures in the left anterior descending (LAD) artery on angiography.Results: In total, 228 patients were included (86% female, mean age 56 ± 9 years). We found coronary artery spasm in 81% of patients and MVD in 45% of patients (15%: abnormal CFR, 30%: abnormal IMR). There were 73 patients with no tortuosity, 114 with mild tortuosity, 41 with moderate tortuosity, and no patients with severe tortuosity. No differences were found in cardiovascular risk factors or medical history, and the prevalence of CVDys did not differ between the no tortuosity, mild tortuosity and moderate tortuosity group (82, 82, and 85%, respectively).Conclusion: In this study, CVDys was not associated with coronary tortuosity. Future experimental and clinical studies on the complex interplay between coronary tortuosity, wall shear stress, endothelial dysfunction and coronary flow are warranted.

scholarly journals A NORMAL RELATIVE CORONARY FLOW RESERVE IS ASSOCIATED WITH A LOWER MORTALITY IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE.

2010 ◽  
Vol 55 (10) ◽  
pp. A204.E1927
Author(s):  
Martijn Meuwissen ◽  
Steven AJ Chamuleau ◽  
Karel T. Koch ◽  
Robbert J. de Winter ◽  
Marije M. Vis ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Stable Coronary Artery Disease ◽  
Lower Mortality ◽  
Flow Reserve ◽  
Artery Disease
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