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) <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.

Abstract 9946: Impact of Sex Differences on Invasive Measures of Coronary Microvascular Dysfunction in Patients With Angina in the Absence of Obstructive Coronary Artery Disease

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yuhei Kobayashi ◽  
Yasuhiro Honda ◽  
William F Fearon ◽  
Shigemitsu Tanaka ◽  
Peter J Fitzgerald ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Sex Differences ◽  
Coronary Artery ◽  
Coronary Flow ◽  
Obstructive Coronary Artery Disease ◽  
Microvascular Dysfunction ◽  
Microvascular Function ◽  
Coronary Microvascular Dysfunction ◽  
Flow Reserve ◽  
Artery Disease

Background: Coronary microvascular dysfunction is associated with worse long-term outcomes, especially in women. Coronary flow reserve (CFR) is typically used to interrogate microvascular function; however its variability limits reliability. Alternatively, the index of microcirculatory resistance (IMR) is a direct measure of the microvasculature, but has been less thoroughly studied. We investigated sex differences in CFR and IMR in patients with angina in the absence of obstructive coronary artery disease (CAD). Methods: We prospectively enrolled 117 women and 40 men with angina in the absence of obstructive CAD. We performed CFR, IMR, fractional flow reserve (FFR), and quantitative coronary angiography (QCA) in the left anterior descending artery. Coronary flow was assessed with a thermodilution method by obtaining mean transit time (Tmn: an inverse correlate to absolute flow) at rest and hyperemia. IMR was measured as distal coronary pressure at hyperemia x hyperemic Tmn. Results: All patients had minimal or no atherosclerosis by QCA (%diameter stenosis: 23.2±12.3%), and epicardial disease was milder in women (FFR: 0.88±0.04 vs. 0.87±0.04, p=0.04). IMR was similar between the sexes (20.7±9.8 vs. 19.1±8.0, p=0.45), but CFR was lower in women (3.8±1.6 vs. 4.8±1.9, p=0.004). This was primarily due to a shorter resting Tmn in women (p=0.005), while hyperemic Tmn was identical (p=0.79) (Figure). The shorter resting Tmn in women, reflecting increased resting coronary flow, accounted for the lower CFR. In multivariate analysis, female sex was an independent predictor of lower CFR and shorter resting Tmn, but not a predictor of IMR or hyperemic Tmn. Conclusions: Despite women and men having similar microvascular function by IMR, CFR is lower in women. This discrepancy appears to be due to differences in resting coronary flow between the sexes. The impact of sex differences should be considered in interpretation of physiologic indices using resting coronary flow.

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

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 Prevalence of Coronary Endothelial and Microvascular Dysfunction in Women with Symptoms of Ischemia and No Obstructive Coronary Artery Disease Is Confirmed by a New Cohort: The NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation–Coronary Vascular Dysfunction (WISE-CVD)

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
R. David Anderson ◽  
John W. Petersen ◽  
Puja K. Mehta ◽  
Janet Wei ◽  
B. Delia Johnson ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Vascular Dysfunction ◽  
Hormone Replacement ◽  
Obstructive Coronary Artery Disease ◽  
Signs And Symptoms ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Cardiac Events ◽  
Flow Reserve ◽  
Artery Disease

Objective. In a separate, contemporary cohort, we sought to confirm findings of the original Women’s Ischemia Syndrome Evaluation (WISE). Background. The original WISE observed a high prevalence of both invasively determined coronary endothelial and coronary microvascular dysfunction (CMD) that predicted adverse events in follow-up. Methods. We comparatively studied the WISE-Coronary Vascular Dysfunction (CVD) cohort (2009-2011), with signs and symptoms of ischemia but without significant CAD, to the original WISE (1997-2001) cohort. CMD was defined as coronary flow reserve (CFR) ≤2.5, or endothelial dysfunction as epicardial coronary artery constriction to acetylcholine (ACH), or <20% epicardial coronary dilation to nitroglycerin (NTG). Results. In WISE (n=181) and WISE-CVD (n=235) women, mean age in both was 54 years, and 83% were white (WISE) vs 74% (WISE-CVD, p=0.04). Use of hormone replacement therapy was less frequent in WISE-CVD vs WISE (46% vs 57%, p=0.026) as was presence of hypertension (40% vs 52%, p=0.013), hyperlipidemia (20% vs 46%, p<0.0001), and smoking (46% vs 56%, p=0.036). Similar rates were observed in WISE-CVD and WISE cohorts for CMD (mean CFR 2.7±0.6 vs 2.6±0.8, p=0.35), mean change in diameter with intracoronary ACH (0.2±10.0 vs 1.6±12.8 mm, p=0.34), and mean change in diameter with intracoronary NTG (9.7±13.0 vs 9.8±13.5 mm, p=0.94), respectively. Conclusions. This study confirms prevalence of CMD in the contemporary WISE-CVD cohort similar to that of the original WISE cohort, despite a lower risk factor burden in WISE-CVD. Because these coronary functional abnormalities predict major adverse cardiac events, clinical trials of therapies targeting these abnormalities are indicated.

scholarly journals Sex Differences in Coronary Function Test Results in Patient With Angina and Nonobstructive Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Tijn P. J. Jansen ◽  
Suzette E. Elias-Smale ◽  
Stijn van den Oord ◽  
Helmut Gehlmann ◽  
Aukelien Dimitiriu-Leen ◽  
...  
Keyword(s):  
Vascular Dysfunction ◽  
Obstructive Coronary Artery Disease ◽  
Coronary Intervention ◽  
Flow Reserve ◽  
Index Of Microvascular Resistance ◽  
Microvascular Spasm ◽  
Traditional Risk Factors ◽  
Artery Disease ◽  
A Prospective Study ◽  
Vasomotor Dysfunction

Introduction: Invasive coronary function testing (CFT) has become the recommended diagnostic tool to assess the various endotypes of coronary vasomotor dysfunction in patients with angina and no obstructive coronary artery disease (ANOCA), which has implications for therapy and prognosis. Although the expanding performance of CFT is leading to increased knowledge of coronary vasomotor dysfunction, little is known about sex-related differences in the results of comprehensive CFT.Methods: We conducted a prospective study of all consecutive patients with ANOCA that underwent clinically indicated CFT in a tertiary interventional from February 2019 to February 2021. CFT consisted of acetylcholine testing to diagnose epicardial or microvascular spasm, and adenosine testing to diagnose CMD. CMD was defined as an index of microvascular resistance (IMR) ≥ 25 and/or coronary flow reserve (CFR) &lt; 2.0.Results: In total, 228 women and 38 men underwent CFT. No differences in traditional risk factors were seen, but women had a higher prevalence of migraine (45 vs. 14%, p = 0.001). Men more often had a history of percutaneous coronary intervention (12 vs. 49%, p = 0.001). We found no difference in clinical presentation. Coronary vasomotor dysfunction was present in 95% of men and 88% of women (p = 0.25), but males show more often epicardial spasm and less microvascular spasm than women (63 vs. 42% and 29 vs. 40% respectively, p = 0.039). Impaired CFR was more prevalent among females (6 vs 20%, p = 0.033). IMR [median of 23 (15–32) vs. 19 (13–25), p = 0.08] did not differ between the sexes.Conclusion: Men undergoing CFT show a comparable prevalence of coronary vascular dysfunction as women. However, men have a higher prevalence of epicardial spasm and a lower prevalence of microvascular spasm compared with women. An impaired CFR was more often present in women, with an equally impairment of IMR.

Abstract 4234: Prognostic Implication of the Continuous Prognostic Spectrum of Coronary Flow Reserve in Patients with and without Angiographically Obstructive Coronary Artery Disease

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Lauro Cortigiani ◽  
Fausto Rigo ◽  
Sonia Gherardi ◽  
Rosa Sicari ◽  
Maria Luisa Gianfaldoni ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Prognostic Value ◽  
Wall Motion ◽  
Obstructive Coronary Artery Disease ◽  
Flow Reserve ◽  
Stress Echo ◽  
Artery Disease

Dual imaging of wall motion and coronary flow reserve (CFR) on left anterior descending (LAD) artery is now the state-of-the art technique for vasodilator stress echo. The additive prognostic value of CFR over regional wall motion has been established, but there is more than a binary (normal-abnormal ) response in CFR, which can be continuously titrated. Objectives. To assess the prognostic value of Doppler echocardiographic derived CFR in patients with and without angiographically obstructive coronary artery disease (CAD). 1244 patients (785 men, age 64±11 yy) with known or suspected CAD underwent dipyridamole (up to 0.84 mg/kg over 6′) stress echo with CFR evaluation of left anterior descending artery by Doppler and coronary angiography. Patients were followed-up for a median of 17 months. Mean CFR in the entire population was 2.25±0.64. During follow-up, there were 227 events (26 deaths, 55 STEMI, and 146 NSTEMI). Patients (n=384) undergoing revascularization were censored. Using the Kaplan-Meier method, the lowest quartile of CFR (<1.80) was associated with a significantly (p<0.0001) worst event rate than other quartiles (Figure ), both considering the group with (83 vs 53%, p<0.0001) and without (53 vs 12%, p<0.0001) obstructive CAD at angiography. CFR is a strong and independent prognostic predictor in patients with known or suspected CAD, but the spectrum of prognostic stratification is expanded if the response is titrated according to a continuous scale rather than artificially dichotomized.

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