scholarly journals Invasive Assessment of Coronary Microvascular Function

2021 ◽  
Vol 11 (1) ◽  
pp. 228
Author(s):  
Fabio Mangiacapra ◽  
Michele Mattia Viscusi ◽  
Giuseppe Verolino ◽  
Luca Paolucci ◽  
Annunziata Nusca ◽  
...  
Keyword(s):  
Critical Role ◽  
Significant Proportion ◽  
Signs And Symptoms ◽  
Microvascular Function ◽  
Diagnostic Tools ◽  
Symptom Improvement ◽  
Coronary Microvascular Dysfunction ◽  
Diagnostic Challenge ◽  
Adequate Treatment ◽  
Coronary Microvascular Function

The critical role of the coronary microvascular compartment and its invasive functional assessment has become apparent in light of the significant proportion of patients presenting signs and symptoms of myocardial ischemia, despite the absence of epicardial disease, or after the adequate treatment of it. However, coronary microvascular dysfunction (CMD) represents a diagnostic challenge because of the small dimensions of the coronary microvasculature, which prevents direct angiographic visualization. Several diagnostic tools are now available for the invasive assessment of the coronary microvascular function, which, in association with the physiological indices used to investigate the epicardial department, may provide a comprehensive evaluation of the coronary circulation as a whole. Recent evidence suggests that the physiology-guided management of CMD, although apparently costly and time-consuming, may offer a net clinical benefit in terms of symptom improvement among patients with angina and ischemic heart disease. However, despite the results of several observational studies, the prognostic effect of the physiology-driven management of CMD within this population is currently a matter of debate, and therefore represents an unmet clinical need that urgently deserves further investigation.

Imaging of microvascular disease

2021 ◽  
pp. 481-494
Author(s):  
Paolo G. Camici ◽  
Ornella Rimoldi
Keyword(s):  
Myocardial Ischaemia ◽  
Imaging Techniques ◽  
Microvascular Disease ◽  
Microvascular Dysfunction ◽  
Microvascular Function ◽  
Coronary Microvascular Dysfunction ◽  
Maximal Increase ◽  
Asymptomatic Subjects ◽  
Coronary Microvascular Function

Beside obstructive disease of the epicardial coronary arteries dysfunction of the coronary microvasculature has emerged in the past 20 years as an additional mechanism of myocardial ischaemia. The coronary microvasculature cannot be directly visualized in vivo, therefore, both invasive and non-invasive techniques, have been developed to assess parameters that depend directly on coronary microvascular function. Studies at the microcirculatory level entail the use of vasodilators to obtain near-maximal vasodilation. The ratio of the maximal increase of blood flow above its resting value the coronary flow reserve (CFR) allows to gain an insight into the integrated circulatory function. The diagnostic accuracy of imaging techniques can be exploited to detect impairments of myocardial perfusion in asymptomatic subjects with cardiovascular risk factors. The assessment of the coronary microvascular function has provided novel details on the pathophysiological role of coronary microvascular dysfunction in the development of myocardial ischaemia bearing also important prognostic implications.

Abstract P278: Coronary Microvascular Dysfunction Is Associated With Augumented Autophagy-lysosomal Signaling In Mice With Hypercholesterolemic Diet

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Yun-Ting Wang ◽  
Wei Zhao ◽  
Ashton A Huckaby ◽  
Xiang Li ◽  
Yang Zhang
Keyword(s):  
Cardiac Function ◽  
Signaling Pathway ◽  
Microvascular Dysfunction ◽  
Microvascular Function ◽  
Coronary Microvascular Dysfunction ◽  
Chow Diet ◽  
Flow Reserve ◽  
Hypercholesterolemic Diet ◽  
Early Effects ◽  
Coronary Microvascular Function

Accumulating evidence indicates coronary microvascular dysfunction (CMD) contributes to myocardial ischemia with or without epicardial coronary atherosclerosis. However, it remains unknown which molecular pathway is associated with compromised coronary microvascular function preceding the development of myocardial ischemic injury. Recent studies suggest that autophagy-lysosomal signaling pathway is involved in the regulation of endothelial homeostasis under various metabolic stresses such as hypercholesterolemia. In this study, the early effects of hypercholesterolemia on the function and integrity of coronary microcirculation were studied in mice and the expressions of various molecular markers of autophagy-lysosome pathway were also determined in the coronary circulation. Mice were fed a hypercholesterolemic paigen diet (PD) for 8 weeks and coronary microvascular function was determined by measuring coronary flow reserve (CFR) under baseline and hyperemic conditions. The effects of PD on cardiac function or remodeling were also assessed by echocardiograph or immunohistochemistry studies. In PD-fed hypercholesterolemic mice, hyperemia-induced increase in CFR was significantly abrogated compared to that in normal chow diet-fed (ND) control mice (PD: 1.583±0.4193 vs. ND: 3.087±0.586) (n=7-8). The diet-induced hypercholesterolemia did not lead to cardiac dysfunction (EF%, PD: 59.870±7.549 vs ND: 64.040±9.088) or hypertrophic remodeling (LV mass (mg), PD: 92.240±14.410 vs ND: 96.030±25.07). PD increased mild cardiac inflammation and fibrosis but did not resulted in rarefaction in the myocardium. In small coronary arterial wall, PD induced endothelial inflammasome activation and inflammation, which was accompanied by upregulation of autophagy and lysosome signaling pathway. In conclusion, hypercholesterolemic diet induces CMD without alterations in cardiac function or remodeling. These alterations in coronary microvascular function represent the early effects of diet-induced hypercholesterolemia, which may be ameliorated with activation of autophagy and lysosome signaling pathways.

scholarly journals Coronary microvascular function in athletes with abnormal exercise test results

2019 ◽  
Vol 27 (12) ◽  
pp. 621-628
Author(s):  
D. A. J. P. van de Sande ◽  
P. C. Barneveld ◽  
J. Hoogsteen ◽  
P. A. Doevendans ◽  
H. M. C. Kemps
Keyword(s):  
Coronary Flow Reserve ◽  
Myocardial Ischaemia ◽  
Coronary Flow ◽  
A Priori ◽  
Microvascular Dysfunction ◽  
Microvascular Function ◽  
Coronary Microvascular Dysfunction ◽  
Endothelin 1 ◽  
Flow Reserve ◽  
Coronary Microvascular Function

Abstract Aims In asymptomatic athletes, abnormal exercise test (ET) results have a poor positive predictive value. It is unknown whether abnormal ET results in the absence of obstructive coronary artery disease (CAD) are related to coronary microvascular dysfunction. It is also unknown whether they should be considered false-positive ET results or a consequence of physiological adaptation to sport. In our study, we evaluated whether athletes with abnormal ET results and documented myocardial ischaemia in the absence of obstructive CAD have an attenuated microvascular function and whether coronary microvascular dysfunction is related to endothelial dysfunction. Methods and results Nine athletes with concordant abnormal ET and myocardial perfusion scintigraphy (MPS) results without obstructive CAD were compared with age- and gender-matched individuals with a low-to-intermediate a priori risk of CAD. Coronary flow reserve was assessed by Rubidium-82 positron emission tomography (PET) imaging. Endothelin‑1 concentrations were measured to evaluate endothelial function. Coronary flow reserve was significantly lower in athletes (3.3 ± 0.8 versus 4.2 ± 0.6, p = 0.014 respectively). Endothelin‑1 levels were significantly higher in athletes (1.3 ± 0.2 pg/ml versus 1.0 ± 0.2 pg/ml, p = 0.012 respectively). There was no correlation between endothelin‑1 concentrations and mean global coronary flow reserve (r = 0.12). Conclusion Athletes with abnormal ET and MPS outcomes indicative for myocardial ischaemia and no obstructive CAD have a lower coronary flow reserve compared with non-athletes with low-to-intermediate a priori risk of CAD, suggesting an attenuated coronary microvascular function. Higher endothelin‑1 concentrations in athletes suggest that endothelial-dependent dysfunction is an important determinant of the attenuated microvascular function.

scholarly journals A Stratified Approach for Cushing’s Syndrome Diagnosis

2019 ◽  
Vol 11 (10) ◽  
pp. 55
Author(s):  
Mervin Chavez ◽  
Joselyn Rojas ◽  
Miguel Aguirre ◽  
Marjorie Villalobos ◽  
Juan Salazar ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Proximal Muscle ◽  
Diagnostic Challenge ◽  
Adequate Treatment ◽  
Primary Origin ◽  
Cutaneous Atrophy ◽  
Buffalo Hump

Cushing’s syndrome is an endocrine disorder broadly renowned as a diagnostic challenge. From the initial clinical presentation up to the identification of the underlying etiology, it is necessary to adhere to a logical and stratified plan of action, directed to the correlation of signs and symptoms to the physiopathology of the syndrome, in order to accurately establish a diagnosis and adequate treatment. From stages as early as the patient’s first clinical evaluation, the physician should be specially attentive of a constellation of clinical signs which strongly suggest the diagnosis of Cushing’s syndrome, such as the presence of a “moon face”, a “buffalo hump”, cutaneous atrophy, proximal muscle weakness and purplish cutaneous striae, among others. Based off these findings, laboratory analyses are necessary for the detection of hypercortisolism. According to these results, and if physiologic causes are ruled out, pathologic hypercortisolism is confirmed. Lastly, a complex array of diagnostic tests must be navigated to identify the primary origin of the disorder. Thus, the diagnosis of Cushing’s syndrome requires a logically structured algorithm of action, constructed off its pathophysiologic implications, in order to optimize time, resources and the interdisciplinary workgroup required for its consecution, and offer patients the possibility of a better quality of life. It is also important to highlight the need for a stratified approach in patients with metabolic disturbance given that medical professionals may simply treat the patient for obesity not recognizing the presence of the complicating condition Cushing’s syndrome.

Abstract 5502: Adiponectin Mediates the Effects of Atherogenic Risk Profile on the Coronary Microcirculation in Patients with Idiopathic Lv Systolic Dysfunction

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Daniela Giannessi ◽  
Chiara Caselli ◽  
Silvia Del Ry ◽  
Maristella Maltinti ◽  
Manuela Cabiati ◽  
...  
Keyword(s):  
Heart Failure ◽  
Plasma Levels ◽  
Vascular Function ◽  
Systolic Dysfunction ◽  
Risk Profile ◽  
Coronary Microcirculation ◽  
Microvascular Function ◽  
Biologically Active ◽  
Coronary Microvascular Dysfunction ◽  
Coronary Microvascular Function

Purpose. Adiponectin (ADN), a biologically active protein produced by the adipose tissue, has protective vascular effects. Accordingly, ADN plasma levels are reduced in patients with coronary artery disease (CAD) while in heart failure ADN tends to increase. We hypothesized that ADN plasma levels could mediate the effects of atherogenic risk profile on the coronary microcirculation of patients with early LV systolic dysfunction (ILVDys) not secondary to established CAD. Methods. Plasma ADN was measured in 55 patients (age 59±1 yrs, 36 males, BMI 26.9±0.49 Kg/m 2 , mean±sem) with angiographically normal coronary arteries, LV systolic dysfunction (LVEF 39.8±1.3 % range 22–54 %) but without overt heart failure (NYHA class I–II) and in 40 age- and BMI-matched healthy controls by using a specific Elisa (Linco Res). BMI, cholesterol and glucose profiles were assessed in all. In a subset of 25 patients coronary microvascular function was studied by PET and 13 N-Ammonia as a flow tracer. Myocardial blood flow (MBF) was measured at rest and during i.v. dipyridamole (Dip) (0.56 mg/Kg in 4 min). Results. ADN was 6.6±0.34 μg/ml in controls and 10.9±0.85 in ILVDys patients (p<0.001). In patients ADN levels were inversely related with BMI (p=0.009) and directly related with age (p=0.007), HDL Cholesterol (p=0.003) and MBF Dip (0.020). Patients showing more severe coronary microvascular dysfunction (MBF Dip<1.42 ml/min/g, median value in patients) had significantly depressed ADN (9.7±2.3 vs 13.7±1.6, p=0.021) as compared with the remaining patients. Conclusions. This is the first study which associates adiponectin plasma levels with atherogenic risk profile and coronary microvascular function in patients with idiopathic LV dysfunction. These results suggest that adiponectin signal is strongly involved in mediating coronary vascular function independently of the presence of overt CAD or heart failure.

Diagnostic Value of a Carpal Tunnel Corticosteroid Injection in Patients with Negative Electrodiagnostic Studies

2020 ◽  
Author(s):  
Brian M. Katt ◽  
Casey Imbergamo ◽  
Fortunato Padua ◽  
Joseph Leider ◽  
Daniel Fletcher ◽  
...  
Keyword(s):  
Carpal Tunnel ◽  
Corticosteroid Injection ◽  
Carpal Tunnel Release ◽  
False Negative ◽  
False Negative Rate ◽  
Signs And Symptoms ◽  
Diagnostic Value ◽  
Symptom Improvement ◽  
Study Cohort ◽  
Chi Square Analysis

Abstract Introduction There is a known false negative rate when using electrodiagnostic studies (EDS) to diagnose carpal tunnel syndrome (CTS). This can pose a management dilemma for patients with signs and symptoms that correlate with CTS but normal EDS. While corticosteroid injection into the carpal tunnel has been used in this setting for diagnostic purposes, there is little data in the literature supporting this practice. The purpose of this study is to evaluate the prognostic value of a carpal tunnel corticosteroid injection in patients with a normal electrodiagnostic study but exhibiting signs and symptoms suggestive of carpal tunnel, who proceed with a carpal tunnel release. Materials and Methods The group included 34 patients presenting to an academic orthopedic practice over the years 2010 to 2019 who had negative EDS, a carpal tunnel corticosteroid injection, and a carpal tunnel release. One patient (2.9%), where the response to the corticosteroid injection was not documented, was excluded from the study, yielding a study cohort of 33 patients. Three patients had bilateral disease, yielding 36 hands for evaluation. Statistical analysis was performed using Chi-square analysis for nonparametric data. Results Thirty-two hands (88.9%) demonstrated complete or partial relief of neuropathic symptoms after the corticosteroid injection, while four (11.1%) did not experience any improvement. Thirty-one hands (86.1%) had symptom improvement following surgery, compared with five (13.9%) which did not. Of the 32 hands that demonstrated relief following the injection, 29 hands (90.6%) improved after surgery. Of the four hands that did not demonstrate relief after the injection, two (50%) improved after surgery. This difference was statistically significant (p = 0.03). Conclusion Patients diagnosed with a high index of suspicion for CTS do well with operative intervention despite a normal electrodiagnostic test if they have had a positive response to a preoperative injection. The injection can provide reassurance to both the patient and surgeon before proceeding to surgery. Although patients with a normal electrodiagnostic test and no response to cortisone can still do well with surgical intervention, the surgeon should carefully review both the history and physical examination as surgical success may decrease when both diagnostic tests are negative. Performing a corticosteroid injection is an additional diagnostic tool to consider in the management of patients with CTS and normal electrodiagnostic testing.

Upashaya and Anupashaya - A Bird’s Eye View

2017 ◽  
Vol 2 (4) ◽  
Author(s):  
Sreeharsha N. ◽  
Gurubasavaraj Yalagachin ◽  
Kavita M. V. ◽  
Divyasree C. H.
Keyword(s):  
Signs And Symptoms ◽  
Symptomatic Treatment ◽  
Diagnostic Tools ◽  
Detailed Knowledge ◽  
Early Signs ◽  
Therapy Result

The approach of the treatment in any disease begins with Roga Pareeksha and Rogi Pareeksha. Once these two concepts are clear, Vyadhi Vinishchaya will be perfect. This enables the Vaidya to choose appropriate Chikitsa. The five entities of Roga Pareeksha are Nidana (aetiology), Purvaroopa (early signs and symptoms), Roopa (cardinal features), Upashaya (symptomatic treatment) and Samprapti (pathogenesis). When Vaidya has doubtful diagnosis of a disease after thorough examination, he will carry out symptomatic first hand simple therapy, result of which will clarify his ambiguity in diagnosis. For example the pain in the Janu Sandhi may raise the doubt in the physician regarding its diagnosis as Amavata or Sandhivata. The Sthanika Taila Prayoga as Upashaya will result in clarity of diagnosis. Hence Upashaya (Pathya) and Anupashaya (Apathya) are the diagnostic tools in Vyadhi Vinishchaya. This creates a pavement for the path of thinking that Ahara, Vihara and Oushadha which relieve the Lakshanas of any Vyadhi are considered as Upashaya and those which aggravate or worsen are called as Anupashaya. This concept can be practically utilised to advice the Rogi regarding Pathya and Apathya in the specific disesase and it also helps to diagnose the disease without confusion. Hence a detailed knowledge of Upashaya (Pathya) and Anupashaya (Apathya) is essential in Chikitsa.

scholarly journals Prevalence and Course of IgA and IgG Antibodies against SARS-CoV-2 in Healthcare Workers during the First Wave of the COVID-19 Outbreak in Germany: Interim Results from an Ongoing Observational Cohort Study

Healthcare ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 498
Author(s):  
Mark Reinwald ◽  
Peter Markus Deckert ◽  
Oliver Ritter ◽  
Henrike Andresen ◽  
Andreas G. Schreyer ◽  
...  
Keyword(s):  
Cohort Study ◽  
Healthcare Workers ◽  
Significant Proportion ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Observational Cohort Study ◽  
Igg Antibodies ◽  
University Hospitals ◽  
Observational Cohort

(1) Background: Healthcare workers (HCWs) are prone to intensified exposure to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in the ongoing pandemic. We prospectively analyzed the prevalence of antibodies against SARS-CoV-2 in HCWs at baseline and follow up with regard to clinical signs and symptoms in two university hospitals in Brandenburg, Germany. (2) Methods: Screening for anti-SARS-CoV-2 IgA and IgG antibodies was offered to HCWs at baseline and follow up two months thereafter in two hospitals of Brandenburg Medical School during the first wave of the COVID-19 pandemic in Germany in an ongoing observational cohort study. Medical history and signs and symptoms were recorded by questionnaires and analyzed. (3) Results: Baseline seroprevalence of anti-SARS-CoV-2 IgA was 11.7% and increased to 15% at follow up, whereas IgG seropositivity was 2.1% at baseline and 2.2% at follow up. The rate of asymptomatic seropositive cases was 39.5%. Symptoms were not associated with general seropositivity for anti-SARS-CoV-2; however, class switch from IgA to IgG was associated with increased symptom burden. (4) Conclusions: The seroprevalence of antibodies against SARS-CoV-2 was low in HCWs but higher compared to population data and increased over time. Screening for antibodies detected a significant proportion of seropositive participants cases without symptoms.

Genetic and Epigenetic landscape of leukocyte infiltration identifies an immune prognosticator in lung adenocarcinoma

2021 ◽  
pp. 1-13
Author(s):  
Seema Khadirnaikar ◽  
Annesha Chatterjee ◽  
Sudhanshu Kumar Shukla
Keyword(s):  
Lung Adenocarcinoma ◽  
Immune Cell ◽  
Cox Regression ◽  
Strong Association ◽  
Critical Role ◽  
Significant Proportion ◽  
Immune Gene ◽  
Leukocyte Infiltration ◽  
Clinical Genetic ◽  
Factors Affecting

BACKGROUND: Leukocyte infiltration plays an critical role in outcome of various diseases including Lung adenocarcinoma (LUAD). OBJECTIVES: To understand the genetic and epigenetic factors affecting leukocyte infiltration and identification and validation of immune based biomarkers. METHOD: Correlation analysis was done to get the associations of the factors. CIBERSORT analysis was done for immune cell infiltration. Genetic and epigenetic analysis were performed. Cox regression was carried out for survival. RESULTS: We categorized the TCGA-LUAD patients based on Leukocyte fraction (LF) and performed extensive immunogenomic analysis. Interestingly, we showed that LF has a negative correlation with copy number variation (CNV) but not with mutational load. However, several individual genetic mutations, including KRAS and KEAP1, were significantly linked with LF. Also, as expected, patients with high LF showed significantly increased expression of genes involved in leukocyte migration and activation. DNA methylation changes also showed a strong association with LF and regulated a significant proportion of genes associated with LF. We also developed and validated an independent prognostic immune signature using the top six prognostic genes associated with LF. CONCLUSION: Together, we have identified clinical, genetic, and epigenetic variations associated with LUAD LF and developed an immune gene-based signature for disease prognostication.

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