vasomotor dysfunction
Recently Published Documents


TOTAL DOCUMENTS

134
(FIVE YEARS 16)

H-INDEX

30
(FIVE YEARS 1)

2022 ◽  
Vol 8 ◽  
Author(s):  
Tijn P. J. Jansen ◽  
Kyra van Keeken ◽  
Regina E. Konst ◽  
Aukelien Dimitriu-Leen ◽  
Angela H. E. M. Maas ◽  
...  

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.


Author(s):  
Sanjay Divakaran ◽  
Jesse P. Caron ◽  
Wunan Zhou ◽  
Jon Hainer ◽  
Courtney F. Bibbo ◽  
...  

2021 ◽  
Vol 8 ◽  
Author(s):  
Tijn P. J. Jansen ◽  
Suzette E. Elias-Smale ◽  
Stijn van den Oord ◽  
Helmut Gehlmann ◽  
Aukelien Dimitiriu-Leen ◽  
...  

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) < 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.


Author(s):  
Aelita Plinta ◽  
Pēteris Tretjakovs ◽  
Ināra Logina ◽  
Indra Miķelsone ◽  
Leons Blumfelds ◽  
...  

Abstract The aim of the study was to evaluate the changes in skin blood flow as a result of local heating tests in migraine patients during the interictal period, measured by laser Doppler perfusion imaging (LDI). The aim of the study was also to estimate the correlations between the results of these tests and interleukin (IL)-8 levels. Twelve migraine patients during their interictal period were compared with twelve healthy control subjects. Only women were included in the study. Both groups were matched with regard of their age, body mass index and blood pressure. For the purpose of measuring cutaneous microvascular blood flow, heating (+44 °C) of the dorsal side of the palm as a response to the local LDI was used. IL-8 was measured in serum by ELISA method. The findings suggested that migraine patients have a cutaneous vasomotor dysfunction during the interictal period. The results showed a significant decrease in the initial peak of vasodilation and the second peak of vasodilation (plateau phase). Also there were significant changes observed in the length of the time interval required to reach the first and second vasodilation peak. It is known that migraine patients have a shorter time interval to reach the first perfusion peak (axonal reflex-mediated) and longer time interval to reach the second peak (endothelium-dependent). The results confirmed the correlation between proinflammatory chemokine IL-8 levels, and the time interval till the second peak of blood flow in all study subjects.


Author(s):  
Kelly A. Stockelman ◽  
Anthony R. Bain ◽  
Caitlin A. Dow ◽  
Kyle J. Diehl ◽  
Jared J. Greiner ◽  
...  

Insufficient sleep is associated with endothelial vasomotor dysfunction and increased cardiovascular risk. Regular aerobic exercise is an effective lifestyle strategy for improving endothelial function and, in turn, reducing cardiovascular risk. We tested the hypotheses that regular aerobic exercise would: 1) improve endothelial vasodilation; and 2) decrease ET-1-mediated vasoconstrictor tone in middle-aged adults who chronically sleep <7 h/night. Thirty-six healthy, middle-aged adults were studied: 16 with normal sleep duration (age: 57±2 yr; sleep duration: 7.4±0.1 h/night) and 20 with short sleep duration (56±1 yr; 6.2±0.1 h/night). The 20 short sleepers completed a 3-month aerobic exercise training intervention. Forearm blood flow was determined (via plethysmography) in response to intra-arterial acetylcholine (ACh), BQ-123 (ETAreceptor antagonist), ACh+BQ-123 and sodium nitroprusside. Forearm blood flow responses to ACh were lower (20%; P<0.05) in the short (from 4.2±0.2 to 10.5±0.6 mL/100 mL tissue/min) vs normal (4.2±0.2 to 12.7±0.6 mL/100 mL tissue/min) sleepers. In response to BQ-123, the short sleep group had a significantly greater increase in resting forearm blood flow than the normal sleep group (~25% vs ~8%). ACh+BQ-123 resulted in a significant (~25%) increase in the ACh-vasodilation in the short sleep group only. After exercise training, although nightly sleep duration was unchanged (6.4±0.1 h/night), ACh-mediated vasodilation was significantly higher (~20%), ET-1-mediated vasoconstriction was significantly lower (~80%) and the vasodilator response to ACh was not increased with ETAreceptor blockade. Regular aerobic exercise, independent of changes in nightly sleep duration, can counteract insufficient sleep-related endothelial vasomotor dysfunction.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Pellegrini ◽  
R Konst ◽  
S Elias-Smale ◽  
R.J Van Geuns ◽  
N Van Royen ◽  
...  

Abstract Background A consistent portion of patients with stable angina is affected by coronary vasomotor dysfunction, in the form of epicardial vasospasm (VSA) or coronary microvascular dysfunction (CMD). Although available data suggest a worse prognosis compared to normal population, anatomical background and associations with atherosclerosis are still uncertain. Purpose To define specific morphological features in patients with stable angina and coronary vasomotor dysfunction. Methods We enrolled all patients referred to our laboratory in the first half of 2019 for coronary reactivity testing (CRT) for stable angina and suspected vasomotor dysfunction. After confirming non-obstructive coronary artery disease by angiography, CRT consisted of acetylcholine test and physiology assessment with resting and hyperemic indexes. In addition, optical coherence tomography (OCT) was performed. All tests were performed in the left anterior descending artery. Patients were divided in 3 groups: VSA, CMD and control group (no CMD/VSA), according to international COVADIS consensus documents. Two independent reviewers assessed the OCTs to identify markers of atherosclerosis. Results We enrolled 48 patients. Mean age was 55.19±7.71 years. 46 (96%) were females. 3 patients were removed due to mixed VSA and CMD, resulting in 45 subjects eligible for analysis: 17 had VSA, 22 CMD and 6 were controls. Baseline characteristics, resting and hyperemic indexes were similar in the groups, except for the index of microvascular resistance (IMR), being higher in CMD group. Moving from control group, to CMD, to VSA, OCT suggested a trend of increasing prevalence of fibroatheromas (0% in controls, 36% in CMD, 47% in VSA, p 0.12), thin-cap fibroatheromas (0% vs 18% vs 29%, respectively, p 0.29) and neovascularisation (17% vs 23% vs 47%, p 0.19). On the other hand, macrophage infiltration was higher in CMD group (55% in CMD, vs 47% in VSA, vs 33% in controls, p 0.64). Plaques covered 43% of the vessel in VSA group (34% being lipid-rich), 35% in CMD (lipid: 36%) and 30% in controls (p 0.69; 17% lipid). Lipid pools showed a different distribution across the groups. Control group had small pools (mean/max lipid arc 56/65°, length: 5.5 mm), CMD showed intermediate width (arc 82/106°), but long extension (11.5 mm), while VSA had large pools (94/127°, p 0.05/0.08), with intermediate length (7 mm, p 0.58). Lipid index (mean arc x lipid length) was similar in VSA (632) and CMD (642), but lower in control group (203, p 0.35). Conclusions This study hints at atherosclerosis as an underlying pathophysiology in VSA and CMD. A trend to increasing burden, both in terms of extension and vulnerability, was observed across patients with normal arteries, CMD and VSA. Peculiar patterns of atherosclerosis may be associated with specific phenotypes of vasomotor dysfunction, with larger lipid pools and neovascularization being associated with VSA and macrophage infiltration being more common in CMD. Funding Acknowledgement Type of funding source: None


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Weber ◽  
J.M Brown ◽  
S Divakaran ◽  
E Stevens ◽  
J Hainer ◽  
...  

Abstract Background Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and psoriasis (PsO) are common inflammatory conditions with excess cardiovascular (CV) risk compared to the general population. This excess CV risk is associated with traditional risk factors, glucocorticoid treatment, and systemic inflammation. Systemic inflammation perturbs endothelial function and has been linked to coronary vasomotor dysfunction. It is not clear if coronary vasomotor dysfunction would be associated with worse clinical outcomes in systemic autoimmune inflammatory conditions. Purpose We tested the hypothesis that impaired coronary flow reserve (CFR), which in the absence of flow-limiting obstructive coronary artery disease (CAD) reflects vasomotor dysfunction, among patients with SLE, RA, and PsO is associated with worse clinical outcomes. Methods We included patients with RA, SLE, and PsO who underwent clinically indicated rest/stress myocardial perfusion positron emission tomography (PET) at a large academic medical center from 2006 to 2019. Patients with an abnormal myocardial perfusion study (summed stress score &gt;3) or left ventricular ejection fraction &lt;40% were excluded. CFR was calculated as the ratio of myocardial blood flow (MBF, ml/min/g) at peak stress compared to the MBF at rest and adjusted for baseline heart rate and blood pressure. Results Among the 175 patients (median age 65.1 years, 80% female) in the cohort, 24% had SLE, 35% PsO, and 41% RA. There was no difference in mean CFR between patients with RA, SLE, or PsO. Over a median follow-up of 8.5 years after PET, there were 47 deaths. Patients in the lowest and middle tertile (CFR &lt;2.18) had a higher all-cause mortality when compared with the highest (Figure 1), and this association remained significant after adjusting for age and a composite clinical score incorporating sex, symptoms, and CV risk factors (lowest vs. highest tertile: HR 2.8; 95% confidence interval 1.2–6.5; p=0.01). CV risk factors such as diabetes, hypertension, obesity, tobacco use, and a family history of CAD were not significantly different across CFR tertiles, suggesting that inflammatory-disease specific risk factors may contribute to coronary vasomotor dysfunction. Conclusions In patients with systemic inflammatory disease, coronary vasomotor dysfunction was associated with worse outcomes independent of traditional CV risk factors and may have utility as a marker of CV risk among patients with inflammatory disease. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): 1. 5T32HL094301-02 NIH T32 Training Grant, “Noninvasive Cardiovascular Imaging Research Training Program”


Author(s):  
John D. Groarke ◽  
Sanjay Divakaran ◽  
Anju Nohria ◽  
Joseph H. Killoran ◽  
Sharmila Dorbala ◽  
...  

Sign in / Sign up

Export Citation Format

Share Document