Additive Prognostic Value of Coronary Flow Reserve in Patients With Chest Pain Syndrome and Normal or Near-Normal Coronary Arteries

Sicari, Rosa; Rigo, Fausto; Cortigiani, Lauro; Gherardi, Sonia; Galderisi, Maurizio; Picaño, Eugenio

doi:10.1016/j.amjcard.2008.10.033

Cited by 165 publications

(128 citation statements)

References 29 publications

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“…19 Of these patients, 22-64% may have coronary microvascular dysfunction (CMD). 20,21 CMD is well-documented in microvascular angina (MVA) and responsible for the decreased coronary flow reserve (CFR) frequently observed in this condition. We did not conduct invasive measurements of CFR in this study, but CMD might be a factor in chest pain onset.…”

Section: Discussionmentioning

confidence: 99%

Chest Pain Without Coronary Artery Obstruction and Calcification in Young Women May Indicate Left Ventricular Diastolic Dysfunction

Watanabe¹,

Moroi²,

Isobe³

2017

Heart Res Open J

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Background: Left ventricular diastolic dysfunction (LVDD) and coronary artery calcification become worse with increasing age. However, it is unclear whether there is a gender difference in patients with chest pain but no obstructive coronary artery disease (CAD). Aim: This study's aim was to investigate whether gender and age differences existed in the association between LVDD and the coronary artery calcium score (CACS) in patients with chest pain but no obstructive CAD. Methods: We retrospectively studied a total of 705 patients (age 65±13 years; men 342, 49%) who had chest pain, normal LV ejection fraction on echocardiography, and no obstructive CAD on computed tomography (CT) coronary angiography. LVDD was defined by the American Society of Echocardiography recommendation of septal e'<8. Abnormal CACS was defined as CACS of >0. Results: Although, there was a significant difference in LVDD prevalence among patients with normal and abnormal CACS (76.1% vs. 88.9%; p<0.001), in a multiple logistic regression analysis, LVDD was not significantly associated with abnormal CACS. When the patients were divided according to gender and age (decades; 20-29, 30-39, 40-49, 50-59, 60-69, 70-79 years), the proportion of men and women with abnormal CACS increased with age. On the other hand, young women (age 20-39 years) with normal CACS showed a high LVDD prevalence, although older women (age 60-69 years) and young men (age 20-39 years) had a low LVDD prevalence. Conclusions: Young women with chest pain but no obstructive and no calcified CAD, which associated with LVDD. LV diastolic function assessment by echocardiography should be performed in young women with chest pain even with normal CT coronary angiogram.

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Section: Discussionmentioning

confidence: 99%

Chest Pain Without Coronary Artery Obstruction and Calcification in Young Women May Indicate Left Ventricular Diastolic Dysfunction

Watanabe¹,

Moroi²,

Isobe³

2017

Heart Res Open J

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“…Furthermore, impairment of CFR seems to account for the poor prognosis of hypertensive patients, especially those with LV hypertrophy. 13,14 On Additive value of vascular markers for CFR S Tzortzis et al Table 3 Stepwise regression analysis of the incremental value of IMT and PWV for the determination of impaired CFR (o2.5) À2 LL…”

Section: Discussionmentioning

confidence: 99%

“…9 The assessment of CFR provides important clinical and prognostic information in hypertensive patients. [10][11][12][13][14] However, its measurement requires specialized medical staff and dedicated echocardiographic equipment, which is not readily available in each hospital. Conversely, IMT and PWV are easier to obtain and do not require prolonged training.…”

Section: Introductionmentioning

confidence: 99%

Incremental predictive value of carotid intima–media thickness to arterial stiffness for impaired coronary flow reserve in untreated hypertensives

et al. 2010

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Coronary microcirculation is disturbed in patients with arterial hypertension. Carotid intima-media thickness (IMT) and arterial stiffness are markers of subclinical atherosclerosis with prognostic significance. We investigated whether the combination of increased carotid IMT and arterial stiffness has a greater predictive value for the presence of impaired coronary flow reserve (CFR) than each index alone in never-treated hypertensives. We studied 110 untreated patients (age: 54.5±12 years) with newly diagnosed arterial hypertension. We measured (1) carotid-to-femoral artery pulse wave velocity (PWV), (2) carotid IMT and (3) CFR by means of color-guided Doppler echocardiography after adenosine infusion. Among other confounders, arterial stiffness and IMT were independent determinants of CFR (coefficient B¼À0.146 and B¼À0.006, Po0.05). Arterial stiffness and IMT had an incremental value for the determination of CFR when added to a model including other confounders (v 2 change¼4.423, P for change¼0.038 after addition of IMT; and v 2 change¼5.369, P for change¼0.020 after addition of PWV). Receiver operating curve analysis showed that PWV410.2 m s À1 and IMT41 mm were the optimal cutoff values to predict a CFRo2.5. Patients with IMT41 mm, PWV410.2 m s À1 or their combination had an odds ratio of 3.5, 5.0 and 11.2, Po0.05, for a CFRo2.5, respectively. The combination of increased carotid IMT and arterial stiffness has a greater predictive value for impaired CFR than each index alone in never-treated hypertensives.

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“…[20][21][22][27][28][29] Prior studies using CMR perfusion imaging in patients with acute coronary syndrome and nonobstructive CAD did not include stress testing. [16][17][18][19]30,31 Adenosine stress perfusion CMR is highly sensitive, specific, and reproducible for identification of obstructive CAD and has been reported to be superior to other stress imaging methods for this purpose.…”

Section: Cmr Evidence Of Infarction (Lge)mentioning

confidence: 99%

“…20 Abnormal coronary flow reserve is a predictor of adverse outcomes, including death, in stable patients with nonobstructive CAD. 21,22 Microvascular coronary disease has been hypothesized to cause acute coronary syndrome in at least some patients with nonobstructive CAD on angiography, 23 but this mechanism has not been specifically investigated.…”

Section: Introductionmentioning

confidence: 99%

Stress Cardiac MRI in Women With Myocardial Infarction and Nonobstructive Coronary Artery Disease

Mauricio

Srichai

Axel

et al. 2016

Clinical Cardiology

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BackgroundIn a prospective study, cardiac MRI (CMR) and intravascular ultrasound were performed in women with myocardial infarction (MI) and nonobstructive coronary artery disease (MINOCA). Forty participants underwent adenosine‐stress CMR (sCMR).HypothesisAbnormal perfusion may co‐localize with ischemic late gadolinium enhancement (LGE) and T2‐weighted signal hyperintensity (T2+), suggesting microvascular dysfunction contributed to MI.MethodsQualitative perfusion analysis was performed by 2 independent readers. Abnormal myocardial perfusion reserve index (MPRI) was defined as global average ≤1.84.ResultsAbnormal rest perfusion was present in 10 patients (25%) and stress perfusion abnormalities in 25 (63%). Abnormal stress perfusion was not associated with LGE but tended to occur with T2+. Among patients with abnormal perfusion and LGE, the LGE pattern was ischemic in half. The locations of abnormal perfusion and LGE matched in 75%, T2+ in 100%. Abnormal stress perfusion was not associated with plaque disruption and matched in location in 63%. MPRI was abnormal in 10 patients (25%) and was not associated with LGE, T2+ or plaque disruption.ConclusionsAbnormal perfusion on sCMR is common among women with MINOCA. Abnormal perfusion usually co‐localized with LGE and/or T2+ when present. Variability in LGE pattern leads to uncertainty about whether the finding of abnormal perfusion was cause or consequence of the tissue state leading to LGE. Low MPRI, possibly indicating diffuse microvascular disease, was observed with and without LGE and T2+. Multiple mechanisms may lead to abnormal perfusion on sCMR. Microvascular dysfunction may contribute to the pathogenesis of and coexist with other causes of MINOCA.

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Additive Prognostic Value of Coronary Flow Reserve in Patients With Chest Pain Syndrome and Normal or Near-Normal Coronary Arteries

Cited by 165 publications

References 29 publications

Chest Pain Without Coronary Artery Obstruction and Calcification in Young Women May Indicate Left Ventricular Diastolic Dysfunction

Chest Pain Without Coronary Artery Obstruction and Calcification in Young Women May Indicate Left Ventricular Diastolic Dysfunction

Incremental predictive value of carotid intima–media thickness to arterial stiffness for impaired coronary flow reserve in untreated hypertensives

Stress Cardiac MRI in Women With Myocardial Infarction and Nonobstructive Coronary Artery Disease

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