Coronary flow reserve in angiographically normal coronary arteries with one-vessel coronary artery disease without traditional risk factors

Fujiwara, Masaki; Tamura, Takashi; Yoshida, Katsuya; Nakagawa, Keiichi; Nakao, Motohiro; Yamanouchi, Masato; Shikama, Nobuaki; Himi, Toshiharu; Masuda, Yoshiaki

doi:10.1053/euhj.2000.2428

Cited by 10 publications

(5 citation statements)

References 23 publications

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“…6,7 Other studies have described an impairment of vasomotor tone of the angiographically normal coronary artery and remote CAD only in patients with coronary risk factors. 8 In our series, all patients with angiographically normal LAD, remote CAD, and no myocardial infarction had a CFR in the LAD within the range of the control group ( Figure 1 and Table 1), which was also independent of risk factors (see confidence intervals in Figure 1) and number of vessels with disease.…”

Section: Discussionmentioning

confidence: 81%

Coronary flow reserve of the angiographically normal left anterior descending coronary artery in patients with remote coronary artery disease

Pizzuto

Voci

Mariano

et al. 2004

The American Journal of Cardiology

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Coronary artery disease (CAD) has been suggested to alter coronary flow reserve (CFR; the ratio between hyperemic and baseline coronary flow velocities) not only in territories supplied by stenotic arteries but also in angiographically normal, remote regions. However, few data exist regarding the left anterior descending (LAD) coronary artery as the normal index artery. The influence of remote CAD on CFR of the angiographically normal LAD was evaluated with transthoracic Doppler ultrasound to measure CFR in the LAD during 90 seconds of venous adenosine infusion (140 g/kg/min) in 122 subjects who were assigned to 1 group; group 1 comprised 49 controls without angiographically detectable CAD, and group 2 consisted of 73 patients with an angiographically normal LAD and remote CAD. Experimental and clinical reports have suggested that acute myocardial infarction decreases coronary flow reserve (CFR; the ratio between hyperemic and baseline flow velocities) not only in the infarctrelated artery but also in remote, angiographically normal coronary arteries. 1-5 Discordant results have been reported in patients without previous myocardial infarction, 6 -8 and it is unclear what the interaction is when the normal vessel is the left anterior descending (LAD) coronary artery. Recent advances in color Doppler technology have allowed imaging of the distal LAD 9,10 by transthoracic echocardiography, thereby opening the way to the noninvasive detection of recanalization in acute anterior myocardial infarction, 11 diagnosis of LAD disease by measurement of CFR, 12-15 and monitoring of changes in CFR after stenting. 16,17 The aim of this study was to assess whether CFR in an angiographically normal LAD is preserved in patients with remote coronary artery disease (CAD), including those with myocardial infarction. CFR was prospectively measured by transthoracic coronary Doppler ultrasound. METHODSStudy population: Patients were selected from a population undergoing diagnostic or therapeutic cardiac catheterization at our institution. The requisite to be enrolled in this study was the presence of an angiographically normal LAD with or without remote CAD. From June 2002 to August 2003, 122 consecutive subjects (105 men and 17 women; mean age 58 Ϯ 10, range 31 to 77) were recruited and assigned to 1 of 2 groups; group 1 comprised 49 controls with chest pain but no angiographically detectable CAD (i.e., coronary arteries with angiographically smooth silhouettes), and group 2 consisted of 73 patients with an angiographically normal LAD and remote CAD. Group 2 was further divided into 4 subgroups: 16 patients with remote percutaneous coronary intervention but no evidence of myocardial infarction (group 2A); 13 patients without remote myocardial infarction but significant (Ն70%) remote coronary stenosis (group 2B); 23 patients with remote myocardial infarction and previous remote percutaneous coronary intervention (group 2C); and 21 patients with remote myocardial infarction but no remote percutaneous coronary intervention (group 2D)....

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Section: Discussionmentioning

confidence: 81%

Coronary flow reserve of the angiographically normal left anterior descending coronary artery in patients with remote coronary artery disease

Pizzuto

Voci

Mariano

et al. 2004

The American Journal of Cardiology

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“…Furthermore, coronary vascular dysfunction may occur in the absence of any angiographically detectible epicardial atherosclerosis. 52,59,60 Abnormalities of coronary vascular function have been demonstrated in a variety of disease states known to be associated with accelerated coronary atherosclerosis without overt cardiovascular disease including hypertension, 61 dyslipidemia, 62,63 tobacco abuse, 64,65 obesity, 66,67 metabolic syndrome, 68 diabetes, 69–71 and renal dysfunction. 72 As such, vascular dysfunction represents the earliest form of atherosclerosis, preceding the development of obstructive stenoses that are detectible by traditional imaging modalities, 64,70,73,74 including coronary calcium scoring.…”

Section: Quantitative Mbf For Diagnosis Of Obstructive Cadmentioning

confidence: 99%

“…59 In some cases, such failure to adequately vasodilate may be sufficient to cause myocardial ischemia even in the absence of epicardial obstructive disease. 76–78 Because the underlying process in these cases is diffuse atherosclerosis and/or endothelial dys-function, affecting all or most of the coronary tree, regional perfusion abnormalities may be difficult in identifying traditional semi-quantitative approaches.…”

Section: Quantitative Mbf For Diagnosis Of Obstructive Cadmentioning

confidence: 99%

“…Coronary risk factors alone, which are highly prevalent in patients referred for diagnostic testing, may result in decreases in peak MBF and flow reserve comparable to that caused by severe coronary artery stenoses. 59 In some cases, such failure to adequately vasodilate may be sufficient to cause myocardial ischemia even in the absence of epicardial obstructive disease. 76–78 Because the underlying process in these cases is diffuse atherosclerosis and/or endothelial dys-function, affecting all or most of the coronary tree, regional perfusion abnormalities may be difficult in identifying traditional semi-quantitative approaches.…”

Section: Quantitative Mbf For Diagnosis Of Obstructive Cadmentioning

confidence: 99%

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Non-invasive quantification of coronary vascular dysfunction for diagnosis and management of coronary artery disease

Murthy

Carli

2012

Journal of Nuclear Cardiology

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“…MBF and MPR are globally reduced also in the remote myocardium supplied by angiographically normal coronary arteries in patients with significant CAD elsewhere (10). However, Fujiwara et al found preserved MPR in regions supplied by angiographically normal coronary arteries in patients with 1-vessel CAD without coronary risk factors (16). It is possible that angiographically undetectable atherosclerosis and endothelial dysfunction, associated with the presence and severity of coronary risk factors, could be responsible for a blunted MPR in patients with or without evident CAD (17).…”

Section: Pet-measured Mpr: a New Target Of Treatmentmentioning

confidence: 99%

Myocardial Perfusion Reserve in Ischemic Heart Disease

Neglia

LʼAbbate²

2009

J Nucl Med

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Coronary flow reserve in angiographically normal coronary arteries with one-vessel coronary artery disease without traditional risk factors

Abstract: Coronary flow reserve is preserved in regions supplied by angiographically normal coronary arteries with one-vessel coronary artery disease without traditional risk factors.

Cited by 10 publications

References 23 publications

Coronary flow reserve of the angiographically normal left anterior descending coronary artery in patients with remote coronary artery disease

Coronary flow reserve of the angiographically normal left anterior descending coronary artery in patients with remote coronary artery disease

Non-invasive quantification of coronary vascular dysfunction for diagnosis and management of coronary artery disease

Myocardial Perfusion Reserve in Ischemic Heart Disease

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