Coronary lumen volume to myocardial mass ratio in primary microvascular angina

Grover, Rominder; Leipsic, Jonathon; Mooney, John; Kueh, Shaw-Hua; Ohana, Mickaël; Nørgaard, Bjarne Linde; Eftekhari, Ashkan; Bax, Jeroen J.; Murphy, Darra; Hague, Cameron; Seidman, Michael A.; Blanke, Philipp; Sedlak, Tara; Sellers, Stephanie

doi:10.1016/j.jcct.2017.09.015

Cited by 38 publications

(20 citation statements)

References 16 publications

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“…The lower cTFC after the injection of verapamil reflect relatively preserved epicardial coronary vasodilation and greater change in the coronary flow velocities and greater FCR, respectively. An impaired response to vasodilators of both conduit arteries and arterioles would result in smaller coronary arterial area for a given amount of myocardium to be perfused [ 20 ]. Although our patients on average presented with percentage of epicardial vasodilation in response to intracoronary verapamil similar to that of healthy controls [ 21 ], in more than one-third the coronary macrovascular dilation was impaired - epicardial lumen did not change after verapamil.…”

Section: Discussionmentioning

confidence: 99%

Association of High Density Cholesterol With Hyperemic Epicardial Flow and Frame Count Reserve in Patients With Moderate Coronary Lesions and Slow Coronary Flow

Semerdzhieva

Денчев²

2021

Cureus

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Background Patients with microvascular angina and non-obstructive coronary atherosclerotic disease have an elevated risk of adverse events and all-cause mortality compared with individuals without ischaemic heart disease. The diagnosis coronary microvascular dysfunction in this setting relies on the detection of impaired coronary flow at rest or on calculation of coronary flow reserve. Previous studies demonstrate that the coronary flow reserve assessed by the corrected thrombolysis in myocardial infarction method-the frame count reserve is an objective quantitative alternative to other widely used invasive methods for microvascular status evaluation. Purpose We assessed the significance of clinical, hemodynamic, angiographic variables and therapy with reference to FCR in a small group of patients with up to moderate atherosclerotic coronary lesions and slow coronary flow. Materials and methods: Frame count reserve was evaluated in 15 patients without flow-limiting (>50%) coronary stenoses admitted with unstable angina. Frame count reserve was calculated by dividing the baseline corrected thrombolysis in myocardial infarction frame count (cTFC) by the cTFC assessed after intracoronary infusion of 100 µg of the calcium channel blocker-verapamil. Results The values of frame count reserve correlate positively with the levels of high density cholesterol (r= 0.900, p=0.001), inversely coronary flow after the application of verapamil-cTFCv (r=-0.534, p=0.049). cTFCv was positively related with the levels of high density lipoproteins (r =-0.645; p= 0.044) and was negatively influenced by the presence of atherosclerotic lesions at quantitative angiography (42.8±19.1 (n=8) vs 23±5.4 (n=7), p=0.029).The therapy with β-blocker and long-acting nitrate was associated with insignificantly higher frame count reserves after intracoronary verapamil compared to the continuous intake only of βblocker or β-blocker and verapamil (2.1±0.78 vs 1.34±0.14 vs 1.70±0.70, p=NS). Conclusions Higher high-density lipoproteins relate to higher frame count reserves evaluated using verapamil. The improved blood flow after this microvascular vasodilator is consistently positively related to high-density cholesterol and the lack of atherosclerosis at conventional coronary angiography. The combined intake of micro-and macrovascular vasodilator could be associated with higher frame count reserves compared to therapy with β-blocker and one vasodilating drug.

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Section: Discussionmentioning

confidence: 99%

Association of High Density Cholesterol With Hyperemic Epicardial Flow and Frame Count Reserve in Patients With Moderate Coronary Lesions and Slow Coronary Flow

Semerdzhieva

Денчев²

2021

Cureus

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“…All other reported papers [10][11][12][13] are related to volume-to-mass computations, which reported total coronary volume as a ratio to total LV myocardial mass.…”

Section: Coronary Artery Diseasementioning

confidence: 99%

“…Several studies have investigated coronary volume to myocardial (V/M) mass computations using FFR CT , but calculation of relative mass per territory (expressed as percentage of total mass) has not been reported. [10][11][12][13] Experimentally, it has been shown that an excellent correlation exists between coronary blood flow and mass of the perfused territory. [14][15][16] Therefore, direct measurement of myocardial perfusion is a good approach to validate myocardial mass.…”

Section: Introductionmentioning

confidence: 99%

Computed tomographic myocardial mass compared with invasive myocardial perfusion measurement

Keulards

Fournier

Veer

et al. 2020

Heart

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ObjectiveThe prognostic importance of a coronary stenosis depends on its functional severity and its depending myocardial mass. Functional severity can be assessed by fractional flow reserve (FFR), estimated non-invasively by a specific validated CT algorithm (FFRCT). Calculation of myocardial mass at risk by that same set of CT data (CTmass), however, has not been prospectively validated so far. The aim of the present study was to compare relative territorial-based CTmass assessment with relative flow distribution, which is closely linked to true myocardial mass.MethodsIn this exploratory study, 35 patients with (near) normal coronary arteries underwent CT scanning for computed flow-based CTmass assessment and underwent invasive myocardial perfusion measurement in all 3 major coronary arteries by continuous thermodilution. Next, the mass and flows were calculated as relative percentages of total mass and perfusion.ResultsThe mean difference between CTmass per territory and invasively measured myocardial perfusion, both expressed as percentage of total mass and perfusion, was 5.3±6.2% for the left anterior descending territory, −2.0±7.4% for the left circumflex territory and −3.2±3.4% for the right coronary artery territory. The intraclass correlation between the two techniques was 0.90.ConclusionsOur study shows a close relationship between the relative mass of the perfusion territory calculated by the specific CT algorithm and invasively measured myocardial perfusion. As such, these data support the use of CTmass to estimate territorial myocardium-at-risk in proximal coronary arteries.

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“…Grover and colleagues expanded on the same concept and used coronary CTA derived mean total coronary luminal volume (V) and the mean myocardial mass (M) to compute the V/M ratio ( Figure 2 ). The mean ratio of coronary luminal volume to myocardial mass (V/M) was significantly lower in the CMD group (25.6 ± 5.9 mm 3 /g vs. 30.0 ± 6.5 mm 3 /g; p = 0.007) [ 47 ]. The major advantages of this method are the superior spatial resolution of CT and rapid scan time.…”

Section: Review Of Non-invasive Modalities For Cmd Assessmentmentioning

confidence: 99%

Coronary Microvascular Dysfunction and the Role of Noninvasive Cardiovascular Imaging

Ayub

2020

Diagnostics

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Patients with coronary microvascular dysfunction (CMD) have significantly higher rates of cardiovascular events, including hospitalization for heart failure, sudden cardiac death, and myocardial infarction (MI). In CMD, several pathophysiological changes lead to functional and structural abnormalities in the coronary microvasculature, which disrupt the ability of the vessels to vasodilate and augment myocardial blood flow in response to increased myocardial oxygen demand, causing ischemia and angina. With the advent of more advanced non-invasive cardiac imaging techniques, the coronary microvasculature has been subjected to more intense study in the past two decades—this has led to further insights into the diagnosis, pathophysiology, treatment, prognosis and follow-up of CMD. This review will highlight and compare the salient features of the currently available non-invasive imaging modalities used in these patients, and discuss the clinical utility of these techniques in the workup and management of these patients.

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Coronary lumen volume to myocardial mass ratio in primary microvascular angina

Cited by 38 publications

References 16 publications

Association of High Density Cholesterol With Hyperemic Epicardial Flow and Frame Count Reserve in Patients With Moderate Coronary Lesions and Slow Coronary Flow

Association of High Density Cholesterol With Hyperemic Epicardial Flow and Frame Count Reserve in Patients With Moderate Coronary Lesions and Slow Coronary Flow

Computed tomographic myocardial mass compared with invasive myocardial perfusion measurement

Coronary Microvascular Dysfunction and the Role of Noninvasive Cardiovascular Imaging

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