Coronary Microvascular Dysfunction by Myocardial Contrast Echocardiography in Nonelderly Patients Referred for Computed Tomographic Coronary Angiography

Taqui, Sahar; Ferencik, Maros; Davidson, Brian P.; Belcik, J. Todd; Moccetti, Federico; Layoun, Michael; Raber, Jacob; Turker, Mitchell S.; Tavori, Hagai; Fazio, Sergio; Lindner, Jonathan R.

doi:10.1016/j.echo.2019.03.001

Cited by 31 publications

(23 citation statements)

References 28 publications

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“…MBF reserve assessed during hyperaemic echocardiography has been shown to be associated with the severity of coronary stenosis in patients with stable angina 118 . In a meta-analysis, MBF reserve had high accuracy for the prediction of flow-limiting coronary artery disease 118 and could be used to determine the pathophysiological basis of microcirculatory angina 127 .…”

Section: Echocardiographymentioning

confidence: 99%

Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia

et al. 2020

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International guidelines advocate noninvasive testing for patients with suspected ischaemia before proceeding with revascularization decision-making 1-4. Noninvasive clinical cardiac imaging continues to undergo rapid evolution, focusing on quantitative perfusion technologies for the assessment of myocardial ischaemia and coronary flow. At present, imaging of myocardial ischaemia stands at a crossroads. During a European meeting on quantitative cardiac imaging, a bench-to-bedside-to-bench perspective was used to summarize the current status and future potential of myocardial ischaemia imaging from the viewpoint of basic scientists and clinical researchers. This approach created discussions, which led to this Consensus Statement on the main advantages and disadvantages of each imaging modality, a clinical consensus on the appropriateness for specific indications and a summary of the latest developments, which together provide a framework for future quantitative imaging of myocardial ischaemia. Pathophysiology considerations The coronary circulation comprises the epicardial conductance vessels (diameter 1-6 mm) feeding an extensive network of small vessels (diameter <300-400 μm) that penetrates the cardiac muscle tissue and is the site of regulation of myocardial blood flow (MBF; Fig. 1a,b). High-resolution 3D fluorescence cryomicrotome imaging 5 has also revealed the existence of abundant small

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Section: Echocardiographymentioning

confidence: 99%

Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia

et al. 2020

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“…Furthermore, during this systematic review, we found several other imaging modalities that are studied for their potential to diagnose CMD, such as myocardial contrast echocardiography (MCE) [ 63 , 75 , 76 ], CT-perfusion [ 77 ] and absolute quantification of myocardial perfusion by CMR [ 78 ]. Even though, current evidence is still limited so the clinical significance and applicability in regular care of these modalities in CMD diagnosis remains unclear, current research shows promising results.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of non-invasive imaging parameters in coronary microvascular disease: a systematic review

et al. 2021

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Background Coronary microvascular dysfunction (CMD) is an important underlying cause of angina pectoris. Currently, no diagnostic tool is available to directly visualize the coronary microvasculature. Invasive microvascular reactivity testing is the diagnostic standard for CMD, but several non-invasive imaging techniques are being evaluated. However, evidence on reported non-invasive parameters and cut-off values is limited. Thus, we aimed to provide an overview of reported non-invasive parameters and corresponding cut-off values for CMD. Methods Pubmed and EMBASE databases were systematically searched for studies enrolling patients with angina pectoris without obstructed coronary arteries, investigating at least one non-invasive imaging technique to quantify CMD. Methodological quality assessment of included studies was performed using QUADAS-2. Results Thirty-seven studies were included. Ten cardiac magnetic resonance studies reported MPRI and nine positron emission tomography (PET) and transthoracic echocardiography (TTE) studies reported CFR. Mean MPRI ranged from 1.47 ± 0.36 to 2.01 ± 0.41 in patients and from 1.50 ± 0.47 to 2.68 ± 0.49 in controls without CMD. Reported mean CFR in PET and TTE ranged from 1.39 ± 0.31 to 2.85 ± 1.35 and 1.69 ± 0.40 to 2.40 ± 0.40 for patients, and 2.68 ± 0.83 to 4.32 ± 1.78 and 2.65 ± 0.65 to 3.31 ± 1.10 for controls, respectively. Conclusions This systematic review summarized current evidence on reported parameters and cut-off values to diagnose CMD for various non-invasive imaging modalities. In current clinical practice, CMD is generally diagnosed with a CFR less than 2.0. However, due to heterogeneity in methodology and reporting of outcome measures, outcomes could not be compared and no definite reference values could be provided.

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“…This method relies on the acoustic signal produced by microbubbles as they transit through the coronary microcirculation and provides key information on perfusion, including the blood microvascular flux rate and functional patency of the microcirculation (microvascular blood volume). 5,6 MCE was performed Submitted 11 June 2020; accepted 3 August 2020; published online 1 September 2020. DOI 10.1182/bloodadvances.2020002644.…”

Section: Methodsmentioning

confidence: 99%

Ponatinib coronary microangiopathy: novel bedside diagnostic approach and management with N-acetylcysteine

Hodovan²,

Kumar³

et al. 2020

Blood Advances

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Coronary Microvascular Dysfunction by Myocardial Contrast Echocardiography in Nonelderly Patients Referred for Computed Tomographic Coronary Angiography

Cited by 31 publications

References 28 publications

Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia

Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia

Evaluation of non-invasive imaging parameters in coronary microvascular disease: a systematic review

Ponatinib coronary microangiopathy: novel bedside diagnostic approach and management with N-acetylcysteine

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