Coronary Microvascular Dysfunction

Camici, Paolo G.; Crea, Filippo

doi:10.1056/nejmra061889

Cited by 1,482 publications

(1,124 citation statements)

References 92 publications

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“…4 Several factors are involved in reducing CFR in hypertensive patients, such as higher BP per se, increased LV mass and endsystolic stress, or a reduction in the overall maximal cross-sectional area of the microcirculatory bed due to increased coronary arteriolar tone, endothelial dysfunction, inadequate angiogenesis or extravascular compression. 2,3,[22][23][24] In the present study, lower values of CFR in hypertensive patients were accompanied by greater LV mass, lower transmitral E/A and myocardial Em/Am ratio, as well as reduced SEVR. Moreover, SEVR and myocardial Em/Am ratio, along with LV mass index, were associated with CFR independently from other clinical and echocardiographic variables.…”

Section: Coronary Flow Reserve and Buckberg Index D Tsiachris Et Alsupporting

confidence: 61%

“…5,[18][19][20][21] Currently, no technique allows the direct in vivo visualization of coronary microcirculation in humans. 2 CFR is often used to express coronary microvascular function and intracoronary Doppler wire provides a reliable measurement of the quantification of blood flow. 4 Several factors are involved in reducing CFR in hypertensive patients, such as higher BP per se, increased LV mass and endsystolic stress, or a reduction in the overall maximal cross-sectional area of the microcirculatory bed due to increased coronary arteriolar tone, endothelial dysfunction, inadequate angiogenesis or extravascular compression.…”

Section: Coronary Flow Reserve and Buckberg Index D Tsiachris Et Almentioning

confidence: 99%

“…1 Abnormal CFR is often present in patients with essential hypertension despite the presence of angiographically normal coronary arteries and even in the absence of left ventricular (LV) hypertrophy. 2,3 Direct measurement of intracoronary flow velocity by using a Doppler guidewire constitutes the most reliable, though invasive, method for the evaluation of CFR. 4 Interest in the non-invasive assessment of cardiovascular function has increased over recent times.…”

Section: Introductionmentioning

confidence: 99%

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Subendocardial viability ratio as an index of impaired coronary flow reserve in hypertensives without significant coronary artery stenoses

et al. 2011

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Subendocardial viability ratio (SEVR), calculated through pulse wave analysis, is an index of myocardial oxygen supply and demand. Our aim was to evaluate the relationship between coronary flow reserve (CFR) and SEVR in 36 consecutive untreated hypertensives (aged 57.9 years, 12 males, all Caucasian) with indications of myocardial ischaemia and normal coronary arteries in coronary angiography. CFR was calculated by a 0.014-inch Doppler guidewire (Flowire, Volcano, San Diego, CA, USA) in response to bolus intracoronary administration of adenosine (30-60 lg). SEVR was calculated by radial applanation tonometry, while diastolic function was evaluated by means of transmitral flow and tissue Doppler imaging. Hypertensive patients with low CFR (n ¼ 24) compared with those with normal CFR (n ¼ 12) exhibited significantly decreased SEVR by 24.5% (P ¼ 0.002). In hypertensives with low CFR, CFR was correlated with SEVR (r ¼ 0.651, P ¼ 0.001). After applying multivariate linear regression analysis, age, left ventricular mass index, Em/Am, 24-h diastolic blood pressure (BP) and SEVR turned out to be the only independent predictors of CFR (adjusted R 2 ¼ 0.718). Estimation of SEVR by using applanation tonometry may provide a reliable tool for the assessment of coronary microcirculation in essential hypertensives with indications of myocardial ischaemia and normal coronary arteries.

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Section: Coronary Flow Reserve and Buckberg Index D Tsiachris Et Alsupporting

confidence: 61%

Section: Coronary Flow Reserve and Buckberg Index D Tsiachris Et Almentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Subendocardial viability ratio as an index of impaired coronary flow reserve in hypertensives without significant coronary artery stenoses

et al. 2011

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“…The presence of microvascular dysfunction, a prominent feature of HCM hearts [30], could also have a detrimental impact on myocardial energetics. Microvascular dysfunction results in a blunted perfusion reserve [31,32] and subsequent myocardial ischaemia during stress [33], even in the non-hypertrophied LV free wall [32].…”

Section: Myocardial Efficiencymentioning

confidence: 99%

Determinants of myocardial energetics and efficiency in symptomatic hypertrophic cardiomyopathy

Timmer

Germans

Götte

et al. 2010

Eur J Nucl Med Mol Imaging

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Purpose Next to hypertrophy, hypertrophic cardiomyopathy (HCM) is characterized by alterations in myocardial energetics. A small number of studies have shown that myocardial external efficiency (MEE), defined by external work (EW) in relation to myocardial oxidative metabolism (MVO 2 ), is reduced. The present study was conducted to identify determinants of MEE in patients with HCM by use of dynamic positron emission tomography (PET) and cardiovascular magnetic resonance imaging (CMR). Methods Twenty patients with HCM (12 men, mean age: 55.2 ± 13.9 years) and 11 healthy controls (7 men, mean age: 48.1 ± 10 years) were studied with [ 11 C]acetate PET to assess MVO 2 . CMR was performed to determine left ventricular (LV) volumes and mass (LVM). Univariate and multivariate analyses were employed to determine independent predictors of myocardial efficiency.Results Between study groups, MVO 2 (controls: 0.12 ± 0.04 ml·min −1 ·g −1 , HCM: 0.13 ± 0.05 ml·min −1 ·g −1 , p = 0.64) and EW (controls: 9,139 ± 2,484 mmHg·ml, HCM: 9,368 ± 2,907 mmHg·ml, p = 0.83) were comparable, whereas LVM was significantly higher (controls: 99 ± 21 g, HCM: 200 ± 76 g, p < 0.001) and MEE was decreased in HCM patients (controls: 35 ± 8%, HCM: 21 ± 10%, p < 0.001). MEE was related to stroke volume (SV), LV outflow tract gradient, NH 2 -terminal pro-brain natriuretic peptide (NT-proBNP) and serum free fatty acid levels (all p < 0.05). Multivariate analysis revealed that SV (ß = 0.74, p < 0.001) and LVM (ß = −0.43, p = 0.013) were independently related to MEE. Conclusion HCM is characterized by unaltered MVO 2 , impaired EW generation per gram of myocardial tissue and subsequent deteriorated myocardial efficiency. Mechanical external efficiency could independently be predicted by SV and LVM.

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“…3,4 This results in obstruction of distal vessels or the microcirculation in the down-stream bed of the ischaemiarelated artery. 4,5 Although normal epicardial flow may be achieved, this will lead to diminished myocardial perfusion, which is associated with larger infarct size, diminished left ventricular ejection fraction and increased mortality. 6 Antiplatelet therapy protects against thrombotic complications after PCI.…”

mentioning

confidence: 99%

Thrombus Aspiration during Percutaneous coronary intervention in Acute non-ST-elevation myocardial infarction Study (TAPAS II)-Study design

Kampinga¹,

Vlaar²,

Fokkema³

et al. 2009

NHJL

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Background and Objective. The Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS) has shown that thrombus aspiration improves myocardial perfusion and clinical outcome compared with conventional primary percutaneous coronary intervention (PCI) in patients with STsegment-elevation myocardial infarction. Impaired myocardial perfusion due to spontaneous or angioplasty-induced embolisation of atherothrombotic material also occurs in patients with non-STelevation myocardial infarction (NSTEMI). The aim of this study is to determine whether thrombus aspiration before stent implantation will result in improved myocardial perfusion in patients with NSTEMI compared with conventional PCI. Study design. The study is a single-centre, prospective, randomised trial with blinded evaluation of endpoints. The planned inclusion is 540 patients with acute NSTEMI who are candidates for urgent PCI. Patients are randomised to treatment with manual thrombus aspiration or to conventional PCI. The primary endpoint is the incidence of myocardial blush grade 3 after PCI. Secondary endpoints are coronary angiographic, histopathological, enzymatic, electrocardiographic and clinical outcomes including major adverse events at 30 days and one year.

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Coronary Microvascular Dysfunction

Cited by 1,482 publications

References 92 publications

Subendocardial viability ratio as an index of impaired coronary flow reserve in hypertensives without significant coronary artery stenoses

Subendocardial viability ratio as an index of impaired coronary flow reserve in hypertensives without significant coronary artery stenoses

Determinants of myocardial energetics and efficiency in symptomatic hypertrophic cardiomyopathy

Thrombus Aspiration during Percutaneous coronary intervention in Acute non-ST-elevation myocardial infarction Study (TAPAS II)-Study design

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