Doppler Echocardiography Assessment of Coronary Microvascular Function in Patients With Angina and No Obstructive Coronary Artery Disease

Schrøder, Jakob; Prescott, Eva

doi:10.3389/fcvm.2021.723542

Cited by 23 publications

(11 citation statements)

References 128 publications

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“…2.4 Image analysis standards <1>. The AS-MCE data saved above were analyzed by software, and a region of interest (5 mm×5 mm) was set in the center of each segment according to the left ventricular 16segment analysis method [14] , from which a time-intensity curve was generated, and the start was set to the rst frame after Flash followed by reperfusion. Peak signal intensity (A-value), upward slope of the curve (β value), and A×β value (re ecting myocardial blood volume) were analyzed.…”

Section: Discussionmentioning

confidence: 99%

Adenosine stress myocardial contrast echocardiography combined with myocardial work function in patients with ischemia and nonobstructive coronary artery disease

ZHANG,

LI,

et al. 2024

Preprint

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Objective To evaluate the abnormal myocardial perfusion in patients with INOCA using adenosine-stressed myocardial contrast echocardiography (AS-MCE) combined with myocardial work (MW). Methods A total of 102 patients who underwent coronary angiography (CAG) or Coronary Artery CT Angiography (CCTA) for chest pain in Shaanxi Provincial People's Hospital from January 2022 to January 2024 were enrolled, those with normal results were then examined by AS-MCE, and 42 patients with INOCA results were classified as the INOCA group, while 30 normal results were classified as the control group. Conventional parameters were measured by two-dimensional echocardiography, left ventricular ejection fraction (Simpson's method) was measured, and the global longitudinal strain (GLS) and MW parameters of the left ventricle were analyzed by the Echo PAC (version 203) workstation. The myocardial perfusion parameters: peak signal intensity (A-value), curve upward slope (β value) and A×β value (reflecting myocardial blood volume) were obtained by analyzing the perfusion parameters of each group of all subjects under rest and stress states using QLab software, and the differences between the above two groups were compared. Results The INOCA group and the control group did not show significant differences in gender, age, heart rate, weight, height, body surface area, prevalence of hypertension and diabetes, hyperlipidemia, alcohol history, smoking history, and conventional ultrasound parameters such as left atrial diameter, left ventricular end-systolic and end-diastolic diameters and volumes, LVEF, diastolic mitral valve velocity, E/A, e, EDT, E/e, MW parameters, and A-value, β-value, and A-× β value at rest (P>0.05, Table 1). However, after hypertension medication, the parameters in the INOCA group decreased significantly compared to those in the control group, and the β-value in the INOCA group was significantly lower than that in the control group at rest (P<0.05). Conclusion Compared to myocardial work, adenosine-stressed myocardial echocardiography is more suitable for the clinical diagnosis of ischemia with non-obstructive coronary artery disease and its application is worthy of clinical practice promotion.

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Section: Discussionmentioning

confidence: 99%

Adenosine stress myocardial contrast echocardiography combined with myocardial work function in patients with ischemia and nonobstructive coronary artery disease

ZHANG,

LI,

et al. 2024

Preprint

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“…However, the role of GLS in evaluating LV function among patients with ANOCA and CMD is controversial. More recently, Schroder J and colleagues suggested that GLS is diminished among patients with ANOCA, and this is linked intricately to CFVR ( 5 ). In contrast to their study, GLS in our study was similar between the control group and CMD group.…”

Section: Discussionmentioning

confidence: 99%

“…However, targeting the distal of left anterior descending artery (LAD) by transthoracic doppler echocardiography makes it possible to infer coronary microvascular function indirectly. In patients not suffering from epicardial disease, a decrease of coronary flow velocity reserve (CFVR) during drug-induced stress can reflect the function of coronary microvascular ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Incremental value of non-invasive myocardial work for the evaluation and prediction of coronary microvascular dysfunction in angina with no obstructive coronary artery disease

Liu

Sun

Zhao

et al. 2023

Front. Cardiovasc. Med.

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BackgroundEvidence suggests that patients suffering from angina with no obstructive coronary artery disease (ANOCA) experience coronary microvascular dysfunction (CMD). We aimed to understand the diagnosis value of noninvasive myocardial work indices (MWIs) with left ventricular pressure-strain loop (LV PSL) by echocardiography in ANOCA patients with CMD.Methods97 patients with ANOCA were recruited. All subjects underwent standard echocardiography with traditional ultrasound parameters, two-dimensional speckle-tracking echocardiography with global longitudinal strain (GLS), LV PSL with MWIs include global work index (GWI), global constructive work (GCW), global waste work (GWW) and global work efficiency (GWE). In addition, all enrolled cases underwent high-dose adenosine stress echocardiography (SE) with coronary flow velocity reserve (CFVR). CMD was defined as CFVR <2.0.ResultsOf the 97 patients with ANOCA, 52 were placed in the CMD group and 45 in the control group. GWI and GCW were decreased significantly in the CMD group compared with the control group (P < 0.001 for both). GWI and GCW were moderately correlated with CFVR (r = 0.430, P < 0.001 and r = 0.538, P < 0.001, respectively). In the multiple logistic regression analyses, GCW was identified as the only independent echocardiography parameter associated with CMD after adjusting for age and baseline APV [OR (95%CI) 1.009 (1.005–1.013); P < 0.001]. Moreover, the best predictor of CMD in patients with ANOCA using receiver operating characteristic (ROC) curve was GWI and GCW, with an area under the curve (AUC) of 0.800 and 0.832, sensitivity of 67.3% and 78.8%, specificity of 80.0% and 75.6%, respectively.ConclusionMWIs with LV PSL is a new method to detect LV systolic function noninvasively in ANOCA patients with CMD.

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“…Coronary flow reserve testing was performed using a previously published and validated protocol ( 15 ). The mid-distal segment of the left anterior descending (LAD) branch was identified in the interventricular sulcus under a modified left ventricular double-chamber view, and the flow spectrum was recorded by color Doppler echocardiography to detect the mid-distal coronary artery flow in the left anterior descending branch.…”

Section: Methodsmentioning

confidence: 99%

The value of myocardial work in the estimation of left ventricular systolic function in patients with coronary microvascular disease: A study based on adenosine stress echocardiography

Liu

Wan

et al. 2023

Front. Cardiovasc. Med.

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BackgroundCoronary microvascular dysfunction (CMD) is associated with increased cardiovascular events in patients with angina with non-obstructive coronary (ANOCA), especially heart failure. Conventional echocardiography is difficult to identify early alterations in cardiac function due to CMD.MethodsWe recruited 78 ANOCA patients. All patients underwent conventional echocardiography examination, adenosine stress echocardiography and examination of coronary flow reserve (CFR) by transthoracic echocardiography. Based on the CFR results, patients were divided into the CMD group (CFR < 2.5) and the non-CMD group (CFVR ≥ 2.5). Demographic data, conventional echocardiographic parameters, two-dimensional speckle-tracking echocardiography (2D-STE) parameters and myocardial work (MW) were compared between the two groups at rest and at stress. Logistic regression was used to analyze the factors associated with CMD.ResultsThere was no significant difference in conventional echocardiography parameters, 2D-STE related indices or MW at rest between the two groups. Global work index (GWI), global contractive work (GCW), and global work efficiency (GWE) were lower in the CMD group than in the non-CMD group at stress (p = 0.040, 0.044, <0.001, respectively), but global waste work (GWW) and peak strain dispersion (PSD) were higher (both p < 0.001). GWI and GCW were associated with systolic blood pressure, diastolic blood pressure, product of heart rate and blood pressure, GLS and coronary flow velocity. While GWW was mainly correlated with PSD, GWE was correlated with PSD and GLS. In the non-CMD group, the responses to adenosine was mainly manifested as an increase in GWI, GCW and GWE (p = 0.001, 0.001, 0.009, respectively) and a decrease in PSD and GWW (p = 0.001, 0.015, respectively). In the CMD group, the response to adenosine was mainly manifested as an increase in GWW and a decrease in GWE (p = 0.002, and 0.006, respectively). In the multivariate regression analysis, we found that ΔGWW (difference in GWW before vs. after adenosine stress) and ΔPSD (difference in PSD before vs. after adenosine stress) were independent factors associated with CMD. The ROC curves showed that the composite prediction model consisting of ΔGWW and ΔPSD had excellent diagnostic value for CMD (area under the curve = 0.913).ConclusionIn the present study, we found that CMD caused deterioration of myocardial work in ANOCA patients under adenosine stress, and that increased cardiac contraction asynchrony and wasted work may be the main changes caused by CMD.

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Doppler Echocardiography Assessment of Coronary Microvascular Function in Patients With Angina and No Obstructive Coronary Artery Disease

Cited by 23 publications

References 128 publications

Adenosine stress myocardial contrast echocardiography combined with myocardial work function in patients with ischemia and nonobstructive coronary artery disease

Adenosine stress myocardial contrast echocardiography combined with myocardial work function in patients with ischemia and nonobstructive coronary artery disease

Incremental value of non-invasive myocardial work for the evaluation and prediction of coronary microvascular dysfunction in angina with no obstructive coronary artery disease

The value of myocardial work in the estimation of left ventricular systolic function in patients with coronary microvascular disease: A study based on adenosine stress echocardiography

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