Magnetic Resonance–Based Assessment of Global Coronary Flow and Flow Reserve and Its Relation to Left Ventricular Functional Parameters

Schwitter, Juerg; DeMarco, Teresa; Kneifel, Stefan; Schulthess, Gustav K. von; Jörg, M. Ciopor; Arheden, Håkan; Rühm, Stefan G.; Stumpe, Klaus O.; Buck, Alfred; Parmley, William W.; Lüscher, T; Higgins, Charles B.

doi:10.1161/01.cir.101.23.2696

Cited by 138 publications

(128 citation statements)

References 33 publications

(27 reference statements)

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“…All patients were asked to refrain from caffeinated beverages for at least 24 hours before MRI scanning. In line with other studies, we corrected coronary sinus blood flow using rate pressure products (RPPs), as follows13, 16, 24, 25, 26, 27, 28:

RPP (mm Hg/min) = Systolic blood pressure (mm Hg) \times Heart rate (beats/min)

\begin{matrix} Corrected coronary sinus flow (mL/min) \\ = coronary sinus flow (mL/min) \\ / RPP (mm Hg/min) \times 7500 \end{matrix}

…”

Section: Methodsmentioning

confidence: 98%

Impairment of Coronary Flow Reserve Evaluated by Phase Contrast Cine‐Magnetic Resonance Imaging in Patients With Heart Failure With Preserved Ejection Fraction

Kato

Saito

Kirigaya

et al. 2016

JAHA

112

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BackgroundPhase contrast (PC) cine‐magnetic resonance imaging (MRI) of the coronary sinus allows for noninvasive evaluation of coronary flow reserve (CFR), which is an index of left ventricular microvascular function. The objective of this study was to investigate coronary flow reserve in patients with heart failure with preserved ejection fraction (HFpEF).Methods and ResultsWe studied 25 patients with HFpEF (mean and SD of age: 73±7 years), 13 with hypertensive left ventricular hypertrophy (LVH) (67±10 years), and 18 controls (65±15 years). Breath‐hold PC cine‐MRI images of the coronary sinus were obtained to assess blood flow at rest and during ATP infusion. CFR was calculated as coronary sinus blood flow during ATP infusion divided by coronary sinus blood flow at rest. Impairment of CFR was defined as CFR <2.5 according to a previous study. The majority (76%) of HFpEF patients had decreased CFR. CFR was significantly decreased in HFpEF patients in comparison to hypertensive LVH patients and control subjects (CFR: 2.21±0.55 in HFpEF vs 3.05±0.74 in hypertensive LVH, 3.83±0.73 in controls; P<0.001 by 1‐way ANOVA). According to multivariable linear regression analysis, CFR independently and significantly correlated with serum brain natriuretic peptide level (β=−68.0; 95% CI, −116.2 to −19.7; P=0.007).Conclusions CFR was significantly lower in patients with HFpEF than in hypertensive LVH patients and controls. These results indicated that impairment of CFR might be a pathophysiological factor for HFpEF and might be related to HFpEF disease severity.

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RPP (mm Hg/min) = Systolic blood pressure (mm Hg) \times Heart rate (beats/min)

\begin{matrix} Corrected coronary sinus flow (mL/min) \\ = coronary sinus flow (mL/min) \\ / RPP (mm Hg/min) \times 7500 \end{matrix}

…”

Section: Methodsmentioning

confidence: 98%

Impairment of Coronary Flow Reserve Evaluated by Phase Contrast Cine‐Magnetic Resonance Imaging in Patients With Heart Failure With Preserved Ejection Fraction

Kato

Saito

Kirigaya

et al. 2016

JAHA

112

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“…Systemic FFA turnover was calculated using the equations of Steele (7). Global coronary blood flow was estimated to be 120 ml/min in all subjects, based on magnetic resonance estimates of blood flow (8), and an estimated left ventricular plus interventricular septal mass of 158 g (9). Plasma flow was estimated from estimated blood flow and hematocrit.…”

Section: Methodsmentioning

confidence: 99%

Myocardial Uptake of Circulating Triglycerides in Nondiabetic Patients With Heart Disease

et al. 2007

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Animal studies indicate that oversupply of fatty acids derived from the action of cardiac lipoprotein lipase (LPL) on plasma lipoproteins may contribute to myocardial dysfunction. However, the contribution of circulating triglycerides to myocardial fatty acid supply in humans is not known. Six postabsorptive nondiabetic subjects who were scheduled for diagnostic coronary angiography were studied. 14 C oleate and a lipid emulsion labeled with 3 H triolein were infused to assess myocardial uptake of free fatty acids (FFAs) and triglycerides, as well as myocardial spillover of LPL-generated fatty acids. Six paired blood samples were taken from the femoral artery and the coronary sinus. Coronary sinus concentrations of unlabeled triglycerides were slightly, but not significantly, lower than arterial (P ‫؍‬ 0.12), whereas labeled triglyceride concentrations were significantly lower in the coronary sinus than in the artery (P < 0.05; extraction fraction Х11%). Triglycerides and FFAs accounted for ϳ17% and ϳ83%, respectively, of myocardial fatty acid uptake. Systemic and myocardial fractional spillover of LPL-generated fatty acids was 49.0 ؎ 7% and 34.7 ؎ 13%, respectively. The myocardium was a minor contributor to systemic triglyceride uptake (ϳ3%) and a trivial contributor to systemic FFA production (ϳ0.5%). These results indicate that circulating triglycerides may be a significant source of fatty acids for myocardial respiration. Diabetes 56:527-530, 2007 I t has been suggested that free fatty acids (FFAs) are the primary energy source for the myocardium (1). However, the heart contains a considerable amount of lipoprotein lipase (LPL) (2), and studies in animals have found significant triglyceride uptake by the myocardium. It has been suggested recently that circulating triglycerides are actually the primary lipid fuel for this tissue (3). Very little information on the role of triglycerides in human myocardial metabolism is available, however. The present study was therefore undertaken to determine whether significant uptake of triglycerides occurs in the heart and also to determine the relative role of triglycerides and FFAs in the provision of lipid fuel to that tissue. RESEARCH DESIGN AND METHODSInformed written consent was obtained from six Caucasian subjects (three male, three female; average age 65 years, weight 91.3 kg, BMI 30.9 kg/m 2 ) scheduled for diagnostic coronary angiography. Individuals with diabetes, significant hypertriglyceridemia (Ͼ2.26 mmol/l), congestive heart failure, unstable angina, recent stroke, previous myocardial infarction or angioplasty, left ventricular ejection fraction Ͻ45%, or significant endocrine, hepatic, or renal disorders were excluded. Five of the six subjects proved to have coronary artery disease; four of these underwent percutaneous stent placement. One subject had valve replacement surgery for aortic stenosis.Subjects were studied according to a protocol approved by the Mayo Institutional Review Board. On the morning of the study (after an overnight fast and after ob...

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“…Several groups have presented data of CFR quantified by CMRI of the coronary sinus showing good correlation with PET or flow phantoms [64][65][66] . More recently, Ishida et al [67] presented data on CFR as independent predictor of MACE in patients with known or suspected CAD.…”

Section: Echocardiographymentioning

confidence: 99%

Diagnosis and management of coronary allograft vasculopathy in children and adolescents

Dedieu

Greil

Wong

et al. 2014

WJT

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Coronary allograft vasculopathy remains one of the leading causes of death beyond the first year post transplant. As a result of denervation following transplantation, patients lack ischaemic symptoms and presentation is often late when the graft is already compromised. Current diagnostic tools are rather invasive, or in case of angiography, significantly lack sensitivity. Therefore a non-invasive tool that could allow early diagnosis would be invaluable.This paper review the disease form its different diagnosis techniques,including new and less invasive diagnostic tools to its pharmacological management and possible treatments. DEFINITION AND PHYSIOPATHOLOGYIn children, coronary allograft vasculopathy (CAV) remains the main limiting survival factor after heart transplantation and the major cause of mortality after the first year post transplant leading ultimately to graft loss [1,2] . One elegant etiological description of CAV is that of "immunologic mechanisms operating in a milieu of nonimmunologic risk factors" [3] . The process is believed to start off as a response to endothelial injury in the graft, originated by a complex interaction of multiple donor and recipient factors. The resulting endothelial dysfunction, leads to altered endothelial permeability and subsequent intimal hyperplasia as a consequence of the vascular remodeling originated by the inflammatory response. The immunologic events constitute the original trigger and noninflammatory events such as cytomegalovirus infection, ischemic time (reperfusion injury), increased donor age and classical cardiovascular risk factors (i.e., diabetes, dyslipidemias, smoking and hypertension), perpetuate the inflammatory response and increase the endothelial injury [4] . Typical lesions (Figures 1 and 2) consist of diffuse intimal proliferation leading to the development of luminal stenosis and small vessels occlusion which then limits blood supply to the graft causing chronic vascular injury and ultimately myocardial ischemia [5] . The lesions develop earlier and quicker than atherosclerotic lesions. REVIEW 276December 24, 2014|Volume 4|Issue 4|

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Magnetic Resonance–Based Assessment of Global Coronary Flow and Flow Reserve and Its Relation to Left Ventricular Functional Parameters

Abstract: This integrated MR approach allows comprehensive assessment of autoregulated and hyperemic coronary flow and is suitable for serial measurements in patients. In transplanted hearts, elevated resting flow is the major cause of reduced CFR.

Cited by 138 publications

References 33 publications

Impairment of Coronary Flow Reserve Evaluated by Phase Contrast Cine‐Magnetic Resonance Imaging in Patients With Heart Failure With Preserved Ejection Fraction

Impairment of Coronary Flow Reserve Evaluated by Phase Contrast Cine‐Magnetic Resonance Imaging in Patients With Heart Failure With Preserved Ejection Fraction

Myocardial Uptake of Circulating Triglycerides in Nondiabetic Patients With Heart Disease

Diagnosis and management of coronary allograft vasculopathy in children and adolescents

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