New Noninvasive Method for Coronary Flow Reserve Assessment

Caiati, Carlo; Montaldo, C; Zedda, N; Bina, Alessandro; Iliceto, Sabino

doi:10.1161/01.cir.99.6.771

Cited by 295 publications

(33 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies have provided evidence that CFR is reduced in dilated cardiomyopathy [11], coronary artery stenosis [12], hypertrophic cardiomyopathy [13], hypertension [14], and diabetes mellitus [17]. Because coronary blood flow occurs predominantly during diastole, it is conceivable that left ventricular diastolic changes also take part in CFR impairment in renal failure.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impaired Coronary Flow Reserve in Hemodialysis Patients: A Transthoracic Doppler Echocardiographic Study

Tok

Güllü²,

Erdoğan³

et al. 2005

Nephron Clin Pract

View full text Add to dashboard Cite

Background: Coronary flow reserve (CFR) reflects the functional capacity of microcirculation to adapt to blood demand during increased cardiac work. In this study, CFR of hemodialysis patients with angiographically normal coronary arteries was evaluated using transthoracic second harmonic Doppler echocardiography. Methods and Results: Ten hemodialysis patients, and 14 sex-, age- and left ventricular mass index-matched hypertensive controls with angiographically normal coronary arteries underwent transthoracic second harmonic Doppler echocardiographic examination. Coronary basal diastolic peak flow velocities and hyperemic peak flow velocities after dipyridamole infusion (0.56 mg/kg over 4 min) were measured. CFR was defined as the ratio of hyperemic to basal diastolic peak velocities. CFR ≧2.0 was regarded as normal. Additionally, Doppler tissue imaging pulse wave measurements were taken from the lateral and septal corners of the mitral annulus. CFR values were significantly lower in the study group than in the control group (2.03 ± 0.3 vs. 2.61 ± 0.5, p = 0.005). In 5 of 10 hemodialysis patients, CFR was <2.0 (50%), however in only 1 of 14 control patients it was <2.0 (5%). Conclusions: Impairment of coronary microvasculature occurs earlier in patients with chronic renal failure and may be the harbinger of subsequent primary uremic myocardial disease. In patients with chronic renal failure and normal coronary arteries, decreased CFR by transthoracic echocardiography might be regarded as an early finding of an affected coronary vasculature.

show abstract

Section: Discussionmentioning

confidence: 99%

“…However, a recently developed and validated, novel, noninvasive method, transthoracic Doppler harmonic echocardiography (TTDHE), allows serial evaluation of the CFR via ultrasound [13, 14]. The technique is noninvasive, not very expensive, and easily repeatable.…”

Section: Introductionmentioning

confidence: 99%

Impaired Coronary Flow Reserve in Hemodialysis Patients: A Transthoracic Doppler Echocardiographic Study

Tok

Güllü²,

Erdoğan³

et al. 2005

Nephron Clin Pract

View full text Add to dashboard Cite

show abstract

“…Therefore we limited our measurement to coronary blood flow velocity. Echo contrast agents have recently been introduced 25. The increase in signal to noise ratio in vascular districts after intravenous injection of such agents should allow more complete imaging of the coronary artery.…”

Section: Discussionmentioning

confidence: 99%

Effect of verapamil on systolic and diastolic coronary blood flow velocity in asymptomatic and mildly symptomatic patients with hypertrophic cardiomyopathy

Dimitrow

Krzanowski

Niżankowski

et al. 2000

Heart

View full text Add to dashboard Cite

Objective-To assess non-invasively the eVect of verapamil treatment on coronary blood flow velocity in asymptomatic and mildly symptomatic patients with hypertrophic cardiomyopathy. Design-High frequency transthoracic Doppler echocardiography was used to compare resting phasic coronary blood flow velocity before and after a one month period of verapamil treatment in 17 patients (14 men and three women) with non-obstructive hypertrophic cardiomyopathy. Eighteen healthy subjects formed an age and sex matched control group. Systolic and diastolic coronary blood flow velocity was measured in the distal portion of left anterior descending coronary artery using high frequency transthoracic Doppler echocardiography. Blood flow velocity before and after verapamil was compared in the patients with cardiomyopathy and with the results in the control group. Results-Compared with the controls, patients with hypertrophic cardiomyopathy had increased diastolic coronary blood flow velocity (41.8 (8.1) v 59.9 (21.9) cm/s, p < 0.01) and a lower mean systolic coronary blood flow velocity (18.7 (10.8) v −11.2 (27.5) cm/s, p < 0.01) before verapamil treatment. A backward pattern of systolic flow, manifested by negative values of coronary blood flow velocity, was recorded in eight of the patients, while no negative values were found in the controls. After verapamil treatment the retrograde systolic blood flow was restored to an anterograde pattern in only one patient. The mean value of systolic coronary blood flow velocity did not change significantly and remained lower than the systolic forward flow velocity in the controls (−3.6 (31.8) v 18.7 (10.8) cm/s, p < 0.05). However, diastolic coronary blood flow velocity decreased significantly after verapamil (59.9 (21.9) v 50.7 (19.5) cm/s p < 0.05), reaching a level comparable with that in the controls (50.7 (19.5) v 41.8 (8.1) cm/s, p > 0.05). Conclusions-In contrast to healthy subjects, in non-obstructive hypertrophic cardiomyopathy the systolic pattern of coronary blood flow was heterogeneous (both retrograde and anterograde), and diastolic coronary blood flow velocity was abnormally increased, despite a lack of significant symptoms. Verapamil treatment did not restore the forward pattern of systolic blood flow but decreased diastolic blood flow velocity to a level comparable with that in healthy subjects. (Heart 2000;83:262-266)

show abstract

“…Following administration of intravenous echocardiography contrast, color Doppler is used to measure coronary blood velocity in the left anterior descending artery before and after a vasodilator infusion. [69-71] Dypyridamole,[69, 72-75] dobutamine,[71, 76] and adenosine[70, 77] can be used to elicit vasodilation during Doppler echocardiography. Blood flow velocity is used as a surrogate for coronary blood flow in the calculation of coronary flow reserve.…”

Section: Diagnostic Imagingmentioning

confidence: 99%

“…Blood flow velocity is used as a surrogate for coronary blood flow in the calculation of coronary flow reserve. [69, 71, 72] Coronary flow reserve determined by Doppler echocardiography correlates with that determined by both intracoronary Doppler ultrasound[69] and positron emission tomography. [72] Lower coronary flow reserve values have also been correlated with myocardial perfusion deficits on cardiac magnetic resonance.…”

Section: Diagnostic Imagingmentioning

confidence: 99%

Current Diagnostic and Therapeutic Strategies in Microvascular Angina

Mumma

Flacke²

2014

Curr Emerg Hosp Med Rep

View full text Add to dashboard Cite

Microvascular angina is common among patients with signs and symptoms of acute coronary syndrome and is associated with an increased risk of cardiovascular and cerebrovascular events. Unfortunately, microvascular is often under-recognized in clinical settings. The diagnosis of microvascular angina relies on assessment of the functional status of the coronary microvasculature. Invasive strategies include acetylcholine provocation, intracoronary Doppler ultrasound, and intracoronary thermodilution; noninvasive strategies include cardiac positron emission tomography (PET), cardiac magnetic resonance, and Doppler echocardiography. Once the diagnosis of microvascular angina is established, treatment is focused on improving symptoms and reducing future risk of cardiovascular and cerebrovascular events. Pharmacologic options and lifestyle modifications for patients with microvascular angina are similar to those for patients with coronary artery disease.

show abstract

New Noninvasive Method for Coronary Flow Reserve Assessment

Abstract: Contrast-enhanced transthoracic echo Doppler with the harmonic mode is a feasible and promising technique for assessing CFR in a totally noninvasive way.

Cited by 295 publications

References 18 publications

Impaired Coronary Flow Reserve in Hemodialysis Patients: A Transthoracic Doppler Echocardiographic Study

Impaired Coronary Flow Reserve in Hemodialysis Patients: A Transthoracic Doppler Echocardiographic Study

Effect of verapamil on systolic and diastolic coronary blood flow velocity in asymptomatic and mildly symptomatic patients with hypertrophic cardiomyopathy

Current Diagnostic and Therapeutic Strategies in Microvascular Angina

Contact Info

Product

Resources

About