Regional Difference of Microcirculation in Patients with Asymmetric Hypertrophic Cardiomyopathy: Transthoracic Doppler Coronary Flow Velocity Reserve Analysis

Tešić, Milorad; Djordjevic‐Dikic, Ana; Beleslin, Branko; Trifunović, D.; Giga, Vojislav; Marinković, Jelena; Petrović, Olga; Petrović, Milan; Stepanović, Jelena; Dobrić, Milan; Vukčević, Vladan; Stanković, Goran; Seferović, Petar; Ostojić, Miodrag; Vujisić-Tešić, Bosiljka

doi:10.1016/j.echo.2013.03.023

Cited by 27 publications

(35 citation statements)

References 40 publications

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“…Also, we found that in HCM patients without left ventricular outflow tract obstruction there is no significant difference between CFR LAD and CFR PD (2.22±0.55 vs. 2.27±0.50, respectively, p=ns) and that relative CFR was 0.98±0.14 8 . So we believe that relative CFR can help us to differentiate presence of significant coronary artery stenosis in these patients with already impaired CFR due to microvascular dysfunction like in presented case report.…”

Section: Discussionmentioning

confidence: 73%

“…In our recent paper we found that in patients with asymmetric HCM, CFR for both LAD and PD is significantly lower compared to the control group 8 . Also, we found that in HCM patients without left ventricular outflow tract obstruction there is no significant difference between CFR LAD and CFR PD (2.22±0.55 vs. 2.27±0.50, respectively, p=ns) and that relative CFR was 0.98±0.14 8 .…”

Section: Discussionmentioning

confidence: 99%

“…Also favorably results were recently published, showing that CFR-TTE is a helpful noninvasive tool in the decision making whether to proceed PCI or to continue treatment with medical therapy in patients with intermediate coronary artery stenosis 1,6,7 . On the other hand, in many clinical conditions such as hypertrophic cardiomyopathy (HCM), aortic stenosis, dilatative cardiomyopathy, diabetes, syndrome X and presence of myocardial scar, there is impairment of microcirculation which is reflected with decreased CFR even though coronary arteries are without stenosis 1,[6][7][8][9] . Thus in these patients prediction of significant stenosis is more difficult and there are more often false positive CFR tests.…”

Section: Discussionmentioning

confidence: 99%

“…To overcome this limitation of the test, CFR might be done in another artery to examine if it has impaired CFR due to microvascular dysfunction. The ratio between CFR LAD and CFR PD, known as relative CFR, should be ≈ 1 if there is no epicardial stenosis 8 . If the relative CFR is ≈1 and stress echocardiographic test is negative, we might exclude presence of severe coronary artery stenosis.…”

Section: Discussionmentioning

confidence: 99%

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Significance of relative coronary flow reserve in patient with microvascular dysfunction to differentiate significant coronary artery stenosis

Tešić¹,

Đorđević-Dikić²,

Kalimanovska-Oštrić³

et al. 2017

Srce i krvni sudovi

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Introduction: Coronary flow reserve (CFR) is defined as a ratio of hyperemic-to-basal coronary flow velocity and it can be measured by a variety of methods. Transthoracic Doppler echocardiography (TTE) CFR became useful method to assess functional significance of coronary artery stenosis in both left anterior descending (LAD) and posterior descending coronary artery (PD). CFR is combined measure of the capacity of epicardial coronary artery and microcirculation to achieve maximal blood flow in response to hyperemic stimulation. Thus in patients with already impaired microcirculation and accordingly CFR, differentiation from presence of significant coronary stenosis is difficult without known coronary angiography. Case report: We present a case of patient with hypertrophic cardiomyopathy and diabetes, where relative CFR as the ratio of the CFRs of two coronary arteries helped us in decision making to do coronarography because of atypical chest pain and fatigue. Conclusion: In patients with known microvascular dysfunction and already impaired CFR, relative CFR might be helpful to differentiate presence of significant epicardial stenosis. Future studies are needed to obtain appropriate clinical implications of relative CFR in everyday practice. coronary flow reserve; relative coronary flow reserve; microcirculation; hypertrophic cardiomyopathy Abstract Key Words

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Significance of relative coronary flow reserve in patient with microvascular dysfunction to differentiate significant coronary artery stenosis

Tešić¹,

Đorđević-Dikić²,

Kalimanovska-Oštrić³

et al. 2017

Srce i krvni sudovi

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“…During dipyridamole (up to 0.84 mg/kg in 6 or 10 min) [7][8] or adenosine (0.14 mg/kg in 2 min), CFVR [13] sampled by pulsed Doppler on mid-distal left anterior descending artery was defined as the ratio between hyperemic peak and resting peak diastolic coronary flow velocities. A CFVR value ≤2.0 was considered abnormal [8].…”

Section: Resting and Stress Echocardiographymentioning

confidence: 99%