Relation of Myocardial Perfusion Defects and Nonsignificant Coronary Lesions by Angiography With Insights from Intravascular Ultrasound and Coronary Pressure Measurements

Rodés‐Cabau, Josep; Candell‐Riera, Jaume; Ángel, Juan; León, Gustavo De; Pereztol, O; Castell-Conesa, Joan; Soto, Adriana; Anivarro, I; Aguadé, S; Vázquez, Manuel Vázquez; Domingo, Enric; Tardif, Jean‐Claude; Soler‐Soler, Jordi

doi:10.1016/j.amjcard.2005.07.077

Cited by 28 publications

(11 citation statements)

References 30 publications

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“…In agreement with a previous report, 201 Tl SPECT might not accurately reflect the severity of diffuse vasculopathy in patients with normal coronary angiograms [25]. …”

Section: Discussionsupporting

confidence: 75%

Intravascular Ultrasound Correlates with Coronary Flow Reserve and Predicts the Survival in Angiographically Normal Cardiac Transplant Recipients

Lee

Wu²,

Jui³

et al. 2007

Cardiology

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Objectives: We aimed to determine whether epicardial and intramyocardial arteries were involved concordantly in early cardiac allograft vasculopathy. Methods: Thirty consecutive recipients who had received cardiac transplantation more than 1 year before and had a normal coronary angiogram were enrolled for intravascular ultrasound (IVUS), fractional flow reserve, coronary flow reserve and dipyridamole thallium-201 single photon emission computed tomography. Graft failure including cardiac death and retransplantation served as the primary outcome. Results: Plaque volume index and maximum area stenosis calculated from IVUS measurements correlated with coronary flow reserve deterioration in a subgroup of patients with normal fractional flow reserve (n = 13; r = –0.80, p = 0.001 and r = –0.91, p <0.0001, respectively). After follow-up for 18.4 ± 7.6 months, maximum area stenosis was found to be an independent predictor of graft failure (hazard ratio 1.43, 95% confidence interval 1.08–1.89, p = 0.012). Conclusion: In patients with physiologically normal epicardial coronary arteries, impairment of microvascular integrity correlates with the plaque burden measured by IVUS, suggesting the concordant involvement of both epicardial and resistant vessels in early cardiac allograft vasculopathy. Evident epicardial coronary narrowing on IVUS may predict graft failure in spite of normal coronary angiograms.

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“…In agreement with a previous report, 201 Tl SPECT might not accurately reflect the severity of diffuse vasculopathy in patients with normal coronary angiograms [25]. …”

Section: Discussionsupporting

confidence: 75%

Intravascular Ultrasound Correlates with Coronary Flow Reserve and Predicts the Survival in Angiographically Normal Cardiac Transplant Recipients

Lee

Wu²,

Jui³

et al. 2007

Cardiology

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“…However, previous studies in diabetic patients imply that a significant proportion of observed perfusion abnormalities is not attributable to obstruction of blood flow in the epicardial coronary arteries (2,3). In the general population, a similar discrepancy has been observed regarding presentation with anginal symptoms and manifested ischemia in the absence of obstructive epicardial CAD (4)(5)(6). Mechanisms underlying myocardial perfusion abnormalities in that particular group of patients have been studied extensively and revealed the presence of diffuse coronary atherosclerosis and endothelial dysfunction as potential causal factors (4-6).…”

Section: Assessment Of Myocardial Perfusion By Spectmentioning

confidence: 64%

“…Also, in the general population, a discrepancy between the presence of myocardial perfusion defects and obstructive epicardial CAD has been observed (4-6). Both endothelial dysfunction and occult coronary atherosclerosis were shown to contribute to this condition (4)(5)(6). However, the potential mechanisms underlying myocardial perfusion abnormalities not attributable to obstruction of flow in the epicardial coronary arteries have not yet been studied in asymptomatic diabetic patients.…”

mentioning

confidence: 99%

Endothelial Dysfunction in Diabetic Patients with Abnormal Myocardial Perfusion in the Absence of Epicardial Obstructive Coronary Artery Disease

Djaberi

Roodt²,

Schuijf³

et al. 2009

J Nucl Med

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In patients with diabetes mellitus, myocardial perfusion defects are often observed in the absence of obstructive epicardial coronary artery disease (CAD), thereby presenting a diagnostic problem. We hypothesized that these perfusion abnormalities may be explained by endothelial dysfunction or occult coronary atherosclerosis. Methods: Prospectively, 130 asymptomatic patients with diabetes mellitus underwent cardiovascular screening by coronary artery calcium (CAC) scoring, multislice CT coronary angiography, and myocardial perfusion imaging by SPECT. Multislice CT images were evaluated for the presence of obstructive epicardial CAD ($50% luminal narrowing). To quantify abnormal myocardial perfusion on SPECT images, we determined the summed stress score for each patient. The presence of abnormal myocardial perfusion was defined as a summed stress score of 3 or more. In addition, flow-mediated dilatation of the brachial artery, a marker of endothelial function, was determined using ultrasonography. Results: In 35 patients (27%), obstructive epicardial CAD was observed on multislice CT, and these patients were excluded from further analysis. In the remaining 95 patients, abnormal myocardial perfusion was observed in 30 (32%) of patients. Flow-mediated dilatation was significantly lower in patients with abnormal myocardial perfusion (3.6% 6 2.4%) than in those with normal myocardial perfusion (6.4% 6 2.6%) (P , 0.001). Importantly, flow-mediated dilatation remained a significant predictor of the extent of abnormal myocardial perfusion after correction for cardiovascular risk factors and CAC score (P , 0.001). In contrast, no association was observed between nonobstructive plaque burden as reflected by CAC scores and extent of abnormal myocardial perfusion. Conclusion: In patients with diabetes mellitus, myocardial perfusion abnormalities in the absence of obstructive epicardial CAD are associated with endothelial dysfunction.

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“…Our data from multi-vessel disease patients were directly compared with other studies derived from subjects with single-vessel diseases. But we chose the LAD territory because it was demonstrated to be LAD-dominant in several studies [2,26]. Hemodynamic change can still be a problem because multi-vessel disease induces coronary steal phenomenon via collateral circulation [27], which was not definitely observed in our patients.…”

Section: Discussionmentioning

confidence: 93%

Myocardial Blood Flow and Flow Reserve in Proximal and Mid-to-Distal Lesions of Left Anterior Descending Artery Measured By N-13 Ammonia PET/CT

Cho

Kim

Cho

et al. 2013

Nucl Med Mol Imaging

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Purpose The purpose of this study is to compare the myocardial blood flow (MBF) and flow reserve (MFR) between proximal and mid-to-distal lesions of the left anterior descending artery (pLAD and mdLAD, respectively) using N-13 ammonia positron emission tomography/computed tomography (PET/CT). Methods Subjects were 11 patients (six men and five women, mean age 64.5 years) with known coronary artery disease (CAD) involving LAD studied by N-13 ammonia PET/CT. They were divided into two groups by the location of stenotic lesions, i.e. pLAD versus mdLAD. Global and regional MBF and MFR were measured and compared. Characteristics of perfusion defects including the number of involved segments, basal area involvement, location, size, and shape were also compared between the two groups. Results The regional MFR in mid-anterior segment was significantly lower in pLAD group (1.80±0.35 vs 2.76±1.13 for pLAD and mdLAD groups, respectively, p=0.034), while global MFR was not different (2.10±1.10 vs 2.34±0.84).Both stress and rest MBF in LAD territories were not different in both groups. The size of the perfusion defects were significantly larger in pLAD group (44.0±11.5 % vs 21.1±15.8 %, p=0.041). Other characteristics such as location, basal area involvement, and shape were not significantly different between two groups. Conclusions The proximal lesion makes lower MFR in the mid-anterior segment and larger perfusion defect in the LAD territory but comparable MBF compared with mdLAD lesion.

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Relation of Myocardial Perfusion Defects and Nonsignificant Coronary Lesions by Angiography With Insights from Intravascular Ultrasound and Coronary Pressure Measurements

Cited by 28 publications

References 30 publications

Intravascular Ultrasound Correlates with Coronary Flow Reserve and Predicts the Survival in Angiographically Normal Cardiac Transplant Recipients

Intravascular Ultrasound Correlates with Coronary Flow Reserve and Predicts the Survival in Angiographically Normal Cardiac Transplant Recipients

Endothelial Dysfunction in Diabetic Patients with Abnormal Myocardial Perfusion in the Absence of Epicardial Obstructive Coronary Artery Disease

Myocardial Blood Flow and Flow Reserve in Proximal and Mid-to-Distal Lesions of Left Anterior Descending Artery Measured By N-13 Ammonia PET/CT

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