Resistive reserve ratio and microvascular resistance reserve in patients with coronary vasospastic angina

Saito, Yuichi; Nishi, Takeshi; Kato, Ken; Kitahara, Hideki; Kobayashi, Yoshio

doi:10.1007/s00380-022-02051-w

Cited by 9 publications

(5 citation statements)

References 32 publications

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“…Interestingly, however, TFC values were unchanged in the positive ACh group when intra-coronary ISDN was administrated in the present study. We previously reported that the patients with a positive result of the ACh provocation test had significantly higher resting Tmn values compared with those without (1.18 ± 0.51 vs. 0.75 ± 0.31 s, p < 0.001) [10], as well as other previous studies [9,32,33]. In addition, a recent European multi-center study evaluating the diagnostic ability of the "ACh rechallenge" to detect coexisting microvascular spasm among patients with epicardial spasm showed that micro-vascular spasm remained after intracoronary administration of ISDN during ACh provocation test in approximately 70% of study patients [34].…”

Section: Discussionsupporting

confidence: 74%

“…For instance, the sequential order of ACh provocation and coronary physiological tests during IDP differs between countries and regions. In the European consensus document, a preceding physiological assessment on intracoronary nitrates and hyperemic agents followed by ACh provocation is recommended [25], while the opposite sequence of IDP is widely performed in Japan [4,9,10]. From a European perspective, the preceding ACh tests may result in an inaccurate assessment of physiological testing potentially because of the alteration of coronary circulation by ACh administration [25,26].…”

Section: Discussionmentioning

confidence: 99%

“…Mean transit time (Tmn) was automatically calculated with a dedicated system (CoroFlow system, Coroventis Research, Uppsala, Sweden). Maximum hyperemia was archived using intracoronary administration of papaverine (12 mg) nicorandil (2 mg), or intravenous adenosine triphosphate (140 µg/kg/min) through the central vein [9,14]. Pa, Pd, and Tmn were measured at resting and hyperemic conditions.…”

Section: Coronary Physiological Assessmentmentioning

confidence: 99%

“…Nonetheless, the protocol of IDP has not been established yet, particularly in the sequential order and coronary physiological metrics during the invasive testing. For instance, although either ACh provocation or coronary physiological testing is performed during IDP, a preceding ACh provocation test may influence on following physiological assessment, hypothesizing that coronary blood flow significantly changes during IDP [9,10]. In addition, guidelines suggest Thrombolysis in Myocardial Infarction frame count (TFC) on coronary angiography as a readily available alternative to wire-based coronary physiological indices for CMD evaluation [4], such as coronary flow reserve (CFR) and index of microcirculatory resistance (IMR), while the impact of IDP on TFC is uncertain.…”

Section: Introductionmentioning

confidence: 99%

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Thrombolysis in Myocardial Infarction Frame Count for Coronary Blood Flow Evaluation during Interventional Diagnostic Procedures

Yamazaki,

Saito,

Kitahara

et al. 2023

Medicina

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Background and Objectives: An interventional diagnostic procedure (IDP), including intracoronary acetylcholine (ACh) provocation and coronary physiological testing, is recommended as an invasive diagnostic standard for patients suspected of ischemia with no obstructive coronary arteries (INOCA). Recent guidelines suggest Thrombolysis In Myocardial Infarction frame count (TFC) as an alternative to wire-based coronary physiological indices for diagnosing coronary microvascular dysfunction. We evaluated trajectories of TFC during IDP and the impact of ACh provocation on TFC. Materials and Methods: This was a single-center, retrospective study. Patients who underwent IDP to diagnose INOCA were included and divided into two groups according to the positive or negative ACh provocation test. Wire-based invasive physiological assessment was preceded by ACh provocation tests and intracoronary isosorbide dinitrate (ISDN). We evaluated TFC at three different time points during IDP; pre-ACh, post-ISDN, and post-hyperemia. Results: Of 104 patients, 58 (55.8%) had positive ACh provocation test. In the positive ACh group, resting mean transit time (Tmn) and baseline resistance index were significantly higher than in the negative ACh group. Post-ISDN TFC was significantly correlated with resting Tmn (r = 0.31, p = 0.002). Absolute TFC values were highest at pre-ACh, followed by post-ISDN and post-hyperemia in both groups. All between-time point differences in TFC were statistically significant in both groups, except for the change from pre-ACh to post-ISDN in the positive ACh group. Conclusions: In patients suspected of INOCA, TFC was modestly correlated with Tmn, a surrogate of coronary blood flow. The positive ACh provocation test influenced coronary blood flow assessment during IDP.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Coronary Physiological Assessmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Thrombolysis in Myocardial Infarction Frame Count for Coronary Blood Flow Evaluation during Interventional Diagnostic Procedures

Yamazaki,

Saito,

Kitahara

et al. 2023

Medicina

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“…Although the coronary microcirculation system predominantly consists of microarterial capillaries and microvenules with a diameter of ≤150 µm, CAG can only show vessels >500 µm in diameter. The main clinical indices used to assess coronary microcirculation are microvascular resistance reserve (MRR), resistive reserve ratio (RRR), coronary flow reserve (CFR), and resting and hyperemic mean transit time (Tmn) ( 4 ). The major drugs currently used to treat MVA are nitrates and beta-blockers.…”

Section: Introductionmentioning

confidence: 99%

Exploring the mechanism of Shexiang Tongxin dropping pill in the treatment of microvascular angina through network pharmacology and molecular docking

Chang¹,

Ren²,

Su³

2022

Ann Transl Med

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Background: Microvascular angina (MVA) is a group of clinical manifestations of angina pectoris or angina-like chest pain, positive exercise test, and exclusion of epicardial coronary artery spasm, wherein coronary angiography (CAG) does not present obvious epicardial vascular stenosis. Shexiang Tongxin dropping pill (STDP) has the effect of benefiting the Qi and opening the blood vessels, activating blood circulation, and resolving blood stasis. We explored the mechanism of STDP against MVA by network pharmacology and molecular docking. Methods: Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP), literature search, SwissTargetPrediction database, and high-throughput experiment-and reference-guided database of traditional Chinese medicine (HERB) were applied to identify the active ingredients and targets of STDP. The MVA targets were searched in the databases of GeneCards, Pharmacogenetics and Pharmacogenomics Knowledge Base (PharmGKB), DisGeNET, Online Mendelian Inheritance in Man (OMIM), and Therapeutic Target Database (TTD). The common targets of STDP and MVA were screened.The software RStudio 4.1.3 was used to analyze the enrichment of these targets using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. Protein-protein interaction (PPI) network analysis of the common targets was performed using the Search Tool for the Retrieval of Interacting Genes/Genomes (STRING) database. The cytoHubba plug-in of Cytoscape 3.9.1 software was employed to analyze the PPI network and obtain the core targets. Molecular docking was performed to verify the relationship between the core compounds and proteins with AutoDock Tools 1.5.7 and Pymol 2.4.0.Results: We identified 93 effective components of STDP, 310 potential targets, 981 MVA targets, and 138 intersectional targets. The potential anti-MVA mechanism of STDP may involve the advanced glycation end products/receptor for advanced glycation end products (AGE-RAGE) signaling pathway in diabetic complications; lipids and atherosclerosis; fluid shear stress; atherosclerosis; the tumor necrosis factor (TNF), interleukin (IL)-17, hypoxia-inducible factor (HIF)-1, and C-type lectin receptor signaling pathways.Further, STDP mainly acts on its targets IL-6, AKT1, STAT3, JUN, and IL-1β to against MVA. Conclusions:The STDP may exert its therapeutic effects through processes, such as anti-inflammation, promotion of smooth muscle cell proliferation and differentiation, lipid metabolism, immunomodulation, and regulation of cellular autophagy.

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Validation of pressure-bounded coronary flow reserve using invasive coronary physiologic assessment

et al. 2022

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Resistive reserve ratio and microvascular resistance reserve in patients with coronary vasospastic angina

Cited by 9 publications

References 32 publications

Thrombolysis in Myocardial Infarction Frame Count for Coronary Blood Flow Evaluation during Interventional Diagnostic Procedures

Thrombolysis in Myocardial Infarction Frame Count for Coronary Blood Flow Evaluation during Interventional Diagnostic Procedures

Exploring the mechanism of Shexiang Tongxin dropping pill in the treatment of microvascular angina through network pharmacology and molecular docking

Validation of pressure-bounded coronary flow reserve using invasive coronary physiologic assessment

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