The Myocardial Oxygen Supply:Demand Index Revisited

Hoffman, Julien I.E.; Buckberg, Gerald D.

doi:10.1161/jaha.113.000285

Cited by 127 publications

(103 citation statements)

References 100 publications

(143 reference statements)

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“…It is reported that the subendocardial viability ratio suggests the likelihood of subendocardial ischemia in normal hearts if the ratio is <0.45 [21]. In present study, no patient shows their subendocardial viability ratio under 0.45, which means subendocardial ischemia, although the ratio was significantly low in small children.…”

Section: Discussioncontrasting

confidence: 46%

The cardiac blood supply–workload balance in children

et al. 2014

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It is well known that the reflected pressure wave in small children returns earlier than that in adolescent. The reason of early return of the reflected pressure wave in infancy is their height.The short distance between heart and reflection point makes the reflected pressure wave returning to the heart earlier. In adult, the early return (during systole) of the reflected pressure wave means disadvantage to cardiac blood supply-workload balance. The purpose of this study is to clarify whether the early return of the reflected pressure wave in small children impairs the cardiac blood supply-workload balance.This study enrolled 37 small left to right shunt patients with normal aortic circulation below 15 years of age. The aortic pressure waveform was recorded using a pressure sensor mounted catheter, and augmentation index and subendocardial viability ratio were calculated.The age of patients was 6.1 ± 3.2 years old. The augmentation index was 8.7 ± 14.3 % and the index had a negative correlation with patients' age (r = -0.6243, p<0.0001). The subendocardial viability ratio, which means the cardiac blood supply-workload balance, was 0.92 ± 0.14 and the index had a positive relationship with patients' age (r = 0.6435, p<0.0001).The cardiac blood supply-workload balance gradually improves from infancy to young adulthood. And one of the causes of the unfavorable cardiac blood supply -workload balance in infancy would be the accelerated aortic pressure wave reflection due to their short height.

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Section: Discussioncontrasting

confidence: 46%

The cardiac blood supply–workload balance in children

et al. 2014

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“…Any reduction in diastolic time would lower the DPTI further and could jeopardise the subendocardial flow [5]. For this reason, a reduction in SEVR corresponds to an impaired subendocardial flow [23]. According to these explanations, we can hypothesise that patients with a low SEVR – despite having no symptoms of coronary heart disease – are, together with a higher heart rate, predisposed to develop myocardial ischaemia and further cardiovascular complications, which results in a higher rate of cardiovascular mortality.…”

Section: Discussionmentioning

confidence: 99%

Derived Subendocardial Viability Ratio and Cardiovascular Events in Patients with Chronic Kidney Disease

et al. 2018

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Background: Chronic kidney disease (CKD) is a well-known mortality risk factor. The subendocardial viability ratio (SEVR) is one of the pulse wave analysis parameters that constitutes a non-invasive measure of coronary perfusion. We aimed to assess the prognostic value of the SEVR for cardiovascular outcome in non-dialysis CKD patients. Methods: A total of 98 CKD patients (mean age 60 years) were prospectively followed up from the date of the SEVR measurement until their death or the start of dialysis/transplantation, maximally up to 7.1 years (mean 5 years). According to the manufacturer’s instructions regarding normal SEVR values, the patients were divided into a low SEVR group (SEVR ≤130%, n = 26) and a normal SEVR group (SEVR > 130%, n = 72). Results: During the follow-up period, 13 patients (13.3%) suffered fatal and 23 patients (23.5%) suffered combined (non-fatal and fatal) cardiovascular events. In the patients who died of cardiovascular causes, the SEVR values were statistically significantly lower (130 vs. 154%; p = 0.017) than in those who survived. A Kaplan-Meier survival analysis showed that the cardiovascular survival rate in the low SEVR group of patients was statistically significantly lower (log-rank test: p < 0.001). Using an unadjusted Cox regression analysis, the patients in the low SEVR group had a 5.6-fold higher risk (95% CI: 1.8–17.3; p = 0.002) of fatal cardiovascular events and a 2.7-fold higher risk (95% CI: 1.1–6.3; p = 0.024) of combined fatal and non-fatal cardiovascular events. In the adjusted Cox regression model, the patients in the low SEVR group had a 16-fold higher risk (95% CI: 1.2–9.7; p = 0.004) of fatal cardiovascular events and a 7-fold higher risk (95% CI: 1–9.7; p = 0.009) of combined fatal and non-fatal cardiovascular events. Conclusions: An SEVR < 130% predicts fatal and non-fatal cardiovascular events in non-dialysis CKD patients.

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“…In CKD (stages 1 and 2), myocardial blood flow reached maximum levels at the lower dose of intravenous dobutamine, indicating that coronary autoregulation was exhausted. When coronary autoregulation fails, transmural myocardial blood flow and its distribution become pressure dependent [20,24]; coronary vasodilatation does not compensate lower perfusion pressures and thereby results in ischemia. The loss of coronary autoregulation is a factor for the J-curve relation associated with worse outcomes in patients with CKD [25].…”

Section: Discussionmentioning

confidence: 99%

Impact of Chronic Kidney Disease on Myocardial Blood Flow Regulation in Dogs

Kingma

Simard²,

Voisine³

et al. 2014

Nephron Exp Nephrol

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Background/Aims: Chronic kidney disease (CKD) increases cardiovascular risk possibly due to coronary microvessel dysfunction and impaired myocardial flow reserve. This study investigated the effects of CKD on the regulation and transmural distribution of myocardial blood flow along with oxygen demand during intravenous dobutamine-induced increases in cardiac work. Methods: CKD was produced in dogs by a two-stage subtotal nephrectomy (kidney ablation-infarction model). Serum creatinine and blood urea nitrogen were evaluated during the development of CKD along with systemic blood pressure (tail-cuff plethysmography). After 5 weeks, the CKD dogs were staged according to the International Renal Interest Society staging system; all dogs were anesthetized and surgically prepared for blood flow studies. Data analyses were performed between sham control (CTR) and stage 1 and 2 CKD dogs. Results: At baseline, myocardial blood flow and diastolic aortic pressure were similar for all groups. During intravenous dobutamine, myocardial blood flow was markedly higher than CTR even though hematocrit levels declined with the severity of CKD. In the CTR dogs, myocardial blood flow increased in direct relation to cardiac work. However, in the CKD dogs (stage 1 and 2), maximum blood flow was achieved with low-dose dobutamine, indicating that coronary autoregulation is more readily exhausted with minimal increases in cardiac work during CKD. Conclusion: We report that CKD markedly impairs coronary vascular reserve and myocardial blood flow regulation which could contribute to greater cardiovascular risk and poor clinical outcomes in CKD patients.

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The Myocardial Oxygen Supply:Demand Index Revisited

Cited by 127 publications

References 100 publications

The cardiac blood supply–workload balance in children

The cardiac blood supply–workload balance in children

Derived Subendocardial Viability Ratio and Cardiovascular Events in Patients with Chronic Kidney Disease

Impact of Chronic Kidney Disease on Myocardial Blood Flow Regulation in Dogs

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