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Cardiac microvascular disease

Walter H Reinhart
The hematocrit (Hct) determines the oxygen carrying capacity of blood, but also increases blood viscosity and thus flow resistance. From this dual role the concept of an optimum Hct for tissue oxygenation has been derived. Viscometric studies using the ratio Hct/blood viscosity at high shear rate showed an optimum Hct of 50-60% for red blood cell (RBC) suspensions in plasma. For the perfusion of an artificial microvascular network with 5-70μm channels the optimum Hct was 60-70% for high driving pressures. With lower shear rates or driving pressures the optimum Hct shifted towards lower values...
October 21, 2016: Clinical Hemorheology and Microcirculation
Junichiro Hashimoto
The central aorta constitutes the main trunk of the systemic arterial tree. It dilates passively with cardiac ejection during systole and then constricts with its recoil function during diastole, thereby regulating blood pressure and blood flow. The central pulsatile hemodynamics affects local hemodynamics within as well as downstream of the aorta (e.g., end organs).The aorta progressively stiffens and dilates with advancing age, and such age-dependent change is accelerated by hypertension. According to the law of Laplace, wall stress depends on the diameter and pressure of the blood vessel...
September 2016: Journal of Hypertension
Sebastian Völz, Sara Svedlund, Bert Andersson, Gan Li-Ming, Bengt Rundqvist
Resistant hypertension is associated with increased risk for cardiovascular events. Coronary flow reserve (CFR) is impaired in patients with hypertension and an independent predictor of cardiac mortality. However, there are no published data on CFR in the subset of treatment-resistant hypertension. The aim of this study was to assess CFR in patients with resistant hypertension. Twenty-five consecutive patients with primary resistant hypertension, scheduled for renal denervation, 25 matched patients with controlled hypertension, and 25 healthy controls underwent transthoracic colour Doppler echocardiography at rest and during adenosine infusion...
October 17, 2016: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Junwei Xu, Lu Lu, Jing Lu, Jihui Xia, Hongjin Lu, Lin Yang, Wensheng Xia, Shihai Shen
BACKGROUND: Recent evidence suggests that CD200 fusion protein (CD200Fc), a CD200R1 agonist may attenuate inflammatory responses in autoimmune diseases and neuro-degeneration. While, little is known about the function of CD200Fc in cigarette smoke extract (CSE)-induced mouse Cardiac Microvascular Endothelial Cells (mCMECs). The present study was designed to elucidate the effects of CD200Fc on CSE-induced vascular endothelial barrier (VEB) dysfunction and inflammatory responses, which is a highly clinically relevant model of smoking related cardiovascular diseases...
October 3, 2016: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
Mohamed F Lutfi
Previous studies assessing effect of ischemia on ventricular repolarization are mostly directed toward patients with coronary artery disease (CAD); however, similar reports on cardiac syndrome X (CSX) are scarce. Whether microvascular dysfunction of CSX and ischemia induced by CAD produce comparable effect on ventricular repolarization is unclear and deserve further studies. In the present study, ECG measures of ventricular repolarization were compared between CAD and CSX patients (40 subjects in each group)...
2016: Frontiers in Physiology
Gabriella Captur, Audrey L Karperien, Alun D Hughes, Darrel P Francis, James C Moon
For clinicians grappling with quantifying the complex spatial and temporal patterns of cardiac structure and function (such as myocardial trabeculae, coronary microvascular anatomy, tissue perfusion, myocyte histology, electrical conduction, heart rate, and blood-pressure variability), fractal analysis is a powerful, but still underused, mathematical tool. In this Perspectives article, we explain some fundamental principles of fractal geometry and place it in a familiar medical setting. We summarize studies in the cardiovascular sciences in which fractal methods have successfully been used to investigate disease mechanisms, and suggest potential future clinical roles in cardiac imaging and time series measurements...
October 6, 2016: Nature Reviews. Cardiology
Salima Qamruddin
BACKGROUND: Stress echocardiography is an integral test in the cardiac diagnostic laboratory and has high sensitivity and specificity. Despite the excellent specificity of stress echocardiography, we continue to see a subset of patients with false-positive tests (defined as <50% diameter stenosis on subsequent coronary angiography). These false-positive findings present a management challenge because it remains unclear if and how to treat these patients. METHODS: This article reviews relevant clinical studies and their outcomes...
2016: Ochsner Journal
Junichiro Hashimoto
The central aorta constitutes the main trunk of the systemic arterial tree. It dilates passively with cardiac ejection during systole and then constricts with its recoil function during diastole, thereby regulating blood pressure and blood flow. The central pulsatile hemodynamics affects local hemodynamics within as well as downstream of the aorta (e.g., end organs).The aorta progressively stiffens and dilates with advancing age, and such age-dependent change is accelerated by hypertension. According to the law of Laplace, wall stress depends on the diameter and pressure of the blood vessel...
September 2016: Journal of Hypertension
Kyoung-Ha Park, Tao Sun, Felipe Diez-Delhoyo, Zhi Liu, Shi-Wei Yang, Ryan J Lennon, Joerg Herrmann, Rajiv Gulati, Martin Rodriguez-Porcel, Lilach O Lerman, Amir Lerman
BACKGROUND AND AIMS: The vasa vasorum (VV) plays a role in the initial phase of atherosclerosis, and abnormalities in microvascular function may be sensitive measures of the early development of atherosclerosis. The current study was designed to access the association between coronary microvascular function and VV density in patients undergoing cardiac catheterization. METHODS: Twenty-four patients with early coronary artery disease underwent endothelium-dependent (coronary blood flow, CBF) and endothelium-independent (coronary flow velocity reserve, CFVR) coronary microvascular function testing, and optical coherence tomography (OCT) imaging of the left anterior descending coronary artery (LAD)...
October 2016: Atherosclerosis
Iain R Murray, James E Baily, William C W Chen, Ayelet Dar, Zaniah N Gonzalez, Andrew R Jensen, Frank A Petrigliano, Arjun Deb, Neil C Henderson
Pericytes are periendothelial mesenchymal cells residing within the microvasculature. Skeletal muscle and cardiac pericytes are now recognized to fulfill an increasing number of functions in normal tissue homeostasis, including contributing to microvascular function by maintaining vessel stability and regulating capillary flow. In the setting of muscle injury, pericytes contribute to a regenerative microenvironment through release of trophic factors and by modulating local immune responses. In skeletal muscle, pericytes also directly enhance tissue healing by differentiating into myofibers...
September 2, 2016: Pharmacology & Therapeutics
Fernanda de Souza Nogueira Sardinha Mendes, Andréa Silvestre Sousa, Fernando Cesar de Castro Cesar Souza, Vivian Liane Mattos Pinto, Paula Simplicio Silva, Roberto Magalhães Saraiva, Sergio Salles Xavier, Henrique Horta Veloso, Marcelo Teixeira Holanda, Andréa Rodrigues Costa, Fernanda Martins Carneiro, Gilberto Marcelo Sperandio Silva, Juliana Pereira Borges, Eduardo Tibirica, Roberta Olmo Pinheiro, Flávio Alves Lara, Alejandro Marcel Hasslocher-Moreno, Pedro Emmanuel Alvarenga Americano Brasil, Mauro Felippe Felix Mediano
BACKGROUND: The effects of exercise training on Chagas heart disease are still unclear. This study aimed to evaluate the effect of exercise training over functional capacity, cardiac function, quality of life, and biomarkers in Chagas heart disease. METHODS: The PEACH study is a superiority randomized clinical trial which will include subjects who meet the following criteria: Chagas heart disease with a left ventricular ejection fraction below 45 % with or without heart failure symptoms; clinical stability in the last 3 months; adherence to clinical treatment; and age above 18 years...
2016: Trials
Ursula Müller-Werdan, Roland Prondzinsky, Karl Werdan
PURPOSE OF REVIEW: Inflammatory mediators can interfere with cardiovascular system. This article describes some recent findings in this field. RECENT FINDINGS: In septic cardiomyopathy, direct and indirect interactions of endotoxin with the pacemaker current contribute to cardiac autonomic dysfunction and inadequately high heart rate, worsening prognosis. In myocardial infarction, inflammatory blood cells correlate with impaired coronary microvascular reperfusion...
October 2016: Current Opinion in Critical Care
Ruth F Dubin, Isabella Guajardo, Amrita Ayer, Claire Mills, Catherine Donovan, Lauren Beussink, Rebecca Scherzer, Peter Ganz, Sanjiv J Shah
Patients with end-stage renal disease (ESRD) suffer high rates of heart failure and cardiovascular mortality, and we lack a thorough understanding of what, if any, modifiable factors contribute to cardiac dysfunction in these high-risk patients. To evaluate endothelial function as a potentially modifiable cause of cardiac dysfunction in ESRD, we investigated cross-sectional associations of macro- and microvascular dysfunction with left and right ventricular dysfunction in a well-controlled ESRD cohort. We performed comprehensive echocardiography, including tissue Doppler imaging and speckle-tracking echocardiography of the left and right ventricle, in 149 ESRD patients enrolled in an ongoing prospective, observational study...
October 2016: Hypertension
Roberto Alberto De Blasi, Stefano Romagnoli, Monica Rocco
OBJECTIVE: Blood volume reserve for venous return and the effects of cardiopulmonary bypass (CPB) on microvascular bed partitioning and blood flow were examined in patients with valvular diseases. DESIGN: Prospective, consecutive, case-control study. SETTING: Single university hospital. PARTICIPANTS: The study comprised 20 adult cardiac surgery patients and 20 healthy volunteers. INTERVENTIONS: Cardiovascular and microvascular variables were collected soon after the induction of anesthesia, after commencement of CPB, 20 minutes after separation from CPB, and in the intensive care unit...
June 3, 2016: Journal of Cardiothoracic and Vascular Anesthesia
Matthew Lumley, Rupert Williams, Kaleab N Asrress, Satpal Arri, Natalia Briceno, Howard Ellis, Ronak Rajani, Maria Siebes, Jan J Piek, Brian Clapp, Simon R Redwood, Michael S Marber, John B Chambers, Divaka Perera
BACKGROUND: Severe aortic stenosis (AS) can manifest as exertional angina even in the presence of unobstructed coronary arteries. OBJECTIVES: The authors describe coronary physiological changes during exercise and hyperemia in the healthy heart and in patients with severe AS. METHODS: Simultaneous intracoronary pressure and flow velocity recordings were made in unobstructed coronary arteries of 22 patients with severe AS (mean effective orifice area 0...
August 16, 2016: Journal of the American College of Cardiology
G Currie, J Flynn, M Lindhardt, H Mischak, P Rossing, C Delles
OBJECTIVE: Microalbuminuria (MA) is a marker of diabetic nephropathy (DN) but also indicates subclinical inflammation and vascular disease, limiting its sensitivity and specificity for early prediction of DN in type 2 diabetes. A urinary proteomic classifier based on 273 peptides (CKD273) shows promise for early detection of DN; however, the influence of inflammation and subclinical vascular disease on CKD27 is unknown. DESIGN AND METHOD: To dissect the relationship between CKD273, vascular phenotypes and inflammation without the confounding influence of MA we studied 145 normoalbuminuric patients with Type 2 diabetes participating in the PRIORITY (Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy In TYpe 2 diabetes with normoalbuminuria) trial...
September 2016: Journal of Hypertension
Irene Bottillo, Carla Giordano, Bruna Cerbelli, Daniela D'Angelantonio, Martina Lipari, Taisia Polidori, Silvia Majore, Enrico Bertini, Adele D'Amico, Diana Giannarelli, Carmelilia De Bernardo, Laura Masuelli, Francesco Musumeci, Andrea Avella, Federica Re, Elisabetta Zachara, Giulia d'Amati, Paola Grammatico
BACKGROUND: Danon disease (DD) is a rare disorder characterized by cardiomyopathy, intellectual disability, and proximal myopathy. It is caused by mutations in the LAMP2 gene on X chromosome. Female patients most often present with late-onset cardiomyopathy and slow disease progression, but early-onset cases with unfavorable prognosis have been reported. CASE REPORT: We describe the clinical, pathological, and molecular features of a novel LAMP2 c.453delT mutation in a female patient with severe hypertrophic cardiomyopathy, Wolff Parkinson White (WPW) syndrome and rapid progression to heart failure, requiring heart transplant...
September 2016: Cardiovascular Pathology: the Official Journal of the Society for Cardiovascular Pathology
Peyman Mesbah Oskui, Guy S Mayeda, Steven Burstein, Ali Gheissari, William J French, Joseph Thomas, Robert A Kloner
We report the case of a 59-year-old woman who presented with symptoms of angina that was refractory to medical management. Although her cardiac catheterization revealed microvascular coronary artery disease, her symptoms were refractory to optimal medical management that included ranolazine. After undergoing transmyocardial revascularization, her myocardial ischemia completely resolved and her symptoms dramatically improved. This case suggests that combination of ranolazine and transmyocardial revascularization can be applied to patients with microvascular coronary artery disease...
2014: SAGE Open Med Case Rep
Rina Mauricio, Monvadi B Srichai, Leon Axel, Judith S Hochman, Harmony R Reynolds
BACKGROUND: In a prospective study, cardiac MRI (CMR) and intravascular ultrasound were performed in women with myocardial infarction (MI) and nonobstructive coronary artery disease (MINOCA). Forty participants underwent adenosine-stress CMR (sCMR). HYPOTHESIS: Abnormal perfusion may co-localize with ischemic late gadolinium enhancement (LGE) and T2-weighted signal hyperintensity (T2+), suggesting microvascular dysfunction contributed to MI. METHODS: Qualitative perfusion analysis was performed by 2 independent readers...
July 26, 2016: Clinical Cardiology
Andrea Cardona, Karolina M Zareba, Subha V Raman
Coronary artery disease (CAD) is the leading cause of death in women. Nevertheless, extensive evidence demonstrates under-diagnosis and under-treatment of women for suspected or known ischemic heart disease (IHD). Stress cardiac magnetic resonance (CMR) is becoming readily available and offers significant advantages over other stress imaging modalities. The high spatial and temporal resolution of CMR provides the unique ability to identify subendocardial ischemia, viability, and the presence of microvascular disease...
October 2016: Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology
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