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Microvascular disease of the heart

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https://www.readbyqxmd.com/read/28540214/coronary-microvascular-dysfunction-in-women-with-nonobstructive-ischemic-heart-disease-as-assessed-by-positron-emission-tomography
#1
REVIEW
Roxana Campisi, Fernando D Marengo
Traditional approaches for risk assessment of ischemic heart disease (IHD) are based on the physiological consequences of an epicardial coronary stenosis. Of note, normal coronary arteries or nonobstructive coronary artery disease (CAD) is a common finding in women with signs and symptoms of ischemia. Therefore, assessment of risk based on a coronary stenosis approach may fail in women. Positron emission tomography (PET) quantifies absolute myocardial blood flow (MBF) which may help to elucidate other mechanisms involved such as endothelial dysfunction and alterations in the smooth muscle cell relaxation responsible for IHD in women...
April 2017: Cardiovascular Diagnosis and Therapy
https://www.readbyqxmd.com/read/28535803/blood-metabolomic-fingerprint-is-distinct-in-healthy-coronary-and-in-stenosing-or-microvascular-ischemic-heart-disease
#2
Martino Deidda, Cristina Piras, Christian Cadeddu Dessalvi, Damiana Congia, Emanuela Locci, Federica Ascedu, Gianfranco De Candia, Mauro Cadeddu, Giorgio Lai, Raimondo Pirisi, Luigi Atzori, Giuseppe Mercuro
BACKGROUND: The endothelium is a key variable in the pathogenesis of atherosclerosis and its complications, particularly coronary artery disease (CAD). Current evidence suggests that the endothelial status can be regarded as an integrated index of individual atherogenic and anti-atherogenic properties, and that the interaction between circulating factors and the arterial wall might be critical for atherogenesis. In organism-level investigations, a functional view is provided by metabolomics, the study of the metabolic profile of small molecules...
May 23, 2017: Journal of Translational Medicine
https://www.readbyqxmd.com/read/28528579/phosphodiesterase-type-5-inhibition-may-reduce-diastolic-function-in-women-with-ischemia-but-no-obstructive-coronary-artery-disease
#3
Michael D Nelson, Puja K Mehta, Janet Wei, Behzad Sharif, Louise E J Thomson, Daniel Berman, Debiao Li, C Noel Bairey Merz
BACKGROUND: Ischemia, in the absence of obstructive coronary artery disease, is prevalent in women, and associated with increased risk for major cardiovascular events. Coronary microvascular dysfunction is prevalent in these patients, and associated with impaired diastolic function. Despite our general understanding, however, optimal treatment of this cohort remains elusive. METHODS: To address this knowledge gap, we performed an open-label treatment trial to assess whether phosphodiesterase type 5 inhibition improves coronary microvascular perfusion and diastolic function in women with signs and symptoms of ischemia but no evidence of obstructive coronary artery disease...
May 22, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28526185/empa-reg-outcome-the-endocrinologist-s-point-of-view
#4
Leigh Perreault
For many years, it was widely accepted that control of plasma lipids and blood pressure could lower macrovascular risk in patients with type 2 diabetes mellitus (T2DM), whereas the benefits of lowering plasma glucose were largely limited to improvements in microvascular complications. The Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients-Removing Excess Glucose (EMPA-REG OUTCOME) study demonstrated for the first time that a glucose-lowering agent, the sodium glucose cotransporter 2 (SGLT2) inhibitor empagliflozin, could reduce major adverse cardiovascular events, cardiovascular mortality, hospitalization for heart failure, and overall mortality when given in addition to standard care in patients with T2DM at high cardiovascular risk...
May 12, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28512159/employing-extracellular-volume-cardiovascular-magnetic-resonance-measures-of-myocardial-fibrosis-to-foster-novel-therapeutics
#5
Erik B Schelbert, Hani N Sabbah, Javed Butler, Mihai Gheorghiade
Quantifying myocardial fibrosis (MF) with myocardial extracellular volume measures acquired during cardiovascular magnetic resonance promises to transform clinical care by advancing pathophysiologic understanding and fostering novel therapeutics. Extracellular volume quantifies MF by measuring the extracellular compartment depicted by the myocardial uptake of contrast relative to plasma. MF is a key domain of dysfunctional but viable myocardium among others (eg, microvascular dysfunction and cardiomyocyte/mitochondrial dysfunction)...
June 2017: Circulation. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28482008/the-microcirculation-a-key-player-in-obesity-associated-cardiovascular-disease
#6
Oana Sorop, T Dylan Olver, Jens van de Wouw, Ilkka Heinonen, Richard W van Duin, Dirk J Duncker, Daphne Merkus
It is increasingly recognized that obesity is a risk factor for microvascular disease, i.e. results in structural and functional changes in the microvasculature. This review aims to describe how obesity impacts the microvasculature of visceral adipose tissue, skeletal muscle, heart, brain, kidneys and lungs. These changes involve endothelial dysfunction, which in turn impacts control of vascular tone, contributes to development of microvascular insulin resistance, alters secretion of paracrine factors like nitric oxide and endothelin, but also influences vascular structure and perivascular inflammation...
May 8, 2017: Cardiovascular Research
https://www.readbyqxmd.com/read/28473471/are-targeted-therapies-for-diabetic-cardiomyopathy-on-the-horizon
#7
REVIEW
Mitchel Tate, David J Grieve, Rebecca H Ritchie
Diabetes increases the risk of heart failure approximately 2.5-fold, independent of coronary artery disease and other comorbidities. This process, termed diabetic cardiomyopathy, is characterized by initial impairment of left ventricular (LV) relaxation followed by LV contractile dysfunction. Post-mortem examination reveals that human diastolic dysfunction is closely associated with LV damage, including cardiomyocyte hypertrophy, apoptosis and fibrosis, with impaired coronary microvascular perfusion. The pathophysiological mechanisms underpinning the characteristic features of diabetic cardiomyopathy remain poorly understood, although multiple factors including altered lipid metabolism, mitochondrial dysfunction, oxidative stress, endoplasmic reticulum (ER) stress, inflammation, as well as epigenetic changes, are implicated...
May 1, 2017: Clinical Science (1979-)
https://www.readbyqxmd.com/read/28455826/subendocardial-viability-ratio-in-patients-with-rheumatoid-arthritis-comparison-with-healthy-controls-and-identification-of-prognostic-factors
#8
Panagiota Anyfanti, Areti Triantafyllou, Eugenia Gkaliagkousi, Georgios Triantafyllou, Nikolaos Koletsos, Sophia Chatzimichailidou, Panagiotis Panagopoulos, Ioannis Botis, Spyros Aslanidis, Stella Douma
Cardiac involvement is common in rheumatoid arthritis. Subendocardial viability ratio (SEVR) is a non-invasive measure of microvascular coronary perfusion, yet it remains unclear whether it is affected in rheumatoid arthritis patients. We additionally sought predictors of SEVR in rheumatoid arthritis among a wide range of disease-related parameters, cardiac and hemodynamic factors, and markers of atherosclerosis, arteriosclerosis, and endothelial dysfunction. SEVR was estimated in rheumatoid arthritis patients and healthy controls by applanation tonometry, which was also used to evaluate arterial stiffness (pulse wave velocity and augmentation index)...
April 28, 2017: Clinical Rheumatology
https://www.readbyqxmd.com/read/28454806/assessing-micro-vascular-resistances-via-imr-to-predict-outcome-in-stemi-patients-with-multivessel-disease-undergoing-primary-pci-amicro-rationale-and-design-of-a-prospective-multicenter-clinical-trial
#9
Massimo Fineschi, Edoardo Verna, Giuseppe Mezzapelle, Davide Bartolini, Giovanni Turiano, Antonio Manari, Katia Lucarelli, Lucia Uguccioni, Alessandra Repetto, Giuseppe Tarantini
BACKGROUND: In STEMI patients treated with primary percutaneous coronary angioplasty (PPCI) the evaluation of coronary microcirculatory resistance index (IMR) predict the extent of microvascular damage and left ventricular (LV) remodeling. However, the impact of IMR on the clinical outcome after PPCI in patients with multivessel disease (MVD) remains unsettled. AIM: We designed a prospective multicenter controlled clinical trial to evaluate the prognostic value of IMR in terms of clinical outcome and left ventricular remodeling in STEMI patients with MVD undergoing PPCI...
May 2017: American Heart Journal
https://www.readbyqxmd.com/read/28424377/sex-differences-in-micro-and-macro-vascular-complications-of-diabetes-mellitus
#10
REVIEW
Christine Maric-Bilkan
Vascular complications are a leading cause of morbidity and mortality in both men and women with type 1 (T1DM) or type 2 (T2DM) diabetes mellitus, however the prevalence, progression and pathophysiology of both microvascular (nephropathy, neuropathy and retinopathy) and macrovascular [coronary heart disease (CHD), myocardial infarction, peripheral arterial disease (PAD) and stroke] disease are different in the two sexes. In general, men appear to be at a higher risk for diabetic microvascular complications, while the consequences of macrovascular complications may be greater in women...
May 1, 2017: Clinical Science (1979-)
https://www.readbyqxmd.com/read/28422124/prevalence-of-type-2-diabetes-and-its-complications-in-india-and-economic-costs-to-the-nation
#11
REVIEW
R Pradeepa, V Mohan
Diabetes, a major lifestyle disorder, has become a global burden, and the prevalence rates are rising steeply in developing economies. Rapid socioeconomic transition with urbanization and industrialization are the main causes for the global diabetes epidemic. Among developing economies, the highest increase in number of people with diabetes is in China followed by India. In India, the epidemic of diabetes continue to increase and is experiencing a shift in diabetes prevalence from urban to rural areas, the affluent to the less privileged and from older to younger people...
April 19, 2017: European Journal of Clinical Nutrition
https://www.readbyqxmd.com/read/28420647/incremental-value-of-transthoracic-doppler-echocardiography-assessed-coronary-flow-reserve-in-patients-with-suspected-myocardial-ischemia-undergoing-myocardial-perfusion-scintigraphy
#12
Li-Ming Gan, Sara Svedlund, Ann Wittfeldt, Charlotte Eklund, Sinsia Gao, Göran Matejka, Anders Jeppsson, Per Albertsson, Elmir Omerovic, Amir Lerman
BACKGROUND: Adenosine-assisted transthoracic Doppler-derived coronary flow reserve (TDE-CFR) reflects coronary vascular function. The prognostic and incremental value of left anterior descending coronary artery TDE-CFR above myocardial perfusion scintigraphy in patients with suspected myocardial ischemia has not yet been studied. METHODS AND RESULTS: Three hundred seventy-one patients (mean age, 62.3±8.7 years; 46.8% males) referred to myocardial perfusion scintigraphy attributed to suspected myocardial ischemia were included in the study...
April 18, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28415836/diabetic-cardiomyopathy-where-we-are-and-where-we-are-going
#13
REVIEW
Wang-Soo Lee, Jaetaek Kim
The global burden of diabetes mellitus and its related complications are currently increasing. Diabetes mellitus affects the heart through various mechanisms including microvascular impairment, metabolic disturbance, subcellular component abnormalities, cardiac autonomic dysfunction, and a maladaptive immune response. Eventually, diabetes mellitus can cause functional and structural changes in the myocardium without coronary artery disease, a disorder known as diabetic cardiomyopathy (DCM). There are many diagnostic tools and management options for DCM, although it is difficult to detect its development and effectively prevent its progression...
May 2017: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/28412277/the-association-of-endothelial-function-and-tone-by-digital-arterial-tonometry-with-mri-left-ventricular-mass-in-african-americans-the-jackson-heart-study
#14
Avnish Tripathi, Emelia J Benjamin, Solomon K Musani, Naomi M Hamburg, Connie W Tsao, Arti Saraswat, Ramachandran S Vasan, Gary F Mitchell, Ervin R Fox
Peripheral vascular endothelial dysfunction assessed by digital peripheral arterial tonometry (PAT) has been associated with risk for adverse cardiovascular events. We examined the relations of peripheral microvascular dysfunction and left ventricular mass in a community-based cohort of African Americans. We examined participants of the Jackson Heart Study who had PAT and cardiac magnetic resonance imaging evaluations between 2007 and 2013. Consistent with pertinent literature, left ventricular mass index (LVMI) was adjusted for body size by indexing to height(2...
March 27, 2017: Journal of the American Society of Hypertension: JASH
https://www.readbyqxmd.com/read/28410144/cardiotoxicity-in-oncology-and-coronary-microcirculation-future-challenges-in-theranostics
#15
Giovanni Peretto, Davide Lazzeroni, Carmem L Sartorio, Paolo G Camici
Many of the patients undergoing chemotherapy or radiotherapy for cancer are at increased risk of developing cardiovascular diseases. Recent evidence suggests that cardiac dysfunction and subsequent heart failure are mainly due to vascular toxicity rather than only to due to myocyte toxicity. However, not all of the vascular toxicity of cancer therapies can be explained by epicardial coronary artery disease. In fact, in the last decades, it has been found that myocardial ischemia may occur as a consequence of structural or functional dysfunction of the complex network of vessels, which cannot be seen by a coronary angiography: the coronary microcirculation...
June 1, 2017: Frontiers in Bioscience (Landmark Edition)
https://www.readbyqxmd.com/read/28385920/blood-pressure-and-calf-muscle-oxygen-extraction-during-plantar-flexion-exercise-in-peripheral-artery-disease
#16
J Carter Luck, Amanda J Miller, Faisal Aziz, John F Radtka, David N Proctor, Urs A Leuenberger, Lawrence I Sinoway, Matthew D Muller
Peripheral artery disease (PAD) is an atherosclerotic vascular disease that affects 200 million worldwide. While PAD primarily affects large arteries, it is also associated with microvascular dysfunction, an exaggerated blood pressure (BP) response to exercise, and high cardiovascular mortality. We hypothesized that fatiguing plantar flexion exercise that evokes claudication elicits a greater reduction in skeletal muscle oxygenation (SmO2) and a higher rise in BP in PAD compared to age-matched healthy subjects, but low-intensity steady state plantar flexion elicits similar responses between groups...
April 6, 2017: Journal of Applied Physiology
https://www.readbyqxmd.com/read/28375659/cardiopulmonary-exercise-test-in-hypertrophic-cardiomyopathy
#17
Damiano Magri, Caterina Santolamazza
Understanding the functional limitation in hypertrophic cardiomyopathy, the most common inherited heart disease, is challenging. Beside the occurrence of disease-related complications, several factors are potential determinants of exercise limitation, including left ventricular hypertrophy, myocardial fiber disarray, left ventricular outflow tract obstruction, microvascular ischemia, and interstitial fibrosis. Furthermore, drugs commonly used in the daily management of these patients may interfere with exercise capacity, especially those with a negative chronotropic effect...
April 4, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28361599/antianginal-therapy-for-stable-ischemic-heart-disease
#18
Santosh K Padala, Michael P Lavelle, Mandeep S Sidhu, Katherine P Cabral, Doralisa Morrone, William E Boden, Peter P Toth
Chronic angina pectoris is associated with considerable morbidity and mortality, especially if treated suboptimally. For many patients, aggressive pharmacologic intervention is necessary in order to alleviate anginal symptoms. The optimal treatment of stable ischemic heart disease (SIHD) should be the prevention of angina and ischemia, with the goal of maximizing both quality and quantity of life. In addition to effective risk factor modification with lifestyle changes, intensive pharmacologic secondary prevention is the therapeutic cornerstone in managing patients with SIHD...
January 1, 2017: Journal of Cardiovascular Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28341374/cardiorenal-disease-connection-during-post-menopause-the-protective-role-of-estrogen-in-uremic-toxins-induced-microvascular-dysfunction
#19
REVIEW
Jiayi Pei, Magdalena Harakalova, Hester den Ruijter, Gerard Pasterkamp, Dirk J Duncker, Marianne C Verhaar, Folkert W Asselbergs, Caroline Cheng
Female gender, post-menopause, chronic kidney disease (CKD) and (CKD linked) microvascular disease are important risk factors for developing heart failure with preserved ejection fraction (HFpEF). Enhancing our understanding of the interrelation between these risk factors could greatly benefit the identification of new drug targets for future therapy. This review discusses the evidence for the protective role of estradiol (E2) in CKD-associated microvascular disease and related HFpEF. Elevated circulating levels of uremic toxins (UTs) during CKD may act in synergy with hormonal changes during post-menopause and could lead to coronary microvascular endothelial dysfunction in HFpEF...
March 14, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28325567/microvascular-surgery-in-the-congenital-cardiac-patient-a-case-series-exploring-feasibility-and-practical-applications
#20
John A LoGiudice, Karri Adamson, Nancy Ghanayem, Ronald K Woods, Michael E Mitchell
BACKGROUND: Pediatric congenital heart disease patients are at risk for vascular injuries during surgical procedures or when the arterial system is accessed for monitoring or diagnostic studies. Our treatment of emergent situations in this patient population using microvascular techniques shows the feasibility of such techniques. METHODS: A retrospective chart review of patients aged 0-18 years with congenital heart disease identified six patients who underwent microvascular surgery by the senior surgeon from June 2007 to May 2015...
May 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
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