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microvascular angina

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https://www.readbyqxmd.com/read/29031990/international-standardization-of-diagnostic-criteria-for-microvascular-angina
#1
Peter Ong, Paolo G Camici, John F Beltrame, Filippo Crea, Hiroaki Shimokawa, Udo Sechtem, Juan Carlos Kaski, C Noel Bairey Merz
Standardization of diagnostic criteria for ischemic symptoms due to coronary microvascular dysfunction (CMD) is needed for further investigation of patients presenting with anginal chest pain consistent with "microvascular angina" (MVA). At the annual Coronary Vasomotion Disorders International Study Group (COVADIS) Summits held in August 2014 and 2015, the following criteria were agreed upon for the investigative diagnosis of microvascular angina: (1) presence of symptoms suggestive of myocardial ischemia; (2) objective documentation of myocardial ischemia, as assessed by currently available techniques; (3) absence of obstructive CAD (<50% coronary diameter reduction and/or fractional flow reserve (FFR) >0...
September 8, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/29030424/stable-coronary-syndromes-pathophysiology-diagnostic-advances-and-therapeutic-need
#2
REVIEW
Thomas J Ford, David Corcoran, Colin Berry
The diagnostic management of patients with angina pectoris typically centres on the detection of obstructive epicardial CAD, which aligns with evidence-based treatment options that include medical therapy and myocardial revascularisation. This clinical paradigm fails to account for the considerable proportion (approximately one-third) of patients with angina in whom obstructive CAD is excluded. This common scenario presents a diagnostic conundrum whereby angina occurs but there is no obstructive CAD (ischaemia and no obstructive coronary artery disease-INOCA)...
October 13, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28993120/coronary-lumen-volume-to-myocardial-mass-ratio-in-primary-microvascular-angina
#3
Rominder Grover, Jonathon A Leipsic, John Mooney, Shaw-Hua Kueh, Mickael Ohana, Bjarne L Nᴓrgaard, Ashkan Eftekhari, Jeroen J Bax, Darra T Murphy, Cameron J Hague, Michael A Seidman, Philipp Blanke, Tara Sedlak, Stephanie L Sellers
BACKGROUND: Microvascular angina (MVA) is an incompletely understood clinical entity. Computational analysis of coronary Computed Tomography Angiography (CTA) has shown an association between low coronary lumen volume to myocardial mass (V/M) ratio and lower Fractional Flow Reserve values, independent of plaque measures. We hypothesized that low V/M ratio may be present in patients with MVA. METHODS: A retrospective case-control analysis was performed using patients fulfilling guideline criteria for MVA with controls matched for age, gender, coronary risk factors and atherosclerotic plaque burden...
September 22, 2017: Journal of Cardiovascular Computed Tomography
https://www.readbyqxmd.com/read/28979725/effect-of-nicorandil-on-qt-dispersion-in-patients-with-stable-angina-pectoris-undergoing-elective-angioplasty-a-triple-blind-randomized-placebo-controlled-study
#4
Homa Fal Suleimani, Ali Eshraghi, Mehdi Hasanzadeh Daloee, Sara Hoseini, Nima Nakhaee
BACKGROUND: Nicorandil leads to the relaxation of fine vascular smooth muscle, and thus causes vasodilatation of major epicardial. Also, it has anti-arrhythmic and cardio-protective effects by improving reperfusion, and ultimately leads to a reduction in microvascular damage caused by percutaneous coronary intervention (PCI). OBJECTIVE: The aim of this study was to determine the effect of nicorandil on QT interval dispersion (QTd) in patients with stable angina pectoris during elective angioplasty...
August 2017: Electronic Physician
https://www.readbyqxmd.com/read/28966326/bevacizumab-related-microvascular-angina-and-its-management-with-nicorandil
#5
Manami Katoh, Norihiko Takeda, Takahide Arimoto, Hajime Abe, Katsutoshi Oda, Yutaka Osuga, Tomoyuki Fujii, Issei Komuro
Bevacizumab, an inhibitor of vascular endothelial growth factor (VEGF) -A, is currently used to treat patients with ovarian or colon cancer. While several cardiovascular toxicities related to bevacizumab-containing regimens have been reported, the effect of bevacizumab on the coronary microcirculation has not been fully elucidated. Here we report a case of 54-year-old female patient who developed microvascular angina after a series of bevacizumab-containing chemotherapeutic regimen. The discontinuation of bevacizumab and nicorandil administration was effective in alleviating her chest discomfort and the ischemic changes on her ECG...
September 30, 2017: International Heart Journal
https://www.readbyqxmd.com/read/28950300/frequency-and-angiographic-characteristics-of-coronary-microvascular-dysfunction-in-stable-angina-a-hybrid-imaging-study
#6
Iida Stenström, Teemu Maaniitty, Valtteri Uusitalo, Mikko Pietilä, Heikki Ukkonen, Sami Kajander, Maija Mäki, Jeroen J Bax, Juhani Knuuti, Antti Saraste
Aims: Coronary microvascular dysfunction (CMD) can cause angina in the absence of obstructive coronary artery disease (CAD). We studied the frequency and angiographic characteristics of CMD in symptomatic patients with suspected stable CAD and identified CMD as diffusely abnormal coronary vasodilator capacity by positron emission tomography (PET) perfusion imaging. Methods and results: We recruited prospectively 189 patients with intermediate pre-test probability of CAD who underwent coronary computed tomography angiography and quantitative 15O-water PET perfusion imaging followed by invasive coronary angiography, and assessment of fractional flow reserve when feasible...
July 27, 2017: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/28942444/peripheral-endothelial-function-and-coronary-flow-velocity-reserve-are-not-associated-in-women-with-angina-and-no-obstructive-coronary-artery-disease-the-ipower-study
#7
Kristoffer Flintholm Raft, Daria Frestad, Marie Mide Michelsen, Hannah Elena Suhrs, Anna Bay Rask, Malin Nilsson, Thomas Steffen Hermann, Eva Prescott
PURPOSE: We investigated whether impaired flow-mediated dilation (FMD) and plasma biomarkers reflecting endothelial dysfunction are associated with coronary microvascular dysfunction (CMD) in women with angina and no obstructive coronary artery disease (CAD). METHODS: Patients (n = 194) were randomly selected women with angina pectoris and no obstructive CAD (<50% stenosis). A reference population of asymptomatic women without CAD (n = 25) was included. We measured FMD in the brachial artery by high-resolution ultrasound...
2017: Journal of Vascular Research
https://www.readbyqxmd.com/read/28939174/ventricular-repolarization-alterations-in-women-with-angina-pectoris-and-suspected-coronary-microvascular-dysfunction
#8
Nynne Dose, Marie Mide Michelsen, Naja Dam Mygind, Adam Pena, Christina Ellervik, Peter R Hansen, Jørgen K Kanters, Eva Prescott, Jens Kastrup, Ida Gustafsson, Henrik Steen Hansen
OBJECTIVES: CMD could be the explanation of angina pectoris with no obstructive CAD and may cause ventricular repolarization changes. We compared T-wave morphology and QTc interval in women with angina pectoris with a control group as well as the associations with CMD. METHODS: Women with angina pectoris and no obstructive coronary artery disease (n=138) and age-matched controls were compared in regard to QTc interval and morphology combination score (MCS) based on T-wave asymmetry, flatness and presence of T-wave notch...
August 17, 2017: Journal of Electrocardiology
https://www.readbyqxmd.com/read/28890527/microvascular-angina%C3%A3-long-term-exercise-stress-test-follow-up
#9
Gaetano A Lanza, Monica Filice, Antonio De Vita, Angelo Villano, Laura Manfredonia, Priscilla Lamendola, Filippo Crea
BACKGROUND: A sizeable proportion of patients with primary stable microvascular angina (MVA; exercise-induced angina, positive exercise stress test [EST], normal coronary arteries) have recurrent symptoms during follow-up. There have been no previous studies, however, on the long-term results of EST and their correlation with symptom outcome.Methods and Results:Follow-up EST was performed in 71 MVA patients at an average of 16.2 years (range, 5-25 years) from the first EST. Angina status was assessed on weekly frequency of angina episodes and nitroglycerin consumption and by whether symptoms had worsened, improved, or remained unchanged over time...
September 9, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28807722/coronary-microvascular-dysfunction-is-not-associated-with-a-history-of-reproductive-risk-factors-in-women-with-angina-pectoris-an-ipower-substudy
#10
Hannah Elena Suhrs, Anna Meta Kristensen, Anna Bay Rask, Marie Mide Michelsen, Daria Frestad, Naja Dam Mygind, Kira Bové, Eva Prescott
BACKGROUND: Reproductive risk factors such as preeclampsia and recurrent miscarriages have been associated with adverse cardiovascular (CV) events. Underlying coronary microvascular dysfunction (CMD) may be a common denominator. PURPOSE: We investigated whether a history of reproductive risk factors was associated with CMD in women with angina pectoris and no obstructive coronary artery disease (CAD). METHODS: Participants from the iPOWER study, including women with angina pectoris and no obstructive CAD (<50% stenosis), were invited to complete an electronic survey regarding reproductive risk factors: recurrent miscarriages, gestational diabetes, preeclampsia, rhesus immunity, polycystic ovary syndrome and menopausal status as well as migraine and Raynaud phenomenon...
August 11, 2017: Maturitas
https://www.readbyqxmd.com/read/28807510/angina-after-percutaneous-coronary-intervention-the-need-for-precision-medicine
#11
Giampaolo Niccoli, Rocco Antonio Montone, Gaetano Antonio Lanza, Filippo Crea
Persistence or recurrence of angina after successful percutaneous coronary intervention (PCI) represent an important clinical issue involving from one fifth to one third of patients undergoing myocardial revascularization at one-year follow-up. A systematic approach to this syndrome is strongly needed. Precision medicine is particularly important in addressing angina after successful PCI because of the multiple underlying causes. Restenosis or coronary atherosclerosis progression explain symptom recurrence after successful PCI in some patients, while functional causes, including vasomotor abnormalities of epicardial coronary arteries and/or coronary microvascular dysfunction, explain symptoms in the remaining patients...
December 1, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28761673/evaluation-of-intermediate-coronary-stenoses-in-acute-coronary-syndromes-using-pressure-guidewire
#12
REVIEW
Giampaolo Niccoli, Ciro Indolfi, Justin E Davies
Fractional flow reserve (FFR) is increasingly used to guide myocardial revascularisation. However, supporting evidence regarding its use originates from studies that have enrolled mainly patients with stable angina, while patients with acute coronary syndromes (ACS) have not been included. Notably, multifactorial microvascular dysfunction and an increased sympathetic tone in patients with ACS may lead to blunted response to adenosine and false-negative results of FFR due to submaximal hyperaemia. This may raise the possibility of deferring treatment of stenosis that instead would have needed dilatation, thus leaving a residual risk of preventable cardiac events...
2017: Open Heart
https://www.readbyqxmd.com/read/28733074/non-invasive-assessment-of-microvascular-dysfunction-in-patients-with-microvascular-angina
#13
Caroline Jaarsma, Hans Vink, Judith van Haare, Sebastiaan C A M Bekkers, Bart D van Rooijen, Walter H Backes, Joachim E Wildberger, Harry J Crijns, Jurgen van Teeffelen, Simon Schalla
BACKGROUND: We aimed to evaluate the microvascular function in patients with microvascular angina (MVA) by assessing 1) the endothelial glycocalyx barrier properties using sublingual microscopy, and 2) the myocardial perfusion reserve using cardiovascular magnetic resonance (CMR) imaging. METHODS: Sublingual microscopy was performed in 13 MVA patients (angina pectoris, ST-depression on treadmill testing, normal coronary angiogram) and compared with 2 control groups of 13 volunteers and 14 patients with known obstructive coronary artery disease (CAD)...
December 1, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28712629/the-prime-diabetes-model-novel-methods-for-estimating-long-term-clinical-and-cost-outcomes-in-type-1-diabetes-mellitus
#14
William J Valentine, Richard F Pollock, Rhodri Saunders, Jay Bae, Kirsi Norrbacka, Kristina Boye
BACKGROUND: Recent publications describing long-term follow-up from landmark trials and diabetes registries represent an opportunity to revisit modeling options in type 1 diabetes mellitus (T1DM). OBJECTIVES: To develop a new product-independent model capable of predicting long-term clinical and cost outcomes. METHODS: After a systematic literature review to identify clinical trial and registry data, a model was developed (the PRIME Diabetes Model) to simulate T1DM progression and complication onset...
July 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/28675064/differential-expression-of-circulating-vascular-cell-adhesion-molecule-1-in-subjects-with-coronary-artery-disease-and-cardiac-syndrome-x-without-known-diabetes-mellitus
#15
Kae-Woei Liang, Wayne H-H Sheu, Wen-Jane Lee, Wen-Lieng Lee, Chia-Po Fu, Jun-Sing Wang
CONTEXT: Inflammation is one of the mechanisms underlying cardiac syndrome X (CSX). OBJECTIVES: Few studies have compared the expression of inflammatory or adhesion molecules between coronary artery disease (CAD) vs. CSX. MATERIALS AND METHODS: Ninety-two CSX and 145 CAD subjects without known diabetes mellitus underwent coronary angiogram for angina. RESULTS: Vascular cell adhesion molecule (VCAM)-1 (median, 507 vs...
July 4, 2017: Biomarkers: Biochemical Indicators of Exposure, Response, and Susceptibility to Chemicals
https://www.readbyqxmd.com/read/28616567/cyp2c19-variants-and-epoxyeicosatrienoic-acids-in-patients-with-microvascular-angina
#16
Tomonori Akasaka, Daisuke Sueta, Yuichiro Arima, Noriaki Tabata, Seiji Takashio, Yasuhiro Izumiya, Eiichiro Yamamoto, Kenichi Tsujita, Sunao Kojima, Koichi Kaikita, Ayami Kajiwara, Kazunori Morita, Kentaro Oniki, Junji Saruwatari, Kazuko Nakagawa, Seiji Hokimoto
BACKGROUND: Categorization as a cytochrome P450 (CYP) 2C19 poor metabolizer (PM) is reported to be an independent risk factor for cardiovascular disease. Epoxyeicosatrienoic acids (EETs) are metabolites of arachidonic acid by CYP2C19 epoxygenases and anti-inflammatory properties, especially in microvascular tissues. We examined the impact of CYP2C19 polymorphisms and EETs on the patients with microvascular angina (MVA) caused by coronary microvascular dysfunction. METHODS AND RESULTS: We examined CYP2C19 genotypes in patients with MVA (n = 81)...
June 2017: IJC Heart & Vasculature
https://www.readbyqxmd.com/read/28605043/typical-angina-is-associated-with-greater-coronary-endothelial-dysfunction-but-not-abnormal-vasodilatory-reserve
#17
Ahmed AlBadri, Derek Leong, C Noel Bairey Merz, Janet Wei, Eileen M Handberg, Chrisandra L Shufelt, Puja K Mehta, Michael D Nelson, Louise E Thomson, Daniel S Berman, Leslee J Shaw, Galen Cook-Wiens, Carl J Pepine
BACKGROUND: Typical angina (TA) is defined as substernal chest pain precipitated by physical exertion or emotional stress and relieved with rest or nitroglycerin. Women and elderly patients are usually have atypical symptoms both at rest and during stress, often in the setting of nonobstructive coronary artery disease (CAD). HYPOTHESIS: To further understand this, we performed subgroup analysis comparing subjects who presented with TA vs nontypical angina (NTA) using baseline data of patients with nonobstructive CAD and coronary microvascular dysfunction (CMD) enrolled in a clinical trial...
June 12, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28577279/role-of-pet-to-evaluate-coronary-microvascular-dysfunction-in-non-ischemic-cardiomyopathies
#18
REVIEW
Paco E Bravo, Marcelo F Di Carli, Sharmila Dorbala
Coronary microvascular dysfunction (CMD) can result from structural and functional abnormalities at the intramural and small coronary vessel level affecting coronary blood flow autoregulation and consequently leading to impaired coronary flow reserve. CMD often co-exists with epicardial coronary artery disease but is also commonly seen in patients with various forms of heart disease, including dilated, hypertrophic, and infiltrative cardiomyopathies. CMD can go unnoticed without any symptoms, or manifest as angina, and/or dyspnea, and contribute to the development of heart failure, and even sudden death especially when co-existing with myocardial fibrosis...
June 3, 2017: Heart Failure Reviews
https://www.readbyqxmd.com/read/28576663/impact-of-ranolazine-on-coronary-microvascular-dysfunction-micro-study
#19
Bina Ahmed, Judith Mondragon, Mark Sheldon, Stacey Clegg
BACKGROUND: Patients with angina and coronary microvascular dysfunction, without evidence of structural or epicardial coronary disease (Type I CMVD) remain without evidence based treatment options. Previous work has demonstrated that ranolazine can improve angina frequency and stability among patients with Type 1 CMVD; however, the mechanism remains unclear. Therefore, the objective of this pilot project was to assess the impact of ranolazine on Type I CMVD as measured using an invasive tool to measure global resistance (index of microcirculatory resistance (IMR))...
September 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28573765/design-and-baseline-characteristics-of-participants-in-the-researching-cardiovascular-events-with-a-weekly-incretin-in-diabetes-rewind-trial-on-the-cardiovascular-effects-of-dulaglutide
#20
Hertzel C Gerstein, Helen M Colhoun, Gilles R Dagenais, Rafael Diaz, Mark Lakshmanan, Prem Pais, Jeffrey Probstfield, Matthew C Riddle, Lars Rydén, Denis Xavier, Charles M Atisso, Alvaro Avezum, Jan Basile, Namsik Chung, Ignacio Conget, William C Cushman, Edward Franek, Nicolae Hancu, Markolf Hanefeld, Shaun Holt, Petr Jansky, Matyas Keltai, Fernando Lanas, Lawrence A Leiter, Patricio Lopez-Jaramillo, Ernesto G Cardona-Munoz, Valdis Pirags, Nana Pogosova, Peter J Raubenheimer, Jonathan Shaw, Wayne H-H Sheu, Theodora Temelkova-Kurktschiev
The aim was to determine the effects of dulaglutide, a synthetic once-weekly, injectable human glucagon-like peptide 1 analogue that lowers blood glucose, body weight, appetite and blood pressure, on cardiovascular outcomes. People with type 2 diabetes, aged ≥50 years, with glycated haemoglobin (HbA1c) ≤9.5%, and either a previous cardiovascular event, evidence of cardiovascular disease or ≥2 cardiovascular risk factors were randomly allocated to a weekly subcutaneous injection of either dulaglutide (1...
June 1, 2017: Diabetes, Obesity & Metabolism
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