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https://www.readbyqxmd.com/read/28448601/determinants-of-coronary-flow-reserve-in-non-diabetic-patients-with-chest-pain-without-myocardial-perfusion-defects
#1
Helena U Westergren, Erik Michaëlsson, Juuso I Blomster, Tasso Miliotis, Sara Svedlund, Li-Ming Gan
BACKGROUND: Microvascular dysfunction could be responsible for chest pain in patients without myocardial perfusion defects. We evaluated microvascular function using ultrasound-assessed coronary flow reserve (CFR) in patients with chest pain and normal myocardial perfusion scintigram. Secondly, we investigated association between cardiovascular parameters and decreased CFR in a sex specific manner. METHODS: A total of 202 (128 women) non-diabetic patients with chest pain and suspected myocardial ischemia, but without myocardial perfusion defects on myocardial perfusion scintigram, were enrolled and underwent CFR examination and blood sampling...
2017: PloS One
https://www.readbyqxmd.com/read/28444638/nuclear-cardiology-are-we-using-the-right-protocols-and-tracers-the-right-way
#2
REVIEW
Maurizio Dondi, Thomas Pascual, Diana Paez, Andrew J Einstein
The field of nuclear cardiology has changed considerably over recent years, with greater attention paid to safety and radiation protection issues. The wider usage of technetium-99m (Tc-99m)-labeled radiopharmaceuticals for single-photon emission computed tomography (SPECT) imaging using gamma cameras has contributed to better quality studies and lower radiation exposure to patients. Increased availability of tracers and scanners for positron emission tomography (PET) will help further improve the quality of studies and quantify myocardial blood flow and myocardial flow reserve, thus enhancing the contribution of non-invasive imaging to the management of coronary artery disease...
April 25, 2017: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
https://www.readbyqxmd.com/read/28444153/computed-tomography-derived-fractional-flow-reserve-testing-in-stable-patients-with-typical-angina-pectoris-influence-on-downstream-rate-of-invasive-coronary-angiography
#3
Jesper Møller Jensen, Hans Erik Bøtker, Ole Norling Mathiassen, Erik Lerkevang Grove, Kristian Altern Øvrehus, Kamilla Bech Pedersen, Christian Juhl Terkelsen, Evald Høj Christiansen, Michael Maeng, Jonathon Leipsic, Anne Kaltoft, Lars Jakobsen, Jacob Thorsted Sørensen, Troels Thim, Steen Dalby Kristensen, Lars Romer Krusell, Bjarne Linde Nørgaard
Aims: To assess the use of downstream coronary angiography (ICA) and short-term safety of frontline coronary CT angiography (CTA) with selective CT-derived fractional flow reserve (FFRCT) testing in stable patients with typical angina pectoris. Methods and results: Between 1 January 2016 and 30 June 2016 all patients (N = 774) referred to non-emergent ICA or coronary CTA at Aarhus University Hospital on a suspicion of CAD had frontline CTA performed. Downstream testing and treatment within 3 months and adverse events ≥90 days were registered...
April 20, 2017: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/28444062/prognostic-value-of-coronary-flow-reserve-obtained-on-dobutamine-stress-echocardiography-and-its-correlation-with-target-heart-rate
#4
José Sebastião de Abreu, Eduardo Arrais Rocha, Isadora Sucupira Machado, Isabelle O Parahyba, Thais Brito Rocha, Fernando José Villar Nogueira Paes, Tereza Cristina Pinheiro Diogenes, Marília Esther Benevides de Abreu, Ana Gardenia Liberato Ponte Farias, Marcia Maria Carneiro, José Nogueira Paes
Background: Normal coronary flow velocity reserve (CFVR) (≥ 2) obtained in the left anterior descending coronary artery (LAD) from transthoracic echocardiography is associated with a good prognosis, but there is no study correlating CFVR with submaximal target heart rate (HR). Objective: To evaluate the prognostic value of CFVR obtained in the LAD of patients with preserved (>50%) left ventricular ejection fraction (LVEF) who completed a dobutamine stress echocardiography (DSE), considering target HR...
April 20, 2017: Arquivos Brasileiros de Cardiologia
https://www.readbyqxmd.com/read/28442659/diagnostic-accuracy-of-endocardial-to-epicardial-myocardial-blood-flow-ratio-for-the-detection-of-significant-coronary-artery-disease-with-dynamic-myocardial-perfusion-dual-source-computed-tomography
#5
Yoshitaka Goto, Kakuya Kitagawa, Mio Uno, Shiro Nakamori, Tatsuro Ito, Naoki Nagasawa, Kaoru Dohi, Hajime Sakuma
BACKGROUND: Previous dynamic stress computed tomography perfusion (CTP) studies used absolute myocardial blood flow (MBF in mL/100 g/min) as a threshold to discriminate flow-limiting coronary artery disease (CAD), but absolute MBF can be vary because of multiple factors. The aim of this study was to compare the diagnostic performance of absolute MBF and the transmural perfusion ratio (TPR) for the detection of flow-limiting CAD, and to clarify the influence of CT delayed enhancement (CTDE) on the diagnostic performance of CTP...
April 25, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28436268/collateral-circulation-alters-downstream-hemodynamic-stress-caused-by-intracranial-atherosclerotic-stenosis
#6
Xin Liu, David Dornbos, Yuehua Pu, Xinyi Leng, Ligang Song, Baixue Jia, Yuesong Pan, David Wang, Zhongrong Miao, Yilong Wang, Liping Liu, Yongjun Wang
OBJECTIVES: Fractional flow reserve (FFR) accurately predicts the degree of stenosis and is now widely used to identify clinically significant severe coronary artery lesions. In the current study, we utilized a similar indicator, fractional flow (FF), to determine the hemodynamic impact of symptomatic intracranial atherosclerotic stenosis (ICAS) and to assess the correlation of FF with the severity of stenosis and collateral circulation. METHODS: Patients with symptomatic ICAS (70-99% stenosis) confirmed on digital subtraction angiography (DSA) were consecutively recruited...
April 23, 2017: Neurological Research
https://www.readbyqxmd.com/read/28432490/thallium-201-washout-rate-of-stress-myocardial-perfusion-imaging-as-a-predictor-of-mortality-in-diabetic-kidney-disease-patients-initiating-hemodialysis-an-observational-follow-up-study
#7
Toshihide Hayashi, Nobuhiko Joki, Yuri Tanaka, Masaki Iwasaki, Shun Kubo, Ai Matsukane, Yasunori Takahashi, Yoshihiko Imamura, Koichi Hirahata, Hiroki Hase
BACKGROUND: Thallium-201 washout rate of stress myocardial perfusion imaging (MPI) has been reported to correlate with coronary flow reserve which is a parameter of myocardial microcirculation. However, the evidence for its use in diabetic kidney disease (DKD) has been lacking, and the association between thallium-201 washout rate and adverse outcomes including death is unknown. Therefore, the present study was conducted to evaluate the predictive ability of thallium-201 washout rate for mortality in DKD patients initiating hemodialysis...
April 21, 2017: Clinical and Experimental Nephrology
https://www.readbyqxmd.com/read/28432157/effect-of-interleukin-6-inhibition-on-coronary-microvascular-and-endothelial-function-in-myocardial-infarction
#8
Espen Holte, Ola Kleveland, Thor Ueland, Gabor Kunszt, Marte Bratlie, Kaspar Broch, Annika E Michelsen, Bjørn Bendz, Brage H Amundsen, Svend Aakhus, Jan Kristian Damås, Lars Gullestad, Pål Aukrust, Rune Wiseth
OBJECTIVE: Interleukin-6 (IL-6) is a driver of inflammation and associated endothelial cell activation in acute coronary syndromes. We evaluated the effect of the IL-6 receptor antagonist tocilizumab on coronary microvascular function and endothelial dysfunction measured by coronary flow reserve (CFR) and markers of endothelial cell activation in patients with non-ST-elevation myocardial infarction (NSTEMI). METHODS: This substudy was part of a two-centre, double-blind, randomised, placebo-controlled trial evaluating the effect of a single dose of tocilizumab in NSTEMI...
April 21, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28429698/coronary-microvascular-dysfunction-equivalent-to-left-main-coronary-artery-disease
#9
Cafer Panç, Mehmet Kocaağa, Onur Erdoğan, Remzi Sarıkaya, Sabahattin Umman
Coronary microvascular dysfunction, also known as cardiac syndrome X, is a clinical syndrome presenting with typical angina and evidence of myocardial ischemia in the absence of flow-limiting stenosis on coronary angiography. Of patients undergoing coronary angiography due to suspected myocardial ischemia, 50% are found to have normal or near-normal coronary arteries. Described in this case report is a patient who developed hypotension and ST segment depressions during treadmill exercise test. Left main coronary artery or multivessel disease was suspected...
April 2017: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
https://www.readbyqxmd.com/read/28420802/clinical-decision-making-for-the-hemodynamic-gray-zone-ffr-0-75-0-80-and-long-term-outcomes
#10
Shiv Kumar Agarwal, Srikanth Kasula, Mohan M Edupuganti, Sameer Raina, Fnu Shailesh, Ahmed Almomani, Jason J Payne, Naga V Pothineni, Barry F Uretsky, Abdul Hakeem
BACKGROUND: Fractional flow reserve (FFR) value between 0.75 and 0.80 is considered the "gray zone" and outcomes data relative to treatment strategy (revascularization vs medical therapy alone [deferral]) are limited for this group. METHODS AND RESULTS: A total of 238 patients (64.3 ± 8.6 years; 97% male; 45% diabetic) with gray-zone FFR were followed for the primary endpoint of major adverse cardiovascular event (MACE), defined as a composite of death, myocardial infarction (MI), and target-vessel revascularization...
April 15, 2017: Journal of Invasive Cardiology
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
#11
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/28419280/fractional-flow-reserve-and-pressure-bounded-coronary-flow-reserve-to-predict-outcomes-in-coronary-artery-disease
#12
Jung-Min Ahn, Frederik M Zimmermann, Nils P Johnson, Eun-Seok Shin, Bon-Kwon Koo, Pil Hyung Lee, Duk-Woo Park, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Cheol Whan Lee, Seong-Wook Park, Nico H J Pijls, Seung-Jung Park
Aims: Fractional flow reserve (FFR) has proven to its prognostic and therapeutic value. However, the additive prognostic value of coronary flow reserve (CFR) remains unclear. This study sought to investigate the clinical utility of combined FFR and CFR measurements to predict outcomes. Methods and results: Using the prospective, multicentre Interventional Cardiology Research Incooperation Society-FFR registry, a total of 2088 lesions from 1837 patients were included in this substudy...
April 17, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28413187/noninvasive-fractional-flow-reserve-derived-from-coronary-computed-tomography-angiography%C3%A3-is-this-just-another-new-diagnostic-test-or-the-long-awaited-game-changer
#13
Hiromasa Otake, Charles A Taylor, Hitoshi Matsuo, Nobuhiro Tanaka, Takashi Akasaka
Despite the clinical importance of ischemia evaluation, obtaining fractional flow reserve (FFR) value has, heretofore, only been available during invasive cardiac catheterization. Although there is a clear linkage between morphology and physiology, a significant gap still exists. FFR derived from coronary computed tomography angiography (FFRCT) is a novel method of quantifying the hemodynamic significance of coronary artery stenoses by translating morphological information into hemodynamic data. Improved diagnostic performance of FFRCThas been repeatedly demonstrated in comparison with coronary computed tomography angiography alone with an invasive FFR reference standard...
April 11, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28412436/noninvasive-ffr-derived-from-coronary-ct-angiography-management-and-outcomes-in-the-promise-trial
#14
Michael T Lu, Maros Ferencik, Rhonda S Roberts, Kerry L Lee, Alexander Ivanov, Elizabeth Adami, Daniel B Mark, Farouc A Jaffer, Jonathon A Leipsic, Pamela S Douglas, Udo Hoffmann
OBJECTIVES: The purpose of this study was to determine whether noninvasive fractional flow reserve derived from computed tomography (FFRCT) predicts coronary revascularization and outcomes and whether its addition improves efficiency of referral to invasive coronary angiography (ICA) after coronary computed tomography angiography (CTA). BACKGROUND: FFRCT may improve the efficiency of an anatomic CTA strategy for stable chest pain. METHODS: This observational cohort study included patients with stable chest pain in the PROMISE trial (PROspective Multicenter Imaging Study for Evaluation of Chest Pain) referred to ICA within 90 days after CTA...
April 7, 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28407768/a-study-of-noninvasive-fractional-flow-reserve-derived-from-a-simplified-method-based-on-coronary-computed-tomography-angiography-in-suspected-coronary-artery-disease
#15
Changzheng Shi, Dong Zhang, Kunlin Cao, Tao Zhang, Liangping Luo, Xin Liu, Heye Zhang
BACKGROUND: The invasive fractional flow reserve has been considered the gold standard for identifying ischaemia-related stenosis in patients with suspected coronary artery disease. Determining non-invasive FFR based on coronary computed tomographic angiography datasets using computational fluid dynamics tends to be a demanding process. Therefore, the diagnostic performance of a simplified method for the calculation of FFRCTA requires further evaluation. OBJECTIVES: The aim of this study was to investigate the diagnostic performance of FFRCTA calculated based on a simplified method by referring to the invasive FFR in patient-specific coronary arteries and clinical decision-making...
April 14, 2017: Biomedical Engineering Online
https://www.readbyqxmd.com/read/28407232/observed-survival-benefit-of-therapeutic-hypothermia-re-analyzing-the-circ-trial
#16
Alexander Nürnberger, Harald Herkner, Fritz Sterz, Jan-Aage Olsen, Michael Lozano, Pierre M van Grunsven, Brooke E Lerner, David Persse, Reinhard Malzer, Marc A Brouwer, Mark Westfall, Chris M Souders, David T Travis, Ulrich R Herken, Lars Wik
BACKGROUND: Mild therapeutic hypothermia is argued being beneficial for outcome after cardiac arrest. MATERIALS AND METHODS: Retrospective analysis of Circulation Improving Resuscitation Care trial data to assess if therapeutic cooling to 33 ±1°C core temperature had an association with survival. Of 4,231 adult out-of-hospital cardiac arrests of presumed cardiac origin initially enrolled, eligibility criteria for therapeutic hypothermia were met by 1,812. Logistic regression was undertaken in a stepwise fashion to account for the impact on outcome of each significant difference and for the variable of interest between the groups...
April 13, 2017: European Journal of Clinical Investigation
https://www.readbyqxmd.com/read/28404623/fractional-flow-reserve-guided-complete-revascularization-improves-the-prognosis-in-patients-with-st-segment-elevation-myocardial-infarction-and-severe-nonculprit-disease-a-danami-3-primulti-substudy-primary-pci-in-patients-with-st-elevation-myocardial-infarction
#17
Jacob Lønborg, Thomas Engstrøm, Henning Kelbæk, Steffen Helqvist, Lene Kløvgaard, Lene Holmvang, Frants Pedersen, Erik Jørgensen, Kari Saunamäki, Peter Clemmensen, Ole De Backer, Jan Ravkilde, Hans-Henrik Tilsted, Anton Boel Villadsen, Jens Aarøe, Svend Eggert Jensen, Bent Raungaard, Lars Køber, Dan Eik Høfsten
BACKGROUND: The impact of disease severity on the outcome after complete revascularization in patients with ST-segment-elevation myocardial infarction and multivessel disease is uncertain. The objective of this post hoc study was to evaluate the impact of number of diseased vessel, lesion location, and severity of the noninfarct-related stenosis on the effect of fractional flow reserve-guided complete revascularization. METHODS AND RESULTS: In the DANAMI-3-PRIMULTI study (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization), we randomized 627 ST-segment-elevation myocardial infarction patients to fractional flow reserve-guided complete revascularization or infarct-related percutaneous coronary intervention only...
April 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28400462/saline-induced-coronary-hyperemia-mechanisms-and-effects-on-left-ventricular-function
#18
Bernard De Bruyne, Julien Adjedj, Panagiotis Xaplanteris, Angela Ferrara, Yujing Mo, Martin Penicka, Vincent Floré, Mariano Pellicano, Gabor Toth, Emanuele Barbato, Dirk J Duncker, Nico H J Pijls
BACKGROUND: During thermodilution-based assessment of volumetric coronary blood flow, we observed that intracoronary infusion of saline increased coronary flow. This study aims to quantify the extent and unravel the mechanisms of saline-induced hyperemia. METHODS AND RESULTS: Thirty-three patients were studied; in 24 patients, intracoronary Doppler flow velocity measurements were performed at rest, after intracoronary adenosine, and during increasing infusion rates of saline at room temperature through a dedicated catheter with 4 lateral side holes...
April 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28398674/melatonin-protects-cardiac-microvasculature-against-ischemia-reperfusion-injury-via-suppression-of-mitochondrial-fission-vdac1-hk2-mptp-mitophagy-axis
#19
Hao Zhou, Ying Zhang, Shunying Hu, Chen Shi, Pingjun Zhu, Qiang Ma, Qinhua Jin, Feng Cao, Feng Tian, Yundai Chen
The cardiac microvascular system, which is primarily composed of monolayer endothelial cells, is the site of blood supply and nutrient exchange to cardiomyocytes. However, microvascular ischemia/reperfusion injury (IRI) following percutaneous coronary intervention is a woefully neglected topic and few strategies are available to reverse such pathologies. Here, we studied the effects of melatonin on microcirculation IRI and elucidated the underlying mechanism. Melatonin markedly reduced infarcted area, improved cardiac function, restored blood flow and lower microcirculation perfusion defects...
April 11, 2017: Journal of Pineal Research
https://www.readbyqxmd.com/read/28389506/dynamic-computed-tomography-myocardial-perfusion-imaging-comparison-of-clinical-analysis-methods-for-the-detection-of-vessel-specific-ischemia
#20
Alexia Rossi, Andrew Wragg, Ernst Klotz, Federica Pirro, James C Moon, Koen Nieman, Francesca Pugliese
BACKGROUND: The clinical analysis of myocardial dynamic computed tomography myocardial perfusion imaging lacks standardization. The objective of this prospective study was to compare different analysis approaches to diagnose ischemia in patients with stable angina referred for invasive coronary angiography. METHODS AND RESULTS: Patients referred for evaluation of stable angina symptoms underwent adenosine-stress dynamic computed tomography myocardial perfusion imaging with a second-generation dual-source scanner...
April 2017: Circulation. Cardiovascular Imaging
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