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coronary microvascular resistance

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https://www.readbyqxmd.com/read/28700893/coronary-microvascular-disease-as-an-early-culprit-in-the-pathophysiology-of-diabetes-and-metabolic-syndrome
#1
REVIEW
Hicham Labazi, Aaron J Trask
Metabolic syndrome (MetS) is a group of cardio-metabolic risk factors that includes obesity, insulin resistance, hypertension, and dyslipidemia; these are also a combination of independent coronary artery disease (CAD) risk factors. Alarmingly, the prevalence of MetS risk factors are increasing and a leading cause for mortality. In the vasculature, complications from MetS and type 2 diabetes (T2D) can be divided into microvascular (retinopathy and nephropathy) and macrovascular (cardiovascular diseases and erectile dysfunction)...
July 9, 2017: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/28663361/hyperaemic-microvascular-resistance-predicts-clinical-outcome-and-microvascular-injury-after-myocardial-infarction
#2
Guus A de Waard, Gregor Fahrni, Douwe de Wit, Hironori Kitabata, Rupert Williams, Niket Patel, Paul F Teunissen, Peter M van de Ven, Sabahattin Umman, Paul Knaapen, Divaka Perera, Takashi Akasaka, Murat Sezer, Rajesh K Kharbanda, Niels van Royen
OBJECTIVES: Early detection of microvascular dysfunction after acute myocardial infarction (AMI) could identify patients at high risk of adverse clinical outcome, who may benefit from adjunctive treatment. Our objective was to compare invasively measured coronary flow reserve (CFR) and hyperaemic microvascular resistance (HMR) for their predictive power of long-term clinical outcome and cardiac magnetic resonance (CMR)-defined microvascular injury (MVI). METHODS: Simultaneous intracoronary Doppler flow velocity and pressure measurements acquired immediately after revascularisation for AMI from five centres were pooled...
June 29, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28653312/link-of-renal-microcirculatory-dysfunction-to-increased-coronary-microcirculatory-resistance-in-hypertensive-patients
#3
Cong Lin, Pu Zhang, Yangjing Xue, Yinqing Huang, Kangting Ji
BACKGROUND: This study investigated the correlation between renal microcirculation and coronary microcirculation in hypertensive patients. METHODS: Participants consisted of 231 consecutive candidates who were referred to the Second Affiliated Hospital of Wenzhou Medical University from March 2014 to May 2016 for elective coronary angiography due to suspected myocardial ischemia. All participants were evaluated for the index of microvascular resistance (IMR), coronary flow reserve (CFR), and fractional flow reserve (FFR) using a pressure wire...
June 27, 2017: Cardiology Journal
https://www.readbyqxmd.com/read/28649956/the-ati-score-age-thrombotic-burden-index-of-microcirculatory-resistance-determined-during-primary-percutaneous-coronary-intervention-predicts-final-infarct-size-in-patients-with-st-elevation-myocardial-infarction-a-cardiac-magnetic-resonance-validation-study
#4
Giovanni Luigi De Maria, Mohammad Alkhalil, Mathias Wolfrum, Gregor Fahrni, Alessandra Borlotti, Lisa Gaughran, Sam Dawkins, Jeremy Langrish, Andrew Lucking, Robin Choudhury, Italo Porto, Filippo Crea, Erica Dall'Armellina, Keith Channon, Rajesh Kharbanda, Adrian Banning
AIMS: The age-thrombus score-index of microcirculatory resistance (ATI) score is a diagnostic tool able to predict suboptimal myocardial reperfusion before stenting, in patients with ST elevation myocardial infarction (STEMI). We aimed to validate the ATI score against cardiac magnetic resonance imaging (cMRI). METHODS AND RESULTS: The ATI score was calculated prospectively in 80 STEMI patients. cMRI was performed within 48 hours in all patients and in 50 patients at six months follow up to assess the extent of infarct size (IS%) and microvascular obstruction (MVO%)...
June 27, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28600102/physiologic-mechanism-of-discordance-between-instantaneous-wave-free-ratio-and-fractional-flow-reserve-insight-from-13-n-ammonium-positron-emission-tomography
#5
Joo Myung Lee, Doyeon Hwang, Jonghanne Park, Yaliang Tong, Bon-Kwon Koo
BACKGROUND: Invasive physiologic indices, such as fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR), are used in clinical practice. We sought to evaluate the physiological mechanism of discordance between iFR and FFR using (13)N-ammonia positron emission tomography (PET)-derived quantitative parameters. METHODS: Data from 113 patients, who underwent both (13)N-ammonia PET and invasive FFR and iFR measurement, were analyzed. Coronary circulatory indices, such as myocardial blood flow (MBF), coronary flow reserve (CFR), microvascular resistance, and trans-stenosis resistance were compared between patients with discordant results (low FFR despite high iFR) and those with concordant abnormal results (low FFR and low iFR), using cut-off values of FFR≤0...
September 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28595700/angiotensin-converting-enzyme-inhibition-early-after-heart-transplantation
#6
RANDOMIZED CONTROLLED TRIAL
William F Fearon, Kozo Okada, Jon A Kobashigawa, Yuhei Kobayashi, Helen Luikart, Sean Sana, Tiffany Daun, Steven A Chmura, Seema Sinha, Garett Cohen, Yasuhiro Honda, Michael Pham, David B Lewis, Daniel Bernstein, Alan C Yeung, Hannah A Valantine, Kiran Khush
BACKGROUND: Cardiac allograft vasculopathy (CAV) remains a leading cause of mortality after heart transplantation (HT). Angiotensin-converting enzyme inhibitors (ACEIs) may retard the development of CAV but have not been well studied after HT. OBJECTIVES: This study tested the safety and efficacy of the ACEI ramipril on the development of CAV early after HT. METHODS: In this prospective, multicenter, randomized, double-blind, placebo-controlled trial, 96 HT recipients were randomized to undergo ramipril or placebo therapy...
June 13, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28577226/pet-measurements-of-myocardial-blood-flow-post-myocardial-infarction-relationship-to-invasive-and-cardiac-magnetic-resonance-studies-and-potential-clinical-applications
#7
Henry Gewirtz
This review focuses on clinical studies concerning assessment of coronary microvascular and conduit vessel function primarily in the context of acute and sub acute myocardial infarction (MI). The ability of quantitative PET measurements of myocardial blood flow (MBF) to delineate underlying pathophysiology and assist in clinical decision making in this setting is discussed. Likewise, considered are physiological metrics fractional flow reserve, coronary flow reserve, index of microvascular resistance (FFR, CFR, IMR) obtained from invasive studies performed in the cardiac catheterization laboratory, typically at the time of PCI for MI...
June 2, 2017: Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology
https://www.readbyqxmd.com/read/28576663/impact-of-ranolazine-on-coronary-microvascular-dysfunction-micro-study
#8
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))...
April 22, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28566295/significance-of-microvascular-function-in-visual-functional-mismatch-between-invasive-coronary-angiography-and-fractional-flow-reserve
#9
Taishi Yonetsu, Tadashi Murai, Yoshihisa Kanaji, Tetsumin Lee, Junji Matsuda, Eisuke Usui, Masahiro Hoshino, Makoto Araki, Takayuki Niida, Masahiro Hada, Sadamitsu Ichijo, Rikuta Hamaya, Yoshinori Kanno, Tsunekazu Kakuta
BACKGROUND: Despite a moderate correlation between angiographical stenosis and physiological significance, the mechanism of discordance has not been fully elucidated, particularly regarding the significance of microvascular function. This study sought to clarify whether microvascular function affects visual-functional mismatch between quantitative coronary angiography (QCA) and fractional flow reserve (FFR). METHODS AND RESULTS: We assessed QCA, FFR, coronary flow reserve, and the index of microcirculatory resistance in 849 non-left-main coronary lesions with visually estimated intermediate stenoses from 532 patients...
May 31, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28550173/experimental-cardiac-radiation-exposure-induces-ventricular-diastolic-dysfunction-with-preserved-ejection-fraction
#10
Hirofumi Saiki, Gilles Moulay, Adam J Guenzel, Weibin Liu, Teresa Decklever, Kelly Classic, Linh Pham, Horng H Chen, John C Burnett, Stephen J Russell, Margaret M Redfield
BACKGROUND: Breast cancer radiotherapy increases the risk of heart failure (HF) with preserved ejection fraction (HFpEF). Cardiomyocytes are highly radio-resistant but radiation specifically affects coronary microvascular endothelial cells with subsequent microvascular inflammation and rarefaction. The effects of radiation on left ventricular (LV) diastolic function are poorly characterized. We hypothesized that cardiac radiation exposure may result in diastolic dysfunction without reduced EF...
May 26, 2017: American Journal of Physiology. Heart and Circulatory Physiology
https://www.readbyqxmd.com/read/28526024/protective-effect-on-the-coronary-microcirculation-of-patients-with-diabetes-by-clopidogrel-or-ticagrelor-predict-study-rationale-and-design-a-randomized-multicenter-clinical-trial-using-intracoronary-multimodal-physiology
#11
Enrico Cerrato, Alicia Quirós, Mauro Echavarría-Pinto, Hernan Mejia-Renteria, Andres Aldazabal, Nicola Ryan, Nieves Gonzalo, Pilar Jimenez-Quevedo, Luis Nombela-Franco, Pablo Salinas, Iván J Núñez-Gil, José Ramón Rumoroso, Antonio Fernández-Ortiz, Carlos Macaya, Javier Escaned
BACKGROUND: In diabetic patients a predisposed coronary microcirculation along with a higher risk of distal particulate embolization during primary percutaneous intervention (PCI) increases the risk of peri-procedural microcirculatory damage. However, new antiplatelet agents, in particular Ticagrelor, may protect the microcirculation through its adenosine-mediated vasodilatory effects. METHODS: PREDICT is an original, prospective, randomized, multicenter controlled study designed to investigate the protective effect of Ticagrelor on the microcirculation during PCI in patient with diabetes mellitus type 2 or pre-diabetic status...
May 19, 2017: Cardiovascular Diabetology
https://www.readbyqxmd.com/read/28521932/discordance-between-fractional-flow-reserve-and-coronary-flow-reserve-insights-from-intracoronary-imaging-and-physiological%C3%A2-assessment
#12
Sung Gyun Ahn, Jon Suh, Olivia Y Hung, Hee Su Lee, Yasir H Bouchi, Wenjie Zeng, Rounak Gandhi, Parham Eshtehardi, Bill D Gogas, Habib Samady
OBJECTIVES: The aim of this study was to investigate the epicardial and microvascular substrates associated with discordances between fractional flow reserve (FFR) and coronary flow reserve (CFR) values. BACKGROUND: Discordances between FFR and CFR remain poorly characterized. METHODS: FFR, hyperemic stenosis resistance (HSR), and intravascular ultrasound were performed as indexes of epicardial function and CFR and hyperemic microvascular resistance (HMR) as measures of microvascular function in 94 patients with moderate coronary stenosis...
May 22, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28514327/postoperative-assessment-of-myocardial-function-and-microcirculation-in-patients-with-acute-coronary-syndrome-by-myocardial-contrast-echocardiography
#13
Li Jiang, Hong Yao, Zhao-Guang Liang
BACKGROUND Postoperative myocardial function and microcirculation of acute coronary syndrome (ACS) was assessed by myocardial contrast echocardiography (MCE). MATERIAL AND METHODS Eighty-nine ACS patients treated with percutaneous coronary intervention (PCI) were detected by MCE and two-dimensional ultrasonography before and a month later after PCI respectively. Their myocardial perfusion was evaluated by myocardial contrast score (MSC) and contrast score index (CSI); cross-sectional area of microvessel (A), average myocardial microvascular impairment (β), and myocardial blood flow (MBF) were analyzed by cardiac ultrasound quantitative analysis (CUSQ), and fractional flow reserve (FFR) change was observed...
May 17, 2017: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/28506937/bivalirudin-infusion-to-reduce-ventricular-infarction-the-open-label-randomised-bivalirudin-infusion-for-ventricular-infarction-limitation-bival-study
#14
Robert Jan van Geuns, Georgios Sideris, Niels Van Royen, Rami El Mahmoud, Roberto Diletti, Claire Bal Dit Sollier, Jerome Garot, Nina W Van Der Hoeven, Bernardo Cortese, Li Ding, Ilknur Lechthaler, Efthymios N Deliargyris, Prodromos Anthopoulos, Ludovic Drouet
AIMS: The aim of the study was to investigate whether bivalirudin versus unfractionated heparin (UFH) reduces infarct size (IS) for primary percutaneous coronary intervention (PPCI) in large acute myocardial infarction (AMI). METHODS AND RESULTS: This multicentre open-label trial randomised 78 patients undergoing PPCI for large AMI to bivalirudin or UFH. The primary endpoint was IS, assessed by cardiac magnetic resonance (CMR) five days after PPCI. Secondary endpoints included index of microcirculatory resistance (IMR), CMR-assessed microvascular obstruction (MVO) and ejection fraction, and biomarkers for thrombin activity and cell injury...
August 4, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28501910/targeting-the-dominant-mechanism-of-coronary-microvascular-dysfunction-with-intracoronary-physiology-tests
#15
REVIEW
Hernán Mejía-Rentería, Nina van der Hoeven, Tim P van de Hoef, Julius Heemelaar, Nicola Ryan, Amir Lerman, Niels van Royen, Javier Escaned
The coronary microcirculation plays a key role in modulating blood supply to the myocardium. Several factors like myocardial oxygen demands, endothelial and neurogenic conditions determine its function. Although there is available evidence supporting microvascular dysfunction as an important cause of myocardial ischaemia, with both prognostic and symptomatic implications, its diagnosis and management in clinical practice is still relegated to a second plane. Both diagnostic and therapeutic approaches are hampered by the broadness of the concept of microvascular dysfunction, which fails addressing the plurality of mechanisms leading to dysfunction...
May 13, 2017: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/28499911/aging-associated-metabolic-disorder-induces-nox2-activation-and-oxidative-damage-of-endothelial-function
#16
Lampson M Fan, Sarah Cahill-Smith, Li Geng, Junjie Du, Gavin Brooks, Jian-Mei Li
Oxidative stress attributable to the activation of a Nox2-containing NADPH oxidase is involved in the development of vascular diseases and in aging. However, the mechanism of Nox2 activation in normal aging remains unclear. In this study, we used age-matched wild-type (WT) and Nox2 knockout (KO) mice at 3-4 months (young); 11-12 months (middle-aged) and 21-22 months (aging) to investigate age-related metabolic disorders, Nox2 activation and endothelial dysfunction. Compared to young mice, middle-aged and aging WT mice had significant hyperglycaemia, hyperinsulinaemia, increased systemic oxidative stress and higher blood pressure...
July 2017: Free Radical Biology & Medicine
https://www.readbyqxmd.com/read/28482008/the-microcirculation-a-key-player-in-obesity-associated-cardiovascular-disease
#17
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/28470563/effects-of-qishen-yiqi-dripping-pills-in-reducing-myocardial-injury-and-preserving-microvascular-function-in-patients-undergoing-elective-percutaneous-coronary-intervention-a-pilot-randomized-study
#18
Gui-Xin He, Jun Xie, Hao Jiang, Wei Tan, Biao Xu
OBJECTIVES: To evaluate the effect of treatment with Qishen Yiqi Dripping Pills (, QSYQ) on myocardial injury and myocardial microvascular function in patients undergoing elective percutaneous coronary intervention (PCI). METHODS: Eighty patients undergoing elective PCI were randomly assigned to QSYQ and control groups. The QSYQ group received QSYQ at a dosage of 0.5 g 3 times daily (3-7 days before PCI and then daily for 1 month) and regular medication, which comprised of aspirin, clopidogrel, statin, β-blocker, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker in the absence of contradiction...
May 3, 2017: Chinese Journal of Integrative Medicine
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
#19
MULTICENTER STUDY
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/28448601/determinants-of-coronary-flow-reserve-in-non-diabetic-patients-with-chest-pain-without-myocardial-perfusion-defects
#20
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
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