scholarly journals Physiological significance of pericoronary inflammation in epicardial functional stenosis and global coronary flow reserve

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yoshihisa Kanaji ◽  
Tomoyo Sugiyama ◽  
Masahiro Hoshino ◽  
Toru Misawa ◽  
Tatsuhiro Nagamine ◽  
...  
Keyword(s):  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Risk Model ◽  
De Novo ◽  
Stable Coronary Artery Disease ◽  
Left Ventricular ◽  
Physiological Significance ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Ct Attenuation

AbstractBoth fractional flow reserve (FFR) and global coronary flow reserve (g-CFR) provide prognostic information in patients with stable coronary artery disease (CAD). Inflammation plays a vital role in impaired endothelial dysfunction and atherosclerotic progression, potentially predicting cardiovascular mortality. This study aimed to evaluate the physiological significance of pericoronary adipose tissue inflammation assessed by CT attenuation (PCATA) in epicardial functional stenosis severity and g-CFR in patients with CAD. A total of 131 CAD patients with a single de novo epicardial coronary stenosis who underwent coronary CT-angiography (CCTA), phase-contrast cine-magnetic resonance imaging (PC-CMR) and FFR measurement were studied. PCATA was assessed using the mean CT attenuation value. G-CFR was obtained by quantifying absolute coronary sinus flow (ml/min/g) by PC-CMR at rest and during maximum hyperemia. Median FFR, g-CFR, and PCATA values were 0.75, 2.59, and − 71.3, respectively. Serum creatinine, NT-proBNP, left ventricular end-diastolic volume, and PCATA were independently associated with g-CFR. PCATA showed a significant incremental predictive efficacy for impaired g-CFR (< 2.0) when added to the clinical risk model. PCATA was significantly associated with g-CFR, independent of FFR. Our results suggest the pathophysiological mechanisms linking perivascular inflammation with g-CFR in CAD patients.

scholarly journals Discordance Between Fractional Flow Reserve and Coronary Flow Reserve

2017 ◽  
Vol 10 (10) ◽  
pp. 999-1007 ◽  
Author(s):  
Sung Gyun Ahn ◽  
Jon Suh ◽  
Olivia Y. Hung ◽  
Hee Su Lee ◽  
Yasir H. Bouchi ◽  
...  
Keyword(s):  
Coronary Flow Reserve ◽  
Fractional Flow Reserve ◽  
Coronary Flow ◽  
Fractional Flow ◽  
Flow Reserve

Optimal Dosage and Method of Administration of Adenosine for Measuring the Coronary Flow Reserve and the Fractional Flow Reserve in Koreans

2006 ◽  
Vol 36 (4) ◽  
pp. 300 ◽  
Author(s):  
Jung Won Suh ◽  
Bon Kwon Koo ◽  
Sang Ho Jo ◽  
Hyun Jae Kang ◽  
Young Seok Cho ◽  
...  
Keyword(s):  
Coronary Flow Reserve ◽  
Fractional Flow Reserve ◽  
Coronary Flow ◽  
Optimal Dosage ◽  
Fractional Flow ◽  
Flow Reserve

Impairment of coronary flow reserve in aortic stenosis

2009 ◽  
Vol 106 (1) ◽  
pp. 113-121 ◽  
Author(s):  
Damien Garcia ◽  
Paolo G. Camici ◽  
Louis-Gilles Durand ◽  
Kim Rajappan ◽  
Emmanuel Gaillard ◽  
...  
Keyword(s):  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Lumped Parameter Model ◽  
Effective Orifice Area ◽  
Sensitivity Index ◽  
Coronary Perfusion ◽  
Flow Reserve ◽  
Wide Range

Coronary flow reserve (CFR) is markedly reduced in patients with severe aortic valve stenosis (AS), but the exact mechanisms underlying this impairment of CFR in AS remain unclear. Reduced CFR is the key mechanism leading to myocardial ischemia symptoms and adverse outcomes in AS patients. The objective of this study was to develop an explicit mathematical model formulated with a limited number of parameters that describes the effect of AS on left coronary inflow patterns and CFR. We combined the mathematical V3 (ventricular-valvular-vascular) model with a new lumped-parameter model of coronary inflow. One thousand Monte-Carlo computational simulations with AS graded from mild up to very severe were performed within a wide range of physiological conditions. There was a good agreement between the CFR values computed with this new model and those measured in 24 patients with isolated AS ( r = 0.77, P < 10−4). A global sensitivity analysis showed that the valve effective orifice area (EOA) was the major physiological determinant of CFR (total sensitivity index = 0.87). CFR was markedly reduced when AS became severe, i.e., when EOA was <1.0 cm2, and was generally exhausted when the EOA was <0.5–0.6 cm2. The reduction of CFR that is associated with AS can be explained by the concomitance of 1) reduced myocardial supply as a result of decreased coronary perfusion pressure, and 2) increased myocardial metabolic demand as a result of increased left ventricular workload.

scholarly journals Fractional Flow Reserve or Coronary Flow Reserve for the Assessment of Myocardial Perfusion

2018 ◽  
Vol 20 (9) ◽  
Author(s):  
Valérie E. Stegehuis ◽  
Gilbert W. Wijntjens ◽  
Jan J. Piek ◽  
Tim P. van de Hoef
Keyword(s):  
Myocardial Perfusion ◽  
Coronary Flow Reserve ◽  
Fractional Flow Reserve ◽  
Coronary Flow ◽  
Fractional Flow ◽  
Flow Reserve

scholarly journals Effects of coronary revascularization on global coronary flow reserve in stable coronary artery disease

2018 ◽  
Vol 115 (1) ◽  
pp. 119-129 ◽  
Author(s):  
Tadao Aikawa ◽  
Masanao Naya ◽  
Masahiko Obara ◽  
Osamu Manabe ◽  
Keiichi Magota ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Stable Coronary Artery Disease ◽  
Flow Reserve ◽  
Artery Disease ◽  
The Impact

Abstract Aims Coronary flow reserve (CFR) is an integrated measure of the entire coronary vasculature, and is a powerful prognostic marker in coronary artery disease (CAD). The extent to which coronary revascularization can improve CFR is unclear. This study aimed to evaluate the impact of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) on CFR in patients with stable CAD. Methods and results In a prospective, multicentre observational study, CFR was measured by 15O-water positron emission tomography as the ratio of stress to rest myocardial blood flow at baseline and 6 months after optimal medical therapy (OMT) alone, PCI, or CABG. Changes in the SYNTAX and Leaman scores were angiographically evaluated as indicators of completeness of revascularization. Follow-up was completed by 75 (25 OMT alone, 28 PCI, and 22 CABG) out of 82 patients. The median SYNTAX and Leaman scores, and baseline CFR were 14.5 [interquartile range (IQR): 8–24.5], 5.5 (IQR: 2.5–12.5), and 1.94 (IQR: 1.67–2.66), respectively. Baseline CFR was negatively correlated with the SYNTAX (ρ = −0.40, P < 0.001) and Leaman scores (ρ = −0.33, P = 0.004). Overall, only CABG was associated with a significant increase in CFR [1.67 (IQR: 1.14–1.96) vs. 1.98 (IQR: 1.60–2.39), P < 0.001]. Among patients with CFR <2.0 (n = 41), CFR significantly increased in the PCI [1.70 (IQR: 1.42–1.79) vs. 2.21 (IQR: 1.78–2.49), P = 0.002, P < 0.001 for interaction between time and CFR] and CABG groups [1.28 (IQR: 1.13–1.80) vs. 1.86 (IQR: 1.57–2.22), P < 0.001]. The reduction in SYNTAX or Leaman scores after PCI or CABG was independently associated with the percent increase in CFR after adjusting for baseline characteristics (P = 0.012 and P = 0.011, respectively). Conclusion Coronary revascularization ameliorated reduced CFR in patients with obstructive CAD. The degree of improvement in angiographic CAD burden by revascularization was correlated with magnitude of improvement in CFR.

scholarly journals Left ventricular concentric remodelling and functional impairment in women with ischaemia with no obstructive coronary artery disease and intermediate coronary flow reserve: a report from the WISE-CVD study

2019 ◽  
Vol 20 (8) ◽  
pp. 875-882 ◽  
Author(s):  
Seong-Mi Park ◽  
Janet Wei ◽  
Galen Cook-Wiens ◽  
Michael D Nelson ◽  
Louise Thomson ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Obstructive Coronary Artery Disease ◽  
Left Ventricular ◽  
Flow Reserve ◽  
Group 2 ◽  
Artery Disease ◽  
Group 1

Abstract Aims Women with evidence of ischaemia but no obstructive coronary artery disease (INOCA) often have coronary microvascular dysfunction (CMD). Although invasively measured coronary flow reserve (CFR) is useful for the diagnosis of CMD, intermediate CFR values are often found of uncertain significance. We investigated myocardial flow reserve and left ventricular (LV) structural and functional remodelling in women with suspected INOCA and intermediate CFR. Methods and results Women’s Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study participants who had invasively measured intermediate CFR of 2.0≤ CFR ≤3.0 (n = 125) were included for this analysis. LV strain, peak filling rate (PFR) and myocardial perfusion reserve index (MPRI) were obtained by cardiac magnetic resonance imaging. Participants were divided: (i) Group 1 (n = 66) high MPRI ≥ 1.8, and (ii) Group 2 (n = 59) low MPRI < 1.8. The mean age was 54 ± 12 years and CFR was 2.46 ± 0.27. MPRI was significantly different but CFR did not differ between groups. LV relative wall thickness (RWT) trended higher in Group 2 and circumferential peak systolic strain and early diastolic strain rate were lower (P = 0.039 and P = 0.035, respectively), despite a similar LV ejection fraction and LV mass. PFR was higher in Group 1 and LV RWT was negatively related to PFR (r = −0.296, P = 0.001). Conclusions In women with suspected INOCA and intermediate CFR, those with lower MPRI had a trend towards more adverse remodelling and impaired diastolic LV function compared with those with higher MPRI. CFR was similar between the two groups. These findings provide evidence that both coronary microvessel vasomotion and structural and functional myocardial remodelling contribute to CMD.

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