PET measurements of myocardial blood flow post myocardial infarction: Relationship to invasive and cardiac magnetic resonance studies and potential clinical applications

Gewirtz, Henry

doi:10.1007/s12350-017-0930-z

Cited by 5 publications

(4 citation statements)

References 78 publications

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“…However, the described methods only assess CFR, which is reflecting just 1 of the 4 endotypes of coronary vascular dysfunction. Although research is being done on non-invasive measures of microvascular resistance, ( 65 ) currently, this endotype cannot be assessed non-invasively in clinical practice. Furthermore, vasospastic disease cannot be evaluated adequately by the contemporary non-invasive techniques such as cold-pressor PET.…”

Section: Demonstration Of Coronary Vascular Dysfunctionmentioning

confidence: 99%

Outpatient Management of Patients With Angina With No Obstructive Coronary Arteries: How to Come to a Proper Diagnosis and Therapy

Meeder

Hartzema-Meijer

Jansen

et al. 2021

Front. Cardiovasc. Med.

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Two-thirds of women and one-third of men who undergo a clinically indicated coronary angiography for stable angina, have no obstructive coronary artery disease (CAD). Coronary vascular dysfunction is a highly prevalent underlying cause of angina in these so called “Angina with No Obstructive Coronary Arteries (ANOCA)” patients, foremost in middle aged women. Coronary vascular dysfunction encompasses various endotypes, namely epicardial and microvascular coronary spasms, impaired vasodilatation, and increased microvascular resistance. ANOCA patients, especially those with underlying coronary vascular dysfunction, have an adverse cardiovascular prognosis, poor physical functioning, and a reduced quality of life. Since standard ischemia detection tests and coronary angiograms are not designed to diagnose coronary vascular dysfunction, this ischemic heart disease is often overlooked and hence undertreated. But adequate diagnosis is vital, so that treatment can be started to reduce symptoms, reduce healthcare costs and improve quality of life and cardiovascular prognosis. The purpose of this review is to give a contemporary overview of ANOCA with focus on coronary vascular dysfunction. We will provide a possible work-up of patients suspected of coronary vascular dysfunction in the outpatient clinical setting, based on the latest scientific insights and international consensus documents. We will discuss the value of ischemia detection testing, and non-invasive and invasive methods to diagnose coronary vascular dysfunction. Furthermore, we will go into pharmacological and non-pharmacological therapeutic options including anti-anginal regimens and lifestyle interventions.

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Section: Demonstration Of Coronary Vascular Dysfunctionmentioning

confidence: 99%

Outpatient Management of Patients With Angina With No Obstructive Coronary Arteries: How to Come to a Proper Diagnosis and Therapy

Meeder

Hartzema-Meijer

Jansen

et al. 2021

Front. Cardiovasc. Med.

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“…The MFR is therefore affected by micro-vascular function even in the absence of underlying obstructive epicardial CAD [25]. Measurements of MBF were acquired to identify patients at increased risk of cardiac death or myocardial infarction who might benefit most from coronary revascularization [26]. Our present results demonstrate a significant but clinically modest relationship between the degree of coronary stenosis severity and the per-vessel MFR.…”

Section: Cviamentioning

confidence: 64%

Reduced Myocardial Flow Reserve Is Associated with Subendocardial Infarction and Coronary Stenosis in Patients with Coronary Artery Disease: A Perfusion MRI Study

Manabe

Oyama‐Manabe

Naya

et al. 2019

Cardiovasc Imaging Asia

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Objective: Although the relationship between coronary stenosis and myocardial perfusion is well established, little is known regarding the contribution of subendocardial infarction to this relationship. The purpose of this study was to evaluate the effects of obstructive coronary stenosis and subendocardial infarction on myocardial flow reserve (MFR). Materials and Methods: Fifty-four patients with suspected and known coronary artery disease (CAD) who underwent perfusion 3T-MRI and invasive angiography were studied. The time-intensity curves of the left ventricle tissue and cavity were fitted by a single-compartment model to compute myocardial blood flow (MBF). Global MFR and regional MFR were calculated by dividing stress MBF by rest MBF. Myocardial infarction lesions were assessed by late gadolinium enhancement. The effects of obstructive coronary stenosis and subendocardial infarction on the regional MFR were evaluated. Results: Obstructed vessels (≥70% diameter stenosis for main vessels or ≥50% for left main) were observed in 65 out of 162 vessels. Further analysis demonstrated that MFR in obstructed vessels was significantly lower than that in non-obstructed vessels {1.48 [the interquartile range (IQR) : 1.31-2.03] vs. 1.84 (IQR: 1.44-2.46), p=0.01}. After excluding vessels with transmural infarction (n=19), the MFR for vessels with subendocardial infarction (n=20) was significantly lower than the MFR for non-infarction vessels (n=123) [1.48 (IQR: 1.40-1.79) vs. 1.88 (IQR: 1.41-2.48), p=0.02]. Conclusion: Subendocardial infarction in addition to obstructive coronary atherosclerosis might be associated with an impairment of regional MFR in patients with CAD.

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“…Another example of an intra-coronary imaging study includes near infrared spectroscopy (NIRS). [140] Other functional intra-coronary measures that can be obtained during cardiac catheterization intra-coronary include instantaneous wave-free ratio (iFR), [141] index of microvascular resistance (IMR), [142] and minimal luminal area (MLA). [143] …”

Section: Imaging Studiesmentioning

confidence: 99%

Ten things to know about ten imaging studies: A preventive cardiology perspective (“ASPC top ten imaging”)

Bays

Khera

Blaha³

et al. 2021

American Journal of Preventive Cardiology

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Knowing the patient's current cardiovascular disease (CVD) status, as well as the patient's current and future CVD risk, helps the clinician make more informed patient-centered management recommendations towards the goal of preventing future CVD events. Imaging tests that can assist the clinician with the diagnosis and prognosis of CVD include imaging studies of the heart and vascular system, as well as imaging studies of other body organs applicable to CVD risk. The American Society for Preventive Cardiology (ASPC) has published “Ten Things to Know About Ten Cardiovascular Disease Risk Factors.” Similarly, this “ASPC Top Ten Imaging” summarizes ten things to know about ten imaging studies related to assessing CVD and CVD risk, listed in tabular form. The ten imaging studies herein include: (1) coronary artery calcium imaging (CAC), (2) coronary computed tomography angiography (CCTA), (3) cardiac ultrasound (echocardiography), (4) nuclear myocardial perfusion imaging (MPI), (5) cardiac magnetic resonance (CMR), (6) cardiac catheterization [with or without intravascular ultrasound (IVUS) or coronary optical coherence tomography (OCT)], (7) dual x-ray absorptiometry (DXA) body composition, (8) hepatic imaging [ultrasound of liver, vibration-controlled transient elastography (VCTE), CT, MRI proton density fat fraction (PDFF), magnetic resonance spectroscopy (MRS)], (9) peripheral artery / endothelial function imaging (e.g., carotid ultrasound, peripheral doppler imaging, ultrasound flow-mediated dilation, other tests of endothelial function and peripheral vascular imaging) and (10) images of other body organs applicable to preventive cardiology (brain, kidney, ovary). Many cardiologists perform cardiovascular-related imaging. Many non-cardiologists perform applicable non-cardiovascular imaging. Cardiologists and non-cardiologists alike may benefit from a working knowledge of imaging studies applicable to the diagnosis and prognosis of CVD and CVD risk – both important in preventive cardiology.

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PET measurements of myocardial blood flow post myocardial infarction: Relationship to invasive and cardiac magnetic resonance studies and potential clinical applications

Cited by 5 publications

References 78 publications

Outpatient Management of Patients With Angina With No Obstructive Coronary Arteries: How to Come to a Proper Diagnosis and Therapy

Outpatient Management of Patients With Angina With No Obstructive Coronary Arteries: How to Come to a Proper Diagnosis and Therapy

Reduced Myocardial Flow Reserve Is Associated with Subendocardial Infarction and Coronary Stenosis in Patients with Coronary Artery Disease: A Perfusion MRI Study

Ten things to know about ten imaging studies: A preventive cardiology perspective (“ASPC top ten imaging”)

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