Assessment of right ventricular metabolism: An emerging tool for monitoring pulmonary artery hypertension

Fehér, Attila; Sinusas, Albert J.

doi:10.1007/s12350-016-0695-9

Cited by 4 publications

(5 citation statements)

References 27 publications

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“…In the absence of obstructive epicardial coronary stenoses, MBFR reflects coronary microvascular function, or the ability of the coronary microvasculature to vasodilate appropriately. PET is the current gold standard for non-invasive diagnosis of CMVD, but its availability is limited to selected tertiary care centers (8). Studies have established PET imaging as a reliable tool for detecting coronary microvascular dysfunction, and MBFR < 2 is often used as a measure of CMVD (9)(10)(11)(12), and predicts adverse cardiovascular outcomes in patients (13).…”

Section: Introductionmentioning

confidence: 99%

“…Studies have established PET imaging as a reliable tool for detecting coronary microvascular dysfunction, and MBFR < 2 is often used as a measure of CMVD (9)(10)(11)(12), and predicts adverse cardiovascular outcomes in patients (13). Other imaging modalities to diagnose CMVD are actively being studied and developed, including magnetic resonance imaging, echo doppler, and computed tomography (CT)-based techniques (8,14,15).…”

Section: Introductionmentioning

confidence: 99%

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Multimodality assessment of the coronary microvasculature with TIMI frame count versus perfusion PET highlights coronary changes characteristic of coronary microvascular disease

Wayne,

Wu,

Moore

et al. 2024

Front. Cardiovasc. Med.

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BackgroundThe diagnosis of coronary microvascular disease (CMVD) remains challenging. Perfusion PET-derived myocardial blood flow (MBF) reserve (MBFR) can quantify CMVD but is not widely available. Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) is an angiography-based method that has been proposed as a measure of CMVD. Here, we compare TFC and PET-derived MBF measurements to establish the role of TFC in assessing for CMVD. We use coronary modeling to elucidate the relationship between MBFR and TFC and propose TFC thresholds for identifying CMVD.MethodsIn a cohort of 123 individuals (age 58 ± 12.1, 63% women, 41% Caucasian) without obstructive coronary artery disease who had undergone perfusion PET and coronary angiography for clinical indications, we compared TFC and perfusion PET parameters using Pearson correlation (PCC) and linear regression modeling. We used mathematical modeling of the coronary circulation to understand the relationship between these parameters and performed Receiver Operating Curve (ROC) analysis.ResultsWe found a significant negative correlation between TFC and MBFR. Sex, race and ethnicity, and nitroglycerin administration impact this relationship. Coronary modeling showed an uncoupling between TFC and flow in epicardial vessels. In ROC analysis, TFC performed well in women (AUC 0.84–0.89) and a moderately in men (AUC 0.68–0.78).ConclusionsWe established an inverse relationship between TFC and PET-derived MBFR, which is affected by patient selection and procedural factors. TFC represents a measure of the volume of the epicardial coronary compartment, which is increased in patients with CMVD, and performs well in identifying women with CMVD.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Multimodality assessment of the coronary microvasculature with TIMI frame count versus perfusion PET highlights coronary changes characteristic of coronary microvascular disease

Wayne,

Wu,

Moore

et al. 2024

Front. Cardiovasc. Med.

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“…In the absence of epicardial coronary artery disease, these measures directly reflect coronary microvascular health. PET is the current gold standard for non-invasive diagnosis of CMVD, but its availability is limited to selected tertiary care centers 8 . Other imaging modalities to diagnose CMVD are actively being studied and developed, including magnetic resonance imaging and computed tomography (CT)-based techniques 8, 9 .…”

Section: Introductionmentioning

confidence: 99%

Establishing Thrombolysis in Myocardial Infarction Frame Count as a Clinical Measure of Coronary Microvascular Disease in Women

Wayne

Moore

et al. 2022

Preprint

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BackgroundDespite growing awareness of the crucial role of the coronary vasculature in cardiovascular health and disease, diagnosing coronary microvascular disease (CMVD) remains challenging because it often requires advanced cardiac imaging that are available at only a few centers. For example, perfusion positron emission tomography (PET) allows for the quantification of the myocardial blood flow (MBF) and, thus, the calculation of the MBF reserve (MBFR), which is the ratio of MBF under rest conditions and MBF under hyperemic or stress conditions. In the absence of obstructive coronary artery disease, MBFR is a measure of CMVD. However, the availability of perfusion PET is limited. Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) is an angiography-based measure of coronary flow that has been proposed, but not well established, as a measure of CMVD. We aim to demonstrate a relationship between TFC and MBFR and to establish cut-off measures from clinical coronary angiograms for the diagnosis of CMVD.MethodsWe identified a cohort of 123 patients (age 58 +/− 12.1, 63% female, 41% Caucasian) who had no obstructive coronary artery disease and had undergone perfusion PET stress testing and clinical coronary angiography for clinical indications. We compared TFC for each coronary territory with regional perfusion PET parameters using linear regression modeling. We then used two mathematical models of the coronary circulation to understand the relationship between these parameters. We performed ROC analysis to determine the ability of TFC to diagnose CMVD, defined as global MBFR < 2.ResultsThere is a very tight sex-dependent correlation between TFC and MBFR, but no association between resting coronary flow and TFC and only a weak association between stress coronary flow and TFC. Mathematical modeling of the coronary circulation highlights an uncoupling between TFC and flow in larger vessels where TFC is measured, providing a likely explanation for the surprising empiric result. ROC analysis shows TFC as an excellent measure of CMVD in women (AUC 0.84-0.89) and establishes TFC cutoffs.ConclusionsTFC from clinical coronary angiograms reflects coronary microvascular function in a sex-dependent manner and performs well in identifying women with CMVD.Clinical PerspectiveWhat is new?Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) is highly correlated with myocardial blood flow reserve (MBFR), which reflects coronary vasodilatory potential, in patients without obstructive coronary artery disease.Computational modeling establishes how the relationship between TFC and MBFR can exist.TFC performs much better in women than in men for the diagnosis of coronary microvascular disease (CMVD) and thresholds for the diagnosis of CMVD with TFC are identified.What are the clinical implications?TFC from clinical coronary angiograms can be used to assess CMVD in women.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessment of right ventricular metabolism: An emerging tool for monitoring pulmonary artery hypertension

Cited by 4 publications

References 27 publications

Multimodality assessment of the coronary microvasculature with TIMI frame count versus perfusion PET highlights coronary changes characteristic of coronary microvascular disease

Multimodality assessment of the coronary microvasculature with TIMI frame count versus perfusion PET highlights coronary changes characteristic of coronary microvascular disease

Establishing Thrombolysis in Myocardial Infarction Frame Count as a Clinical Measure of Coronary Microvascular Disease in Women

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