Coronary flow reserve as a link between diastolic and systolic function and exercise capacity in heart failure

Snoer, Martin; Monk-Hansen, Tea; Olsen, Rasmus Huan; Pedersen, Lene Roerholm; Nielsen, Olav Wendelboe; Rasmusen, Hanne Kruuse; Dela, Flemming; Prescott, Eva

doi:10.1093/ehjci/jes269

Cited by 25 publications

(26 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This non-invasive measure of CFR has been validated against invasive measurements [43,44] and PET [45]. CFR is performed at our research unit with a low intra- and inter-observer variability and good repeatability [29,46]. …”

Section: Discussionmentioning

confidence: 99%

“…CFR has been shown to be a predictor of poor prognosis and mortality in patients with known or suspected CAD even when the coronary arteries were normal [27,28]. In CHF patients CFR has been shown to be positively correlated to VO 2 peak [29]. Exercise training has been shown to improve CFR in patients with CAD [30], while weight reduction following a multidisciplinary rehabilitation program resulted in improved CFR in overweight persons with no CAD [25].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Copenhagen study of overweight patients with coronary artery disease undergoing low energy diet or interval training: the randomized CUT-IT trial protocol

Pedersen

Olsen

Frederiksen

et al. 2013

BMC Cardiovasc Disord

View full text Add to dashboard Cite

BackgroundCoronary artery disease (CAD) is accountable for more than 7 million deaths each year according to the World Health Organization (WHO). In a European population 80% of patients diagnosed with CAD are overweight and 31% are obese. Physical inactivity and overweight are major risk factors in CAD, thus central strategies in secondary prevention are increased physical activity and weight loss.Methods/DesignIn a randomized controlled trial 70 participants with stable CAD, age 45–75, body mass index 28–40 kg/m2 and no diabetes are randomized (1:1) to 12 weeks of intensive exercise or weight loss both succeeded by a 40-week follow-up. The exercise protocol consist of supervised aerobic interval training (AIT) at 85-90% of VO2peak 3 times weekly for 12 weeks followed by supervised AIT twice weekly for 40 weeks. In the weight loss arm dieticians instruct the participants in a low energy diet (800–1000 kcal/day) for 12 weeks, followed by 40 weeks of weight maintenance combined with supervised AIT twice weekly. The primary endpoint of the study is change in coronary flow reserve after the first 12 weeks’ intervention. Secondary endpoints include cardiovascular, metabolic, inflammatory and anthropometric measures.DiscussionThe study will compare the short and long-term effects of a protocol consisting of AIT alone or a rapid weight loss followed by AIT. Additionally, it will provide new insight in mechanisms behind the benefits of exercise and weight loss. We wish to contribute to the creation of effective secondary prevention and sustainable rehabilitation strategies in the large population of overweight and obese patients diagnosed with CAD.Trial registrationClinicalTrials.gov: NCT01724567

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Copenhagen study of overweight patients with coronary artery disease undergoing low energy diet or interval training: the randomized CUT-IT trial protocol

Pedersen

Olsen

Frederiksen

et al. 2013

BMC Cardiovasc Disord

View full text Add to dashboard Cite

show abstract

“…Tschöpe et al measured CFR in patients with diastolic dysfunction, showing a reduced vasodilatory response to intracoronary acetylcholine infusion even before onset of HF symptoms [78]. Furthermore, invasively measured CFR is reduced in HFpEF patients and CFR correlates with echocardiographic measures of diastolic function and LV hypertrophy [76, 78, 79]. Interestingly, two studies in HFrEF patients showed no relationship between CFR and peripheral endothelial function [75, 80].…”

Section: Various Vascular Beds Display Endothelial Dysfunction In mentioning

confidence: 99%

Targeting Endothelial Function to Treat Heart Failure with Preserved Ejection Fraction: The Promise of Exercise Training

Gevaert

Lemmens

Vrints

et al. 2017

Oxidative Medicine and Cellular Longevity

View full text Add to dashboard Cite

Although the burden of heart failure with preserved ejection fraction (HFpEF) is increasing, there is no therapy available that improves prognosis. Clinical trials using beta blockers and angiotensin converting enzyme inhibitors, cardiac-targeting drugs that reduce mortality in heart failure with reduced ejection fraction (HFrEF), have had disappointing results in HFpEF patients. A new “whole-systems” approach has been proposed for designing future HFpEF therapies, moving focus from the cardiomyocyte to the endothelium. Indeed, dysfunction of endothelial cells throughout the entire cardiovascular system is suggested as a central mechanism in HFpEF pathophysiology. The objective of this review is to provide an overview of current knowledge regarding endothelial dysfunction in HFpEF. We discuss the molecular and cellular mechanisms leading to endothelial dysfunction and the extent, presence, and prognostic importance of clinical endothelial dysfunction in different vascular beds. We also consider implications towards exercise training, a promising therapy targeting system-wide endothelial dysfunction in HFpEF.

show abstract

“…As a result of these changes in coronary physiology, there is likely remodeling of the coronary arteries. This helps mitigate the effects of low oxygen diffusion and LV diastolic dysfunction that could result in susceptibility to myocardial ischemia 1,2,13 .…”

Section: Introductionmentioning

confidence: 99%

Ultrasound Based Assessment of Coronary Artery Flow and Coronary Flow Reserve Using the Pressure Overload Model in Mice

Chang

Fisch

Chen

et al. 2015

JoVE

View full text Add to dashboard Cite

Transthoracic Doppler echocardiography (TTDE) is a clinically useful, noninvasive tool for studying coronary artery flow velocity and coronary flow reserve (CFR) in humans. Reduced CFR is accompanied by marked intramyocardial and pericoronary fibrosis and is used as an indication of the severity of dysfunction. This study explores, step-by-step, the real-time changes measured in the coronary flow velocity, CFR and systolic to diastolic peak velocity (S/D) ratio in the setting of an aortic banding model in mice. By using a Doppler transthoracic imaging technique that yields reproducible and reliable data, the method assesses changes in flow in the septal coronary artery (SCA), for a period of over two weeks in mice, that previously either underwent aortic banding or thoracotomy.During imaging, hyperemia in all mice was induced by isoflurane, an anesthetic that increased coronary flow velocity when compared with resting flow. All images were acquired by a single imager. Two ratios, (1) CFR, the ratio between hyperemic and baseline flow velocities, and (2) systolic (S) to diastolic (D) flow were determined, using a proprietary software and by two independent observers. Importantly, the observed changes in coronary flow preceded LV dysfunction as evidenced by normal LV mass and fractional shortening (FS).The method was benchmarked against the current gold standard of coronary assessment, histopathology. The latter technique showed clear pathologic changes in the coronary artery in the form of peri-coronary fibrosis that correlated to the flow changes as assessed by echocardiography.The study underscores the value of using a non-invasive technique to monitor coronary circulation in mouse hearts. The method minimizes redundant use of research animals and demonstrates that advanced ultrasound-based indices, such as CFR and S/D ratios, can serve as viable diagnostic tools in a variety of investigational protocols including drug studies and the study of genetically modified strains. Video LinkThe video component of this article can be found at

show abstract

Coronary flow reserve as a link between diastolic and systolic function and exercise capacity in heart failure

Cited by 25 publications

References 28 publications

Copenhagen study of overweight patients with coronary artery disease undergoing low energy diet or interval training: the randomized CUT-IT trial protocol

Copenhagen study of overweight patients with coronary artery disease undergoing low energy diet or interval training: the randomized CUT-IT trial protocol

Targeting Endothelial Function to Treat Heart Failure with Preserved Ejection Fraction: The Promise of Exercise Training

Ultrasound Based Assessment of Coronary Artery Flow and Coronary Flow Reserve Using the Pressure Overload Model in Mice

Contact Info

Product

Resources

About