Coronary flow reserve assessed by myocardial contrast echocardiography predicts mortality in patients with heart failure

Anantharam, Brijesh; Janardhanan, Raj; Hayat, Sajad; Hickman, Michael; Chahal, Navtej; Bassett, Paul; Senior, Roxy

doi:10.1093/ejechocard/jeq109

Cited by 31 publications

(28 citation statements)

References 27 publications

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“…Subsequently, microvascular function can be estimated by measuring coronary flow reserve (CFR), the ratio of coronary blood flow after the vasodilating stimulus over blood flow at rest. In HFrEF patients, CFR correlates with VO 2 peak, invasive and echocardiographic hemodynamics, and mortality [75–77]. 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].…”

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

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et al. 2017

Oxidative Medicine and Cellular Longevity

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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.

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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

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“…CFR in the remote region measured using MCE with dobutamine stress is an effective parameter for predicting LVR in patients with AMI 13,14. Following successful PCI, the average CFR was 2.05 in the remote myocardium, lower than that in the normal subjects, although the remote myocardium was not supplied directly by the infarct-related coronary artery.…”

Section: Discussionmentioning

confidence: 99%

Coronary Flow Reserve in the Remote Myocardium Predicts Left Ventricular Remodeling Following Acute Myocardial Infarction

et al. 2014

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PurposeCoronary flow reserve (CFR) in the non-infarcted myocardium is often impaired following acute myocardial infarction (AMI). However, the clinical significance of CFR in the non-infarcted myocardium is not fully understood. The objective of the present study was to assess whether a relationship exists between CFR and left ventricular remodeling following AMI.Materials and MethodsWe enrolled 18 consecutive patients undergoing coronary intervention. Heart function was analyzed using real-time myocardial contrast echocardiography at one week and six months after coronary angioplasty. Ten subjects were enrolled as the control group and were examined using the same method at the same time to assess CFR. Cardiac troponin I (cTnI) levels were routinely analyzed to estimate peak concentration.ResultsCFR was 1.55±0.11 in the infarcted zone and 2.05±0.31 in the remote zone (p<0.01) at one week following AMI. According to CFR values in the remote zone, all patients were divided into two groups: Group I (CFR <2.05) and Group II (CFR >2.05). The levels of cTnI were higher in Group I compared to Group II on admission (36.40 vs. 21.38, p<0.05). Furthermore, left ventricular end diastolic volume was higher in Group I compared to Group II at six months following coronary angioplasty.ConclusionMicrovascular dysfunction is commonly observed in the remote myocardium. The CFR value accurately predicts adverse ventricular remodeling following AMI.

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“…33 Additionally, CFR derived from quantitative MCE has shown promise in the prediction of heart failure (HF) outcomes (Fig 7). 34 …”

Section: Infarct Size and Viabilitymentioning

confidence: 99%

Myocardial Perfusion Imaging Using Contrast Echocardiography

Pathan

Marwick

2015

Progress in Cardiovascular Diseases

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Coronary flow reserve assessed by myocardial contrast echocardiography predicts mortality in patients with heart failure

Abstract: CFR determined by MCE is a powerful predictor of mortality in patients with heart failure.

Cited by 31 publications

References 27 publications

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

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

Coronary Flow Reserve in the Remote Myocardium Predicts Left Ventricular Remodeling Following Acute Myocardial Infarction

Myocardial Perfusion Imaging Using Contrast Echocardiography

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