Coronary Flow Velocity Pattern and Coronary Flow Reserve by Contrast-Enhanced Transthoracic Echocardiography Predict Long-Term Outcome in Heart Transplantation

Tona, Francesco; Caforio, Alida L.P.; Montisci, Roberta; Gambino, Antonio; Angelini, Annalisa; Ruscazio, Massimo; Toscano, Giuseppe; Feltrin, Giuseppe; Ramondo, Angelo; Gerosa, Gino; Iliceto, Sabino

doi:10.1161/circulationaha.105.001321

Cited by 76 publications

(95 citation statements)

References 27 publications

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“…Assessment of microvascular function has been shown to be of predictive value after HTx in some 51,52 but not all studies. 53 Predominant allograft microvascular dysfunction is detectable in Ϸ15% of patients after HTx.…”

Section: Detection Of Coronary Vasomotor Alterationsmentioning

confidence: 99%

Cardiac Allograft Vasculopathy

2008

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Abstract-Cardiac allograft vasculopathy (CAV) continues to limit the long-term success of cardiac transplantation.Recent insights have underscored the fact that innate and adaptive immune responses are involved in the pathogenesis of CAV. Vascular lesions are the result of cumulative endothelial injuries induced both by alloimmune responses and by nonspecific insults (including ischemia-reperfusion injury, viral infections, and metabolic disorders) in the context of impaired repair mechanisms. Intravascular ultrasound is the most sensitive method for detection of CAV, and progressive intimal thickening in the first posttransplant year identifies patients at high risk for future cardiovascular events. Encouraging results with regard to the detection of CAV by noninvasive methods should be an incentive to apply routine noninvasive imaging during mid-to long-term follow-up. Improved immunosuppressive drugs, including mycophenolate mofetil and proliferation signal inhibitors, as well as statins (in part via immunomodulation), have beneficial effects on CAV progression, although there is still a need to confirm the impact of vasodilators in improving outcome after heart transplantation. Coronary revascularization for CAV is only palliative, with no long-term survival benefit. Three main strategies for CAV prevention are currently under investigation: inhibition of growth factors and cytokines, cell therapy, and tolerance induction. However, because individual responses to an allograft change over time, assays to monitor the recipient's immune response and individualized methods for therapeutic immune modulation are clearly needed. (Circulation. 2008;117:2131-2141.)

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Section: Detection Of Coronary Vasomotor Alterationsmentioning

confidence: 99%

Cardiac Allograft Vasculopathy

2008

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“…The independent prognostic value of pulse-wave Doppler-derived CFR during dipyridamole stress echocardiography has been demonstrated in patients with known or suspected coronary artery disease (CAD) 16 dilated cardiomyopathy, 17 and after heart transplantation. 18 However, owing to its semiinvasiveness (probe intubation), stress transoesophageal echocardiography-derived CFR measurement did not become popular among cardiologists. Although dipyridamole stress TTE can assess LV wall motion and CFR, its value is limited because of difficult visualization of the proximal part of the LAD coronary artery.…”

Section: Echocardiographic Evaluation Of Coronary Flow Reservementioning

confidence: 99%

Echocardiographic Evaluation and Clinical Implications of Aortic Stiffness and Coronary Flow Reserve and their Relation

Nemes

Geleijnse

Forster

et al. 2007

Clinical Cardiology

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The normal human aorta is not a stiff tube, but is characterized by elastic properties with a buffering Windkessel function. Aortic stiffening may cause an increase in aortic pulse pressure, left ventricular (LV) load, and ultimately left ventricular hypertrophy. This, together with the decreased diastolic transmyocardial pressure gradient, interacts with coronary flow and flow reserve. In recent studies, significant correlations between coronary flow reserve and aortic stiffness have been demonstrated in different patient populations. The aim of this review is to describe the current echocardiographic modalities to measure aortic stiffness and coronary flow reserve, and to overview knowledge about the relationship between aortic stiffness and coronary flow reserve.

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“…This leads to subendocardial ischemia and left ventricular contractile dysfunction (work capacity), which would probably be exacerbated with the presence of progressive vascular disease. Reductions in coronary flow reserve and the onset of subendocardial ischemia during myocardial stress in the decentralized heart may therefore contribute to progressive cardiovascular dysfunction as observed in cardiac transplant patients (21).…”

Section: Regulation Of the Distribution Of Myocardial Blood Flowmentioning

confidence: 99%

Coronary vasoregulation in health and disease

Kingma

Rouleau

2007

Canadian Journal of Cardiology

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E arly interests of clinical researchers at the Quebec HeartInstitute focused on various aspects of cardiac physiology, biochemistry (ie, metabolism) and pathology. In the late 1970s, the Quebec Heart Institute recruited Dr Jacques Rouleau, a cardiologist whose primary research interests focused on biophysical mechanisms that regulate the distribution of blood flow across the ventricular wall. The later addition to this laboratory of Dr John Kingma, whose research focused on mechanisms involved in myocardial protection following ischemia-reperfusion injury, created a basic scienceclinical research collaboration that continues today.The principal function of the heart is to supply the different organs in the body with blood containing essential nutrients and oxygen required for their proper functioning. In addition, the heart is essential for the transport of metabolic waste products, the accumulation of which would influence organ function. Mechanical work necessary to pump blood is performed by the myocardium. Proper functioning of the myocardium depends on blood flow in the coronary circulation, which comprises large epicardial conductance vessels originating from the coronary ostia. These large vessels branch into smaller vessels that supply the capillary network responsible for the transport of oxygen and nutrients to the myocytes. Comprehension of mechanisms responsible for regulation of the coronary circulation requires the interpretation of information from several disciplines, including cardiology, physiology, biochemistry and physics; this list is far from exclusive because new information regarding interactions of molecular and mechanical signals is consistently being added to the equation. The present review summarizes several achievements resulting from this research collaboration over the past two decades. REGULATION OF THE DISTRIBUTION OF MYOCARDIAL BLOOD FLOWControl of the coronary circulation involves a host of interactions among mechanical factors, such as arterial pressure, blood flow, ventricular contraction and myocardial wall tension. Suffice it to say that coronary blood flow is never constant but rather adaptive in relation to the metabolic and oxygen requirements of the myocardium; approximately 70% of oxygen transported is extracted from blood flowing in arterial vessels. This intrinsic capacity of arterial vessels to adjust in calibre and maintain constant perfusion over a range of arterial pressures is referred to as 'coronary autoregulation' (Figure 1). Principal mechanisms involved in the control of coronary blood flow include metabolic mediator(s) between myocytes and vascular cells, myogenic tone (induced by stretch) and neurogenic stimulation. However, studies on flow control mechanisms in the coronary circulation are limited because function of intramyocardial resistance vessels cannot be investigated with the currently available techniques. Exercise-induced increases in myocardial oxygen demand are accommodated by increases in coronary blood flow, the latter being controlled by ...

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Coronary Flow Velocity Pattern and Coronary Flow Reserve by Contrast-Enhanced Transthoracic Echocardiography Predict Long-Term Outcome in Heart Transplantation

Cited by 76 publications

References 27 publications

Cardiac Allograft Vasculopathy

Cardiac Allograft Vasculopathy

Echocardiographic Evaluation and Clinical Implications of Aortic Stiffness and Coronary Flow Reserve and their Relation

Coronary vasoregulation in health and disease

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