Coronary microvascular dysfunction and myocardial contractile reserve in women with angina and no obstructive coronary artery disease

Michelsen, Marie Mide; Mygind, Naja Dam; Bech, Jan; Gustafsson, Ida; Kastrup, Jens; Hansen, Henrik Steen; Høst, Nis; Hansen, Peter Riis; Prescott, Eva

doi:10.1111/echo.13767

Cited by 35 publications

(42 citation statements)

References 43 publications

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“…The potential prognostic role of DIPSEinduced changes has not been previously reported. It has been suggested that DIPSE could serve as a means to assess the systolic and diastolic reserve of myocardial function in these patient groups [40][41][42]. Currently, we showed that DIPSE-induced changes at baseline in selected indices such as GLS, GRS, and LVEF were associated with deterioration of these indices at follow-up.…”

mentioning

confidence: 74%

“…36 DIPSE has been traditionally used to assess myocardial ischemia and CFR 4-6 but it has been suggested that it could be also used as a stress test to assess the systolic and diastolic cardiac function. [40][41][42] Currently, we showed that DIPSE-induced changes at baseline in selected indices such as GLS, GRS, and LVEF were associated with deterioration of these indices at follow-up. To our knowledge, this is the first study to describe in detail the effects of DIPSE on various indices of LV deformation besides GLS.…”

Section: Discussionmentioning

confidence: 98%

“…39 DIPSE has been traditionally used to assess myocardial ischemia and CFR 4-6 but it has been suggested that it could be also used as a stress test to assess the systolic and diastolic cardiac function. [40][41][42] Currently, we demonstrated in RT patients that dipyridamole caused a significant increase in heart rate (ie, 25%-…”

Section: Discussionmentioning

confidence: 99%

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The prognostic role of myocardial strain indices and dipyridamole stress test in renal transplantation patients

et al. 2019

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Introduction: Renal transplantation (RT) increases survival in end-stage kidney disease patients but cardiovascular diseases remain the leading cause of morbidity and mortality. We evaluated the role of myocardial strain (2DSTE) indices and dipyridamole-induced (DIPSE) changes in echocardiographic parameters at baseline for the prediction of clinical events and echocardiographically assessed deterioration of cardiac function in a RT population. Methods: Forty-five RT patients underwent an echocardiographic study at baseline including 2DSTE and DIPSE. If no cardiovascular/renal event occurred, patients were investigated at 3-year follow-up; eight patients presented a clinical event while 37 patients were re-evaluated. Results: Coronary flow reserve (CFR) was abnormal in 24% of the population. DIPSE induced improvements in classic and 2DSTE systolic and diastolic echocardiographic indices including TWIST, UNTWIST, global longitudinal strain (GLS), and circumferential strain (P < .05 for all). Compared to baseline, deteriorations in E/E', LVEF, E', and TWIST were observed at follow-up (P < .05 for all). DIPSE-induced changes in GLS, global radial strain, and LVEF were associated with changes in these indices at follow-up (P < .05 for all). Higher LV mass index, E/E', and lower MAPSE, E', and CFR at baseline were associated with the occurrence of clinical events at follow-up (P < .05 for all). Conclusions: In RT patients, coronary vascular dysfunction (ie, low CFR) was associated with the occurrence of adverse events. DIPSE-induced changes in myocardial strain and classic echocardiographic indices could identify individuals with a subclinical deterioration in cardiac function at follow-up. This may indicate that DIPSE could serve as a means to assess myocardial reserve in this population. K E Y W O R D S coronary flow reserve, dipyridamole, global longitudinal strain, myocardial strain, renal transplantation | 63 LAKKAS et AL.

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confidence: 74%

Section: Discussionmentioning

confidence: 98%

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The prognostic role of myocardial strain indices and dipyridamole stress test in renal transplantation patients

et al. 2019

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“…Previous autopsy studies have found HFpEF patients compared with controls have a propensity for diffuse CAD and sequelae of microvascular endothelial dysfunction including microvascular rarefaction and myocardial fibrosis 24 . Microvascular dysfunction is also an important predictor of both reduced strain reserve post‐exercise in asymptomatic patients as well as in HFpEF 25,26 . Inflammation is now recognized as a key component of atheroma progression and vascular calcification, 27 and up‐regulation of inflammatory pathways and development of endothelial oxidative stress are similarly implicated in the development of HFpEF 28,29 .…”

Section: Discussionmentioning

confidence: 99%

“…Exercise testing may unmask microvascular disease and endothelial dysfunction. GLS reserve post‐exercise may better correlate with overall burden of coronary calcification, and Michelsen et al found GLS reserve was a more sensitive marker of microvascular dysfunction than absolute resting GLS values 25 . Coronary flow reserve by reflecting both epicardial and microvascular function could further illuminate the interaction between subclinical atherosclerosis and myocardial dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Independence of coronary artery disease to subclinical left ventricular dysfunction

et al. 2020

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Objective: Epicardial atherosclerosis and heart failure while distinct clinical entities share common pathophysiological features including endothelial dysfunction and inflammation. Presence of subclinical disease could lead to early diagnosis and intervention in the other. The aim of our study was to assess the association between coronary calcium score (CCS), conventional cardiovascular risk factors, and echocardiographic markers of subclinical left ventricular dysfunction (S-LVD). Methods: One hundred and fifty-nine participants aged 40-70 years with intermediate risk of coronary artery disease (5-year risk of 2%-15%) were identified. Computed tomography (CT) CCS and 2-D transthoracic echocardiography were performed. Main outcomes included presence of subclinical left ventricular dysfunction defined by reduced average global longitudinal strain, left atrial volume enlargement, and elevated E/e'. Results: Fifteen participants had evidence of subclinical LV dysfunction (8 with systolic dysfunction and 7 with diastolic dysfunction) and 85 participants had CCS > 0.CCS > 0 was present in 10 participants with S-LVD compared to 75 participants without S-LVD (67% vs 53%, P = .47). There was no significant difference between in mean GLS (19.2 vs 19.5, P = .14), E/e' (7.2 vs 7.5 P = .33) in those without or with coronary artery calcium. Elevated CCS was also not associated with a higher tertiles of indexed LV mass (OR 1.15, P = .49) or index left atrial volume (OR 1.15, P = .49). Conclusions: In an asymptomatic, low-intermediate-risk group, mechanistic processes that lead to atherosclerosis are not directly associated with subclinical LV dysfunction. K E Y W O R D S coronary artery calcification, diastology, familial coronary artery disease, global longitudinal strain | 679 VENKATARAMAN ET Al.Coronary artery calcification (CAC) provides direct evidence of coronary artery disease (CAD) in the asymptomatic stage. Although there is a strong association between CAC and incident HF, only partly mitigated after adjustment for cardiovascular risk factors, 7,8 it seems likely that this reflects the contribution of overt CAD to HF.Previous studies suggesting a link between CAC and LV dysfunction were in patients with very high burdens of CAC (≥400), 9 greater severity of LV dysfunction measured by ejection fraction, 10,11 or high baseline risk, such as those with suspected CAD or known diabetes. 12,13 The role of CAD in the development of SBHF is unclear in the setting of early disease. Thus, we sought to investigate the relationship between CAC and echocardiographic markers of subclinical LV dysfunction in asymptomatic individuals. | ME THODS | Study designThe Coronary Artery calcium score: Use to Guide Management of HerediTary CAD (CAUGHT-CAD) trial (ACTRN 12614001294640, https://www.anzctr.org.au/) is a randomized controlled trial to assess the utility of coronary calcium score (CCS) to guide risk evaluation and statin therapy in asymptomatic, intermediate-risk patients (5-year risk 2%-15%) of age 40-70 years with a family hi...

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Role of different echocardiographic modalities in the assessment of microvascular function in women with ischemia and no obstructive coronary arteries

Jovanovic¹,

Tešić

Djordjevic‐Dikic

et al. 2022

J of Clinical Ultrasound

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This review summarizes current knowledge about echocardiographic modalities used to assess microvascular function and left ventricular (LV) systolic function in women with ischemia and no obstructive coronary arteries (INOCA). Although the entire pathophysiological background of this clinical entity still remains elusive, it is primarily linked to microvascular dysfunction which can be assessed by coronary flow velocity reserve. Subtle impairments of LV systolic function in women with INOCA are difficult to assess by interpretation of wall motion abnormalities. LV longitudinal function impairment is considered to be an early marker of subclinical systolic dysfunction and can be assessed by global longitudinal strain quantification.

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Coronary microvascular dysfunction and myocardial contractile reserve in women with angina and no obstructive coronary artery disease

Abstract: The GLS reserve was significantly lower in women with CMD. The mechanisms underlying the association between CMD and GLS reserve warrant further study.

Cited by 35 publications

References 43 publications

The prognostic role of myocardial strain indices and dipyridamole stress test in renal transplantation patients

The prognostic role of myocardial strain indices and dipyridamole stress test in renal transplantation patients

Independence of coronary artery disease to subclinical left ventricular dysfunction

Role of different echocardiographic modalities in the assessment of microvascular function in women with ischemia and no obstructive coronary arteries

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