Curriculum in interventional cardiology: Coronary pressure and flow measurements in the cardiac catheterization laboratory

Kern, Morton J.

doi:10.1002/ccd.1303

Cited by 20 publications

(6 citation statements)

References 90 publications

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“…Coronary artery diameter was measured 5 mm distal to the tip of the Doppler wire. Four CRT measures were assessed: 1) abnormal endothelial function defined as a change in epicardial coronary artery diameter ≤ 0% in response to a maximum dose of acetylcholine (ΔACH) 14 ; 2) abnormal CFR, defined as CFR<2.5 in response to adenosine 15 ; 3) abnormal microvascular endothelial dysfunction, defined as an increase in coronary blood flow (CBF)≤50% in response to acetylcholine (ΔCBF); 4) abnormal non-endothelial function defined as a change in epicardial coronary artery diameter≤20% in response to nitroglycerin (ΔNTG). CBF was determined as π(coronary artery diameter/2)2 × (APV/2).…”

Section: Methodsmentioning

confidence: 99%

Cardiac Magnetic Resonance Myocardial Perfusion Reserve Index Is Reduced in Women With Coronary Microvascular Dysfunction

Thomson

Wei

Agarwal

et al. 2015

Circ: Cardiovascular Imaging

201

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Background Women with signs and symptoms of ischemia and no obstructive coronary artery disease often have coronary microvascular dysfunction (CMD), diagnosed by invasive coronary reactivity testing (CRT). While traditional noninvasive stress imaging is often normal in CMD, cardiac magnetic resonance imaging (CMRI) may be able to detect CMD in this population. Methods and Results Vasodilator stress CMRI was performed in 118 women with suspected CMD who had undergone CRT and 21 asymptomatic reference subjects. Semi quantitative evaluation of the first-pass perfusion images was completed to determine myocardial perfusion reserve index (MPRI). The relationship between CRT findings and MPRI was examined by Pearson correlations, logistic regression and sensitivity/specificity. Symptomatic women had lower mean pharmacologic stress MPRI compared to reference subjects (1.71±0.43 vs. 2.23±0.37, p<0.0001). Lower MPRI was predictive of one or more abnormal CRT variables (OR = 0.78 [0.70, 0.88], p<0.0001, c-statistic 0.78 [0.68, 0.88]). An MPRI threshold of 1.84 predicted CRT abnormality with sensitivity 73% and specificity 74%. Conclusions Noninvasive CMRI MPRI can detect CMD defined by invasive CRT. Further work is aimed to optimize the non-invasive identification and management of CMD patients.

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Section: Methodsmentioning

confidence: 99%

Cardiac Magnetic Resonance Myocardial Perfusion Reserve Index Is Reduced in Women With Coronary Microvascular Dysfunction

Thomson

Wei

Agarwal

et al. 2015

Circ: Cardiovascular Imaging

201

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“…The endothelium-independent coronary flow reserve (CFR) ratio was calculated by dividing the APV after adenosine injection by the baseline APV20. We performed intracoronary adenosine instead of intravenous adenosine to avoid confounding effects associated with intravenous use such as transient lowering of systemic blood pressure and changes in heart rate, both of which can decrease coronary perfusion pressure and alter coronary flow independent of the functional integrity of the coronary microcirculation.…”

Section: Methodsmentioning

confidence: 99%

Lack of Correlation Between Noninvasive Stress Tests and Invasive Coronary Vasomotor Dysfunction in Patients With Nonobstructive Coronary Artery Disease

Cassar¹,

Chareonthaitawee²,

Rihal³

et al. 2009

Circ: Cardiovascular Interventions

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“…In the presence of normal epicardial coronary arteries, a reduced coronary flow reserve (CFR) indicates microvascular dysfunction. CFR is the ratio of the average peak velocity (APV) during maximal hyperemia to the APV at baseline [43]. It can be measured invasively with a Doppler flow wire or noninvasively with transthoracic echocardiography.…”

Section: Microvascular Dysfunctionmentioning

confidence: 99%

Angina Pectoris with a Normal Coronary Angiogram

Yang¹,

Lerman

2005

Herz

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Angina in the setting of a normal angiogram (NOCAD) occurs in 20-30% of patients undergoing coronary angiography. The etiologies of NOCAD can be anatomically classified into three groups: epicardial disease, coronary microvascular dysfunction, and noncoronary disease. Epicardial disease resulting in NOCAD includes endothelial dysfunction, coronary artery spasm, and coronary artery bridging. Microvascular dysfunction may be secondary to hypertension, cardiomyopathy, infiltrative disease, valvular disease, or idiopathic. Noncoronary artery disease states involving other organs systems such as the pulmonary, gastrointestinal, or musculoskeletal systems can also result in NOCAD. This review focuses on the coronary etiologies of NOCAD. The pathophysiology of disease is discussed as well as a systematic diagnostic strategy. Potential therapeutic options and prognosis are also reviewed.

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Curriculum in interventional cardiology: Coronary pressure and flow measurements in the cardiac catheterization laboratory

Cited by 20 publications

References 90 publications

Cardiac Magnetic Resonance Myocardial Perfusion Reserve Index Is Reduced in Women With Coronary Microvascular Dysfunction

Cardiac Magnetic Resonance Myocardial Perfusion Reserve Index Is Reduced in Women With Coronary Microvascular Dysfunction

Lack of Correlation Between Noninvasive Stress Tests and Invasive Coronary Vasomotor Dysfunction in Patients With Nonobstructive Coronary Artery Disease

Angina Pectoris with a Normal Coronary Angiogram

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