Effects of coronary revascularization on global coronary flow reserve in stable coronary artery disease

Aikawa, Tadao; Naya, Masanao; Obara, Masahiko; Manabe, Osamu; Magota, Keiichi; Koyanagawa, Kazuhiro; Asakawa, Naoya; Ito, Yoichi M.; Shiga, Tohru; Katoh, Chietsugu; Anzai, Toshihisa; Tsutsui, Hiroyuki; Murthy, Venkatesh L.; Tamaki, Nagara

doi:10.1093/cvr/cvy169

Cited by 25 publications

(17 citation statements)

References 27 publications

(33 reference statements)

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“…Additionally, our results indicated that FFR‐guided revascularization decision‐making could not improve g‐CFR and HCSF in approximately 50% and 30% patients, suggesting that considering factors in addition to FFR could optimize the identification of patients in whom coronary flow improvement can be expected with respect to the concordant improvement in HCSF and g‐CFR (Figure 3 and Table 3). These results are in line with the recent study using PET 3 and suggest the potential ability of PC‐CMR‐derived factors to predict coronary flow improvement in addition to FFR. The existence and extent of ischemia have been proposed as an essential factor in stable CAD and a therapeutic target; however, no previous studies have documented a reduced risk of death or MI in relation to absolute coronary flow improvement.…”

Section: Discussionsupporting

confidence: 90%

“…In uncomplicated PCI, post‐PCI hyperemic coronary flow, post‐PCI global coronary flow reserve (g‐CFR), and post‐PCI FFR are expected to improve given less effect from epicardial stenosis, although randomized trials have failed to show a reduced risk of myocardial infarction (MI) and death after PCI in comparison with that after guideline‐directed medical therapy (GDMT) in patients with stable coronary artery disease (CAD). In a previous study, revascularization improved the regional coronary flow reserve (CFR) and stress myocardial blood flow using positron emission tomography (PET) 3 . The degree of improvement was correlated with the degree of reduction of epicardial atherosclerotic burden.…”

Section: Introductionmentioning

confidence: 87%

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Effect of percutaneous coronary intervention on global hemodynamics and the prevalence of residual microvascular dysfunction

et al. 2021

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Objectives We aimed to examine the changes in hyperemic coronary sinus flow (CSF) and global coronary flow reserve (g‐CFR) after percutaneous coronary intervention (PCI) and investigate the predictors to improve these metrics and the prevalence of residual coronary microvascular dysfunction (CMD). Methods This prospective, single‐center study included 118 patients with stable coronary artery disease undergoing PCI for a single proximal lesion. Phase‐contrast cine‐cardiac magnetic resonance (PC‐CMR) was used to assess hyperemic CSF (HCSF) and g‐CFR, before and after PCI. Residual CMD was defined as concordantly impaired post‐PCI HCSF (<2.3 ml/min/g) and g‐CFR (<2.0). Results HCSF significantly increased, although 38 (32.2%) patients showed a decrease. There was no significant change in g‐CFR despite fractional flow reserve (FFR) improvement in all target territories. Concordantly increased HCSF and g‐CFR were effectively discriminated by adding PC‐CMR‐derived information to pre‐PCI FFR. Residual CMD was observed in 30 (25.4%) patients and was associated with pre‐PCI renal dysfunction and lower pre‐PCI rest and hyperemic CSF, but not with pre‐PCI regional physiological indices. Conclusions FFR‐guided PCI was associated with increased HCSF, but not with increased g‐CFR. After uncomplicated PCI, one‐quarter of patients showed residual CMD. Our approach may help identify patients who may benefit from increased coronary perfusion or show residual CMD.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 87%

Effect of percutaneous coronary intervention on global hemodynamics and the prevalence of residual microvascular dysfunction

et al. 2021

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“…The primary outcome of this prospective study was to assess the effects of coronary revascularization on CFR, and the findings were recently published. [6] Blood Chemical Analysis Venous blood samples were obtained at the same time as the PET scans. They were centrifuged at 4°C at 2,500 rpm for 15 min, and their supernatant was stored at −70°C.…”

Section: Study Populationmentioning

confidence: 99%

“…Coronary revascularization can relieve the flow-limiting stenosis, but cannot ameliorate CMD. [6] The optimal medical therapies for CAD, such as exercise [7],…”

Section: Introductionmentioning

confidence: 99%

“…The noninvasive quantitative measurement of myocardial blood flow (MBF) and CFR by oxygen-15 labeled ( 15 O-) water positron emission tomography (PET) and adenosine triphosphate (ATP)-induced hyperemia is useful for the detection of CMD in patients with non-obstructive CAD. [6] We therefore designed the present prospective study to assess the contribution of serum endothelin-1 to CMD in non-obstructive regions in patients with CAD.…”

Section: Introductionmentioning

confidence: 99%

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Elevated serum endothelin-1 is an independent predictor of coronary microvascular dysfunction in non-obstructive territories in patients with coronary artery disease

et al. 2021

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Objective: Endothelin-1 contributes to the constrictor response of the coronary arteries in patients with ischemia with normal coronary arteries. There is thus increasing evidence that endothelin-1 plays a role in coronary microvascular dysfunction (CMD). We investigated whether elevated endothelin-1 is associated with CMD in patients with coronary artery disease (CAD). Methods and Results:We prospectively studied 49 consecutive CAD patients with 1or 2-vessel disease (age 71 ± 10 yrs, 43 males). Myocardial blood flow (MBF) was measured by 15 O-water PET/CT at rest and during stress, and the coronary flow reserve (CFR) was calculated by dividing the stress MBF by the rest MBF. A CFR of less than 2.0 in non-obstructive regions was defined as a marker of CMD. Eighteen out of 49 (37%) CAD patients had CMD. Endothelin-1 in patients with CMD was significantly higher than in those without CMD (2.27 ± 0.81 vs. 1.64 ± 0.48 pg/mL, P = 0.001). Accordingly, univariate ROC analysis showed that the continuous endothelin-1 levels significantly discriminated between the presence and absence of CMD (area under the curve = 0.746 [95%CI 0.592-0.899]). The dichotomous treatment of elevated endothelin-1 as 4 1.961 pg/mL or more yielded the optimal discriminatory capacity, with a sensitivity of 72.2% and a specificity of 71.0%. High endothelin-1 was still a significant predictor of CMD after adjusting for diabetes mellitus (odds ratio = 6. 64 [1.75-25.22], P = 0.005). Conclusion:Endothelin-1 is associated with CMD in non-obstructive territories in patients with CAD, suggesting that endothelin-1 is a potential target for treating CMD in CAD patients.

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Medical 15O production via the 16O(γ,n)15O reaction for blood flow examination

Fujiwara

Kurosawa

Tamura

et al. 2021

J Radioanal Nucl Chem

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Effects of coronary revascularization on global coronary flow reserve in stable coronary artery disease

Abstract: Coronary revascularisation ameliorated reduced CFR in patients with obstructive CAD. The degree of improvement in angiographic CAD burden by revascularisation was correlated with magnitude of improvement in CFR.

Cited by 25 publications

References 27 publications

Effect of percutaneous coronary intervention on global hemodynamics and the prevalence of residual microvascular dysfunction

Effect of percutaneous coronary intervention on global hemodynamics and the prevalence of residual microvascular dysfunction

Elevated serum endothelin-1 is an independent predictor of coronary microvascular dysfunction in non-obstructive territories in patients with coronary artery disease

Medical 15O production via the 16O(γ,n)15O reaction for blood flow examination

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