Impact of Individual and Cumulative Coronary Risk Factors on Coronary Flow Reserve Assessed by Dobutamine Stress Echocardiography

Ahmari, Saeed Al; Bunch, T. Jared; Modesto, Karen; Stussy, Vicky L.; Dichak, Amy; Seward, James B.; Pellikka, Patricia A.; Chandrasekaran, Krishnaswamy

doi:10.1016/j.amjcard.2008.02.055

Cited by 24 publications

(12 citation statements)

References 22 publications

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“…It is worthy of note that in the present study total blood cholesterol, diastolic BP and LV mass index were independently associated to the reduction of hyperemic coronary velocity, true expression of impaired coronary microcirculation when epicardial coronary arteries are normal. Our results are also consistent with findings of Ahmari et al [32] who have demonstrated on 59 patients that traditional risk factors are related to a lower CFR in the face of a negative dobutamine stress echocardiography for wall motion criteria.. In the present study we evaluated intermediate risk patients with chest pain and/or positive test of inducible ischemia but totally normal coronary arteries at coronary angiography.…”

Section: Discussionsupporting

confidence: 92%

The impact of aging and atherosclerotic risk factors on transthoracic coronary flow reserve in subjects with normal coronary angiography

Galderisi

Rigo

Gherardi

et al. 2012

Cardiovasc Ultrasound

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Age may affect coronary flow reserve (CFR) especially in subjects with atherosclerotic risk factors (ARFs). The aim of this prospective, multicenter, observational study was to determine the effects of aging on CFR in patients with normal epicardial coronary arteries and ARFs. Three-hundred-thirty-five subjects (mean age = 61 years) with at least one ARF but normal coronary angiography underwent high-dose dipyridamole stress-echo with Doppler evaluation of left anterior descending artery. CFR was calculated as the ratio between hyperemic and resting coronary diastolic peak velocities. Patients were divided in age quartiles. CFR was progressively reduced with aging (1st quartile: 3.01 ± 0.69, 4th quartile: 2.39 ± 0.49, p < 0.001). This was mainly due to a gradual increase of resting velocities (1st quartile = 26.3 ± 6.1 cm/s, 4th quartile = 30.2 ± 6.4 cm/s, p < 0.001) while the reduction of hyperemic velocities remained unaffected (1st quartile = 77.7 ± 18.9 cm/s, 4th quartile = 70.9 ± 18.4 cm/s, NS). When age quartiles and ARFs were entered into a regression model, third and fourth age quartile (p < 0.0005 and p < 0.0001 respectively), left ventricular mass index (p < 0.0001), diastolic blood pressure (p < 0.001), total cholesterol (p < 0.002), fasting blood glucose (p < 0.01) and male gender (p < 0.05) were independent determinants of CFR in the whole population. Aging reduces coronary flow reserve in patients with angiographically normal coronary arteries due to a gradual increase of resting coronary flow velocity. CFR is also affected by atherosclerotic risk factors and left ventricular hypertrophy.

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Section: Discussionsupporting

confidence: 92%

The impact of aging and atherosclerotic risk factors on transthoracic coronary flow reserve in subjects with normal coronary angiography

Galderisi

Rigo

Gherardi

et al. 2012

Cardiovasc Ultrasound

View full text Add to dashboard Cite

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“…Furthermore, improved primary prevention risk factor control (reduced smoking, increased aspirin and statin use) has likely contributed to altered atherosclerosis burden with relatively less large‐vessel plaque rupture, potentially leading to less adverse arterial remodeling/obstructive CAD,17 while increasing rates of obesity18 and diabetes mellitus19 may contribute to increasing prevalence of CMD or pathology 20, 21…”

Section: Inoca—prevalencementioning

confidence: 99%

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

Herscovici

Sedlak

Wei

et al. 2018

JAHA

134

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“…63 Diabetics have reduced CFR. 64, 65 It is not surprising that hyperglycemia adversely affects the coronary microvasculature given the effect of diabetes on other microcirculations (i.e., retina, kidney and neuron). CMD in diabetic patients may be early progression of epicardial coronary disease.…”

Section: Risk Factorsmentioning

confidence: 99%

Coronary Microvascular Dysfunction　― Epidemiology, Pathogenesis, Prognosis, Diagnosis, Risk Factors and Therapy ―

Chen

Wei

AlBadri

et al. 2017

Circ J

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Angina has traditionally been thought to be caused by obstructive coronary artery disease (CAD). However, a substantial number of patients with angina are found to not have obstructive CAD when undergoing coronary angiography. A significant proportion of these patients have coronary microvascular dysfunction (CMD), characterized by heightened sensitivity to vasoconstrictor stimuli and limited microvascular vasodilator capacity. With the advent of non-invasive and invasive techniques, the coronary microvasculature has been more extensively studied in the past 2 decades. CMD has been identified as a cause of cardiac ischemia, in addition to traditional atherosclerotic disease and vasospastic disease. CMD can occur alone or in the presence obstructive CAD. CMD shares many similar risk factors with macrovascular CAD. Diagnosis is achieved through detection of an attenuated response of coronary blood flow in response to vasodilatory agents. Imaging modalities such as cardiovascular magnetic resonance, positron emission tomography, and transthoracic Doppler echocardiography have become more widely used, but have not yet completely replaced the traditional intracoronary vasoreactivity testing. Treatment of CMD starts with lifestyle modification and risk factor control. The use of traditional antianginal, antiatherosclerotic medications and some novel agents may be beneficial; however, clinical trials are needed to assess the efficacy of the pharmacologic and non-pharmacologic therapeutic modalities. In addition, studies with longer-term follow-up are needed to determine the prognostic benefits of these agents. We review the epidemiology, prognosis, pathogenesis, diagnosis, risk factors and current therapies for CMD.

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Impact of Individual and Cumulative Coronary Risk Factors on Coronary Flow Reserve Assessed by Dobutamine Stress Echocardiography

Cited by 24 publications

References 22 publications

The impact of aging and atherosclerotic risk factors on transthoracic coronary flow reserve in subjects with normal coronary angiography

The impact of aging and atherosclerotic risk factors on transthoracic coronary flow reserve in subjects with normal coronary angiography

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

Coronary Microvascular Dysfunction　― Epidemiology, Pathogenesis, Prognosis, Diagnosis, Risk Factors and Therapy ―

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Impact of Individual and Cumulative Coronary Risk Factors on Coronary Flow Reserve Assessed by Dobutamine Stress Echocardiography

Cited by 24 publications

References 22 publications

The impact of aging and atherosclerotic risk factors on transthoracic coronary flow reserve in subjects with normal coronary angiography

The impact of aging and atherosclerotic risk factors on transthoracic coronary flow reserve in subjects with normal coronary angiography

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

Coronary Microvascular Dysfunction ― Epidemiology, Pathogenesis, Prognosis, Diagnosis, Risk Factors and Therapy ―

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Product

Resources

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Coronary Microvascular Dysfunction　― Epidemiology, Pathogenesis, Prognosis, Diagnosis, Risk Factors and Therapy ―