Noninvasive Assessment of Significant Left Anterior Descending Coronary Artery Stenosis by Coronary Flow Velocity Reserve With Transthoracic Color Doppler Echocardiography

Hozumi, Takeshi; Yoshida, Kiyoshi; Ogata, Yumiko; Akasaka, Takashi; Asami, Yoshio; Takagi, Tsutomu; Morioka, Shigefumi

doi:10.1161/01.cir.97.16.1557

Cited by 375 publications

(277 citation statements)

References 39 publications

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“…CFR is the difference between the basal, autoregulated coronary flow and the maximal flow, at any given perfusion pressure,19, 20 but it is calculated as the ratio between hyperemic and resting coronary flow. To date, CFR can be easily assessed by transthoracic Doppler echocardiography by recording Doppler‐derived flow velocities with great feasibility on the mid‐distal left anterior descending artery (LAD) 21. CFR of LAD has shown excellent compliance with invasive Doppler flow wire and optimal reproducibility 22, 23.…”

Section: Introductionmentioning

confidence: 99%

“…CFR of LAD has shown excellent compliance with invasive Doppler flow wire and optimal reproducibility 22, 23. Several conditions can be associated with decreased CFR, such as a significant epicardial coronary artery stenosis, but also aging, aortic valve stenosis, left ventricular (LV) hypertrophy, hypertrophic and dilated cardiomyopathy, and even isolated coronary microvascular dysfunction 20, 21, 22, 23. Although previous studies have shown an inverse relationship between arterial stiffness and CFR,24, 25 limited information is available on the relationships between PP and CFR, in particular in patients who have cardiovascular risk factors but are free of obstructive coronary artery disease 26, 27, 28.…”

Section: Introductionmentioning

confidence: 99%

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Association Between Elevated Pulse Pressure and High Resting Coronary Blood Flow Velocity in Patients With Angiographically Normal Epicardial Coronary Arteries

Lembo

Sicari

Esposito

et al. 2017

JAHA

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BackgroundThe aim of our study was to evaluate the relationship of pulse pressure (PP), a raw index of arterial stiffness, with noninvasively determined coronary flow reserve (CFR) and its components, in patients with angiographically normal epicardial coronary arteries.Methods and ResultsThe study population included 398 patients without angiographic evidence of coronary stenosis, who underwent high‐dose dipyridamole stress echocardiography with transthoracic‐derived CFR evaluation on the left anterior descending artery. CFR was calculated as the ratio between high‐dose dipyridamole and resting coronary diastolic peak velocities. Patients were divided into 2 groups: the first group included the first and second PP tertiles (n=298, PP ≤60 mm Hg) and the second group included the highest PP tertile (n=100, PP >60 mm Hg). Mean blood pressure, systolic blood pressure (both P<0.0001), age (P<0.002), and left ventricular mass index (P=0.013) were higher in the highest PP tertile, which also showed higher resting coronary flow velocity (31.6±9.6 cm/s versus 27.7±6.4 cm/s, P<0.0001) and marginally lower CFR (2.5±0.6 versus 2.6±0.6, P=0.044). Hyperemic coronary flow velocity did not differ between the 2 groups. By separate multiple linear regression analyses, after adjusting for sex, age, the highest systolic blood pressure tertile (≥140 mm Hg), left ventricular mass index, and cardiovascular risk factors, the highest PP tertile was associated with resting coronary flow velocity (P=0.003) and only marginally with hyperemic coronary flow velocity (P<0.02), whereas its association with CFR was not significant.ConclusionsIn patients without epicardial coronary artery stenosis, the highest PP tertile is associated with an increased coronary flow velocity at rest.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association Between Elevated Pulse Pressure and High Resting Coronary Blood Flow Velocity in Patients With Angiographically Normal Epicardial Coronary Arteries

Lembo

Sicari

Esposito

et al. 2017

JAHA

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“…Indeed, a decrease in the release of endothelium-derived nitric oxide has been well documented in experimental animal models of hypertension as well as in hypertensive patients (23). Recently, we reported a significant correlation between CFVR, forearm endothelial function and asymmetric dimethylarginine, which is an endogenous (14,16).…”

Section: Discussionmentioning

confidence: 71%

“…CFVR was defined as the ratio of hyperemic to basal MDV. We adopted a CFVR of less than 2.0 as the cut-off value for the presence of significant coronary arterial stenosis, as has been done in published reports (14,16).…”

Section: Cfvr Measurement Using Transthoracic Doppler Echocardiographymentioning

confidence: 99%

Clinical Implications of Assessing Coronary Flow Velocity Reserve and Plasma Endothelin-1 in Hypertensive Patients

et al. 2005

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“…It is also influenced by serious epicardial coronary stenosis, previous myocardial infarction, etc. Pharmacological hyperemic vasodilatation induced by adenosine is a reliable and reproducible technique with which CFVR is evaluated by Doppler echocardiography (3,10). Adenosine is often used to assess microcirculatory function on the basis of their ability to induce maximal vasodilatation of coronary resistance vessels.…”

mentioning

confidence: 99%

Reply to letter to the editor: coronary flow velocity reserve was impaired in chronic hyperhomocysteinemic patients: why?

Wang¹,

Hong³

2011

American Journal of Physiology-Endocrinology and Metabolism

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TO THE EDITOR: Hyperhomocysteinemia (HHcy) is considered a potentially modifiable risk factor for coronary artery disease (CAD) and atherosclerosis. The possible mechanisms of accelerated CAD in HHcy include endothelial dysfunction and enhanced oxidative stress (13). However, the precise mechanism by which homocysteine (Hcy) promotes atherosclerosis is not well understood. Hcy could impair coronary microvascular dilated function in healthy individuals. Endothelium-dependent dilation was significantly impaired in acute methionine-induced HHcy patients (1).Noninvasive transthoracic ultrasound imaging of coronary blood flow has been increasingly used to assessment of coronary microcirculation in individuals free of epicardial coronary stenosis (2). Coronary flow velocity reserve (CFVR), which is derived from the ratio of maximal hyperemic to basal coronary blood flow, is an accepted index for assessment of the coronary microcirculation and provides important information about coronary endothelial function. We thank Dr. Kietadisorn et al. (10a) for their interest in our paper (9). We fully agree that CFVR as an independent index of coronary microvascular function has multiple limitations. CFVR is influenced by both epicardial and microvascular factors of the coronary artery. It is also influenced by serious epicardial coronary stenosis, previous myocardial infarction, etc. Pharmacological hyperemic vasodilatation induced by adenosine is a reliable and reproducible technique with which CFVR is evaluated by Doppler echocardiography (3, 10). Adenosine is often used to assess microcirculatory function on the basis of their ability to induce maximal vasodilatation of coronary resistance vessels. This vasodilatation is primarily achieved through effects of adenosine on vascular smooth muscle cells. However, adenosine-induced vasodilatation is partly dependent on the release of nitric oxide (NO) from endothelial cells through the effect of adenosine on endothelial cells and/or via flow-induced shearing force (4, 8). Hence, adenosine-derived CFVR may involve both endothelium-dependent and -independent microcirculatory function. CFVR in response to adenosine may be partly endothelium dependent. In our study, we investigated whether CFVR was damaged in patients with chronic HHcy and, if so, whether this impaired effect was associated with the endothelial dysfunction. Quantification of CFVR was after rest and after adenosine administration by noninvasive Doppler echocardiography. Our results showed that CFVR was significantly lower in the HHcy patients than in the control group (2.76 Ϯ 0.49 vs. 3.09 Ϯ 0.52). In addition, the plasma level of Hcy was negatively correlated with CFVR. Regarding the potential effect of multiple factors on CFVR, the patients with myocardial infarction, CAD (Ͼ50% stenosis as shown on angiography), heart failure, renal function impairment, or a serious illness or who were undergoing nitrate or vitamin treatment that would affect their participation were excluded from our study. Consistent with our f...

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Noninvasive Assessment of Significant Left Anterior Descending Coronary Artery Stenosis by Coronary Flow Velocity Reserve With Transthoracic Color Doppler Echocardiography

Abstract: CFVR determined by TTDE is useful in the noninvasive assessment of significant stenotic lesion in the LAD.

Cited by 375 publications

References 39 publications

Association Between Elevated Pulse Pressure and High Resting Coronary Blood Flow Velocity in Patients With Angiographically Normal Epicardial Coronary Arteries

Association Between Elevated Pulse Pressure and High Resting Coronary Blood Flow Velocity in Patients With Angiographically Normal Epicardial Coronary Arteries

Clinical Implications of Assessing Coronary Flow Velocity Reserve and Plasma Endothelin-1 in Hypertensive Patients

Reply to letter to the editor: coronary flow velocity reserve was impaired in chronic hyperhomocysteinemic patients: why?

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