Prevalence and characteristics of coronary microvascular dysfunction among chest pain patients in the emergency department

Safdar, Basmah; D’Onofrio, Gail; Dziura, James; Russell, Raymond R.; Johnson, Caitlin E.; Sinusas, Albert J.

doi:10.1177/2048872618764418

Cited by 38 publications

(29 citation statements)

References 54 publications

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“…Although sex differences in resting MBF and CFR have been observed in invasive CRT [3,17,57], only one of the included studies included assessed sex differences regarding CBF and reported no signi cant sex differences [30]. These ndings are consistent with another study comparing non-invasive CFR between men and women using PET [58]. Therefore, further research is needed to establish whether or not sex-speci c cut-off values are required for the non-invasive diagnosis of CMD.…”

Section: Sex Differencesmentioning

confidence: 57%

Evaluation of Non-invasive Imaging Parameters in Coronary Microvascular Disease: A Systematic Review

Groepenhoff

Klaassen

Valstar

et al. 2020

Preprint

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Background: Coronary microvascular dysfunction (CMD) is an important underlying cause of angina pectoris. Currently, no diagnostic tool is available to directly visualize the coronary microvasculature. Invasive microvascular reactivity testing is the diagnostic standard for CMD, but several non-invasive imaging techniques are being evaluated. However, evidence on reported non-invasive parameters and cut-off values is limited. Thus, we aimed to provide an overview of reported non-invasive parameters and corresponding cut-off values for CMD.Methods: Pubmed and EMBASE databases were systematically searched for studies enrolling patients with angina pectoris without obstructed coronary arteries, investigating at least one non-invasive imaging technique to quantify CMD. Methodological quality assessment of included studies was performed using QUADAS-2.Results: Thirty-six studies were included. Nine cardiac magnetic resonance (CMR) studies reported MPRI (n = 9) and nine positron emission tomography (PET) and transthoracic echocardiography (TTE) studies reported CFR. Mean MPRI ranged from 1.47 ± 0.36 to 1.83 ± 0.50 in patients and from 1.50 ± 0.47 to 2.23 ± 0.37 in healthy controls. Reported mean CFR in PET and TTE ranged from 1.39 ± 0.31 to 2.85 ± 1.35 and 1.69 ± 0.40 to 2.40 ± 0.40 for patients, and 2.68 ± 0.83 to 4.32 ± 1.78 and 2.65 ± 0.65 to 3.31 ± 1.10 for controls, respectively.Conclusions: This systematic review summarized current evidence on reported parameters and cut-off values to diagnose CMD for various non-invasive imaging modalities. Nonetheless, standardization of methodology and reporting of outcome measures is required to provide clinically applicable reference values.

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Section: Sex Differencesmentioning

confidence: 57%

Evaluation of Non-invasive Imaging Parameters in Coronary Microvascular Disease: A Systematic Review

Groepenhoff

Klaassen

Valstar

et al. 2020

Preprint

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“…A full description of patient flow in the chest pain center has been described previously. 15 Briefly, all patients presented with chest pain and underwent a standard protocol to rule out ACS with serial cardiac enzymes and electrocardiograms at 0, 3 and 6 hours before imaging (see Appendix Figure). Consenting patients provided blood samples between 7 and 11am prior to PET/CT, after an overnight rest and within 24 of hours of the chest pain symptoms.…”

Section: Methodsmentioning

confidence: 99%

“…Full protocol is described elsewhere. 15 Attenuation corrected PET images were first evaluated visually for regional perfusion defects. Regional and global quantitative flow was determined using a commercial software package, Corridor 4DM v2013 (INVIA Medical Imaging Solutions, Inc.) that employs a previously validated generalized factor analysis of dynamic sequences (GFADS).…”

Section: Methodsmentioning

confidence: 99%

Elevated renalase levels in patients with acute coronary microvascular dysfunction – A possible biomarker for ischemia

Safdar

Guo²,

Johnson

et al. 2019

International Journal of Cardiology

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Aims We explored the relationship between inflammation, renalase an anti-inflammatory protein, and acute chest pain with coronary microvascular dysfunction (CMD). Methods and Results We used cardiac Rb-82 PET/CT imaging to diagnose coronary artery disease (CAD/CALC) (defect or coronary calcification) and CMD (depressed coronary flow reserve without CAD) in patients with chest pain in an emergency department (ED). Blood samples were collected pre-imaging within 24 hours of ED presentation and were analyzed for renalase and inflammatory markers including C-reactive protein, interleukins, interferon gamma, tumor necrosis factor, vascular endothelial growth factor, and metalloproteinases. Exclusions were age ≤30 years, myocardial infarction, hemodynamic instability, hypertensive crisis, heart failure or dialysis. Between 6/2014-11/2015, 80 patients undergoing PET/CT provided blood and were categorized as normal (18%), CAD/CALC (27%) and CMD (55%). Median renalase values were highest in patients with CMD (5503 ng/ml; IQR 3070) compared to patients with normal flows (4266 ng/ml; IQR 1503; p = 0.02) or CAD/CALC (4069 ng/ml IQR 1850; p =0.004). CMD patients had similar median values for inflammatory markers as normal patients (p > 0.05). Renalase remained an independent predictor of CMD (OR 1.34; 95% CI= 1.1-1.7, per 1,000 ng/ml) after adjustment for smoking, family history, obesity and Framingham risk score. In a model for CMD diagnosis with Framingham risk score, typical angina history and CRP, renalase improved discrimination from C-statistic=0.60 (95% CI 0.47, 0.73) to 0.70 (95% CI, 0.59-0.82). Conclusion We found elevated renalase in response to ischemia from acute CMD. Its role as a biomarker needs validation in larger trials.

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“…Microvascular dysfunction has been identified as an important cause of ischaemia in cardiovascular disease. Coronary microvascular dysfunction (CMD) is quite common in non-obstructive coronary artery disease and affects patients' life quality (Safdar et al 2020). However, there is still no effective therapy for CMD.…”

Section: Introductionmentioning

confidence: 99%

Pre-treatment with compound Danshen dripping pills prevents lipid infusion-induced microvascular dysfunction in mice

Zhang

Zhao

Ding

et al. 2020

Pharmaceutical Biology

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Context: Recent studies have shown compound Danshen dripping pills (CDDP) could improve microcirculation in ischemic/reperfusion injury and other microvascular disorders. The mechanism for CDDP's role in microcirculation is not clear. Objective: To explore the protective effects of CDDP on microvascular dysfunction. Materials and methods: C57BL/6 male mice (6-8 weeks) were randomized into control, model and CDDP groups (n ¼ 10), which were treated with normal saline or CDDP (105.30 mg/kg), respectively. Then, lipid emulsion and heparin were infused via mice jugular vein to establish systemic microvascular dysfunction model. Coronary flow reserve (CFR) and leukocytes adhesion on microvascular wall were measured. Relative CD11b and CD62L expression levels on neutrophils were measured by flow cytometric analysis. Expression level of forkhead box transcription factor O1 (FOXO1) mRNA was identified by realtime PCR. Results: Lipid infusion significantly attenuated the CFR (1.84 ± 0.14 vs. 2.65 ± 0.02) and increased the number of leukocytes adherent to microvascular wall in cremaster (4067.00 ± 581.20 cells/mm 2 vs. 10.67 ± 4.81 cells/mm 2). The expression level of CD11b and FOXO1 in neutrophils was also up-regulated by lipid infusion. Pre-treatment with CDDP significantly improved CFR (2.57 ± 0.29 vs. 1.84 ± 0.14), decreased the number of leukocytes adherent to microvascular wall (2500.00 ± 288.70 cells/mm 2 vs. 4067.00 ± 581.20 cells/ mm 2) and down-regulated CD11b and FOXO1 expression. Discussion and conclusions: Pre-treatment with CDDP could prevent lipid infusion-induced systemic microvascular disorder including coronary and peripheral microvascular dysfunction. Down-regulated FOXO1 and decreased leukocyte adhesion might play an important role in the mechanisms of CDDP's efficacy.

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Prevalence and characteristics of coronary microvascular dysfunction among chest pain patients in the emergency department

Cited by 38 publications

References 54 publications

Evaluation of Non-invasive Imaging Parameters in Coronary Microvascular Disease: A Systematic Review

Evaluation of Non-invasive Imaging Parameters in Coronary Microvascular Disease: A Systematic Review

Elevated renalase levels in patients with acute coronary microvascular dysfunction – A possible biomarker for ischemia

Pre-treatment with compound Danshen dripping pills prevents lipid infusion-induced microvascular dysfunction in mice

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