Prognostic Meaning of Coronary Microvascular Disease in Type 2 Diabetes Mellitus: A Transthoracic Doppler Echocardiographic Study

Cortigiani, Lauro; Rigo, Fausto; Gherardi, Sonia; Galderisi, Maurizio; Bovenzi, Francesco; Sicari, Rosa

doi:10.1016/j.echo.2014.02.010

Cited by 68 publications

(55 citation statements)

References 41 publications

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“…The coronary endothelial and microvascular dysfunction affects the left ventricle globally, with the left anterior descending artery (LAD) being the most important coronary vessel determining the left ventricle function 14. Also, the feasibility of CFR measurements in the LAD is superior to other coronary arteries 6.…”

Section: Methodsmentioning

confidence: 99%

Effect of interleukin-6 inhibition on coronary microvascular and endothelial function in myocardial infarction

Holte

Kleveland²,

Ueland

et al. 2017

Heart

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Section: Methodsmentioning

confidence: 99%

Effect of interleukin-6 inhibition on coronary microvascular and endothelial function in myocardial infarction

Holte

Kleveland²,

Ueland

et al. 2017

Heart

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“…Moreover, CFR yields useful prognostic information in several clinical subsets, such as diabetics with unchanged wall motion during stress [146] (Fig. 8), hypertensives [147], patients with intermediate coronary stenosis [148], left bundle branch block [149], and normal or near normal coronary arteries [147, 149–151] (Fig. 9).…”

Section: Coronary Flow Reservementioning

confidence: 99%

The clinical use of stress echocardiography in ischemic heart disease

Sicari

Cortigiani²

2017

Cardiovasc Ultrasound

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Stress echocardiography is an established technique for the assessment of extent and severity of coronary artery disease. The combination of echocardiography with a physical, pharmacological or electrical stress allows to detect myocardial ischemia with an excellent accuracy. A transient worsening of regional function during stress is the hallmark of inducible ischemia. Stress echocardiography provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion imaging or magnetic resonance, but at a substantially lower cost, without environmental impact, and with no biohazards for the patient and the physician.The evidence on its clinical impact has been collected over 35 years, based on solid experimental, pathophysiological, technological and clinical foundations. There is the need to implement the combination of wall motion and coronary flow reserve, assessed in the left anterior descending artery, into a single test. The improvement of technology and in imaging quality will make this approach more and more feasible. The future issues in stress echo will be the possibility of obtaining quantitative information translating the current qualitative assessment of regional wall motion into a number. The next challenge for stress echocardiography is to overcome its main weaknesses: dependance on operator expertise, the lack of outcome data (a widesperad problem in clinical imaging) to document the improvement of patient outcomes. This paper summarizes the main indications for the clinical applications of stress echocardiography to ischemic heart disease.

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“…Indeed 21% of the events recorded in the follow-up period were cerebrovascular accidents. Our patients were not investigated with Doppler coronary flow reserve or other validated methods to confirm microvascular disease (23, 24); therefore, certain correlations between limited apical ischaemia and microvascular disease in patients with normal coronary arteries cannot be made. We also did not assess myocardial perfusion in patients who received ultrasound contrast.…”

Section: Discussionmentioning

confidence: 99%

The prognostic role of stress echocardiography in a contemporary population and the clinical significance of limited apical ischaemia

et al. 2016

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IntroductionIn this study, we aim to reassess the prognostic value of stress echocardiography (SE) in a contemporary population and to evaluate the clinical significance of limited apical ischaemia, which has not been previously studied.MethodsWe included 880 patients who underwent SE. Follow-up data with regards to MACCE (cardiac death, myocardial infarction, any repeat revascularisation and cerebrovascular accident) were collected over 12 months after the SE. Mortality data were recorded over 27.02 ± 4.6 months (5.5–34.2 months). We sought to investigate the predictors of MACCE and all-cause mortality.ResultsIn a multivariable analysis, only the positive result of SE was predictive of MACCE (HR, 3.71; P = 0.012). The positive SE group was divided into 2 subgroups: (a) inducible ischaemia limited to the apical segments (‘apical ischaemia’) and (b) ischaemia in any other segments with or without apical involvement (‘other positive’). The subgroup of patients with apical ischaemia had a significantly worse outcome compared to the patients with a negative SE (HR, 3.68; P = 0.041) but a similar outcome to the ‘other positive’ subgroup. However, when investigated with invasive coronary angiography, the prevalence of coronary artery disease (CAD) and their rate of revascularisation was considerably lower. Only age (HR, 1.07; P < 0.001) was correlated with all-cause mortality.ConclusionSE remains a strong predictor of patients’ outcome in a contemporary population. A positive SE result was the only predictor of 12-month MACCE. The subgroup of patients with limited apical ischaemia have similar outcome to patients with ischaemia in other segments despite a lower prevalence of CAD and a lower revascularisation rate.

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Prognostic Meaning of Coronary Microvascular Disease in Type 2 Diabetes Mellitus: A Transthoracic Doppler Echocardiographic Study

Cited by 68 publications

References 41 publications

Effect of interleukin-6 inhibition on coronary microvascular and endothelial function in myocardial infarction

Effect of interleukin-6 inhibition on coronary microvascular and endothelial function in myocardial infarction

The clinical use of stress echocardiography in ischemic heart disease

The prognostic role of stress echocardiography in a contemporary population and the clinical significance of limited apical ischaemia

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