Quantification of coronary flow reserve in patients with ischaemic and non-ischaemic cardiomyopathy and its association with clinical outcomes

Majmudar, Maulik D.; Murthy, Venkatesh L.; Shah, Ravi; Kolli, Swathy; Mousavi, Negareh; Foster, Courtney; Hainer, Jon; Blankstein, Ron; Dorbala, Sharmila; Sitek, Arkadiusz; Stevenson, Lynne Warner; Mehra, Mandeep R.; Carli, Marcelo F. Di

doi:10.1093/ehjci/jev012

Cited by 105 publications

(76 citation statements)

References 27 publications

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“…37) Coronary anatomy and myocardial blood flow are the major determinants of clinical symptoms and survival in patients with epicardial coronary artery. 37,38) LVEF and HDL were found to be relatively benign predictors for postprocedural suboptimal flow despite the presence of other factors in STEMI patients. Although previous studies found a significant relationship between preprocedural TIMI flow and enzymatic infarct size and predischarge EF, 18,39) this study showed that postprocedural TIMI flow related with predischarge LVEF.…”

Section: Discussionmentioning

confidence: 92%

Impact of Postprocedural TIMI Flow on Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction

et al. 2017

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SummaryThis study aimed to evaluate the clinical prognostic implications of postprocedural Thrombolysis in Myocardial Infarction (TIMI) flow in acute myocardial infarction patients. A total of 2796 ST-elevation myocardial infarction (STEMI) and 1720 non ST-elevation myocardial infarction (NSTEMI) patients treated in 8 hospitals affiliated with the Catholic University of Korea and Chonnam National University Hospital were analyzed. The study populations were divided according to the final TIMI flow. The primary outcome were the major adverse cardiac events (MACE), defined as a composite of cardiac deaths (CD), nonfatal myocardial infarctions (MI), and target lesion revascularization (TLR). Over a median follow-up of 3.3 years (minimum 2 to maximum 5 years), MACE and CD occurred more frequently in STEMI patients with TIMI !2 group than those with TIMI 3 (MACE: adjusted hazard ratio [aHR], 1.962; 95% confidence interval [CI] 1.513 to 2.546, P < 0.001, CD: aHR, 3.154, CI 2.308 to 4.309, P < 0.001). However, there was no significant difference between the two subgroups in NSTEMI (aHR, 0.932; 95% CI 0.586 to 1.484, P = 0.087). In STEMI patients, good postprocedural TIMI flow after PCI was associated with favorable clinical outcomes. And the effect of poor TIMI flow in STEMI was on death, not the components of MACE. Meanwhile, postprocedural TIMI flow had no effect on long-term outcomes in NSTEMI patients.(Int Heart J 2017; 58: 674-685)

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Section: Discussionmentioning

confidence: 92%

Impact of Postprocedural TIMI Flow on Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction

et al. 2017

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“…Similarly, Majmudar et al[12] showed that a composite event of cardiac death, heart failure hospitalization, aborted sudden death or late revascularization was two-fold higher in individuals with non-ischemic cardiomyopathy and CFR ≤ 1.65 compared to CFR >1.65.…”

Section: Dilated Cardiomyopathymentioning

confidence: 99%

Role of PET to evaluate coronary microvascular dysfunction in non-ischemic cardiomyopathies

2017

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Coronary microvascular dysfunction (CMD) can result from structural and functional abnormalities at the intramural and small coronary vessel level affecting coronary blood flow autoregulation, and consequently leading to impaired coronary flow reserve. CMD often co-exists with epicardial coronary artery disease, but is also commonly seen in patients with various forms of heart disease, including dilated, hypertrophic and infiltrative cardiomyopathies. CMD can go unnoticed without any symptoms, or manifest as angina, and/or dyspnea, and contribute to the development of heart failure, and even sudden death especially when co-existing with myocardial fibrosis. However, whether CMD in non-ischemic cardiomyopathy is a cause or an effect of the underlying cardiomyopathic process, or whether it can be potentially modifiable with specific therapies, remains incompletely understood.

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“…Quantification of regional MBF and CFR by PET may identify microvascular dysfunction, better characterize the extent and severity of CAD in multi-vessel disease, detect balanced decreases of MBF in all major coronary artery vascular territories, and provide prognostic information beyond regional myocardial ischemia [82,83]. Reduced CFR is a typical feature of a cardiomyopathic heart as a consequence of microvascular dysfunction even in the absence of epicardial CAD [84,85]. Outcome studies have supported microvascular dysfunction as an independent contributing factor to the symptoms and progression of heart failure and reduced CFR was a predictor of adverse cardiac events in ischemic and dilated cardiomyopathy [84,85].…”

Section: Myocardial Perfusionmentioning

confidence: 99%

Molecular Imaging to Monitor Left Ventricular Remodeling in Heart Failure

Ylä-Herttuala

Saraste

Knuuti

et al. 2019

Curr Cardiovasc Imaging Rep

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Purpose of Review Cardiovascular diseases are the leading cause of deaths worldwide. Many complex cellular and molecular pathways lead to myocardial remodeling after ischemic insults. Anatomy, function, and viability of the myocardium can be assessed by modern medical imaging techniques by both visualizing and quantifying damages. Novel imaging techniques aim for a precise and accurate visualization of the myocardium and for the detection of alternations at the molecular level. Recent Findings Magnetic resonance imaging assesses anatomy, function, and tissue characterization of the myocardium noninvasively with high spatial resolution, sensitivity, and specificity. Using hyperpolarized magnetic resonance imaging, molecular and metabolic conditions can be assessed non-invasively. Single photon-emission tomography and positron-emission tomography are the most sensitive techniques to detect biological processes in the myocardium. Cardiac perfusion, metabolism, and viability are the most common clinical targets. In addition, molecular-targeted imaging of biological processes involved in heart failure, such as myocardial innervation, inflammation, and extracellular matrix remodeling, is feasible. Summary Novel imaging techniques can provide a precise and accurate visualization of the myocardium and for the detection of alternations at molecular level.

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Quantification of coronary flow reserve in patients with ischaemic and non-ischaemic cardiomyopathy and its association with clinical outcomes

Abstract: Impaired coronary vascular function, as assessed by reduced CFR by PET imaging, is common in patients with both ischaemic and non-ischaemic cardiomyopathy and is associated with MACE.

Cited by 105 publications

References 27 publications

Impact of Postprocedural TIMI Flow on Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction

Impact of Postprocedural TIMI Flow on Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction

Role of PET to evaluate coronary microvascular dysfunction in non-ischemic cardiomyopathies

Molecular Imaging to Monitor Left Ventricular Remodeling in Heart Failure

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