Reduced Survival in Patients with “Coronary Microvascular Disease”

Lin, Terence; Rechenmacher, Stephen; Rasool, Shuja; Varadarajan, Padmini; Pai, Ramdas G.

doi:10.1055/s-0032-1315799

Cited by 8 publications

(8 citation statements)

References 16 publications

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“…Furthermore, there was no significant relationship between the presence of significant epicardial coronary artery disease and impaired myocardial perfusion reserve, implying that the mechanism of MPRI reduction is small vessel related (“coronary microvascular”) rather than epicardial disease. Microvascular CAD has been shown to be associated with reduced survival, although the rate of survival is better than for epicardial CAD [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Myocardial perfusion is impaired in asymptomatic renal and liver transplant recipients: a cardiovascular magnetic resonance study

Parnham

Gleadle

Leong

et al. 2015

Journal of Cardiovascular Magnetic Resonance

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BackgroundMyocardial ischemia is a major cause of death in chronic kidney disease (CKD) patients, which can be caused by either epicardial or microvascular coronary artery disease (CAD). Although renal transplantation improves survival, cardiovascular disease remains a major cause of mortality in post renal transplant recipients, including those with no significant epicardial CAD pre-transplant. We aim to utilize stress cardiovascular magnetic resonance (CMR) and MR coronary angiography (MRCA) to assess silent myocardial ischemia and epicardial CAD in renal transplant recipients.MethodsForty-five subjects: twenty renal transplant (RT) with no known CAD, fifteen liver transplant (LT) controls without prior CKD and no known CAD, and ten hypertensive (HT) controls underwent stress perfusion CMR and MRCA.ResultsA total of 1308 myocardial segments (576 of RT, 468 of LT, and 264 of HT) were compared using mixed linear modeling. Left ventricular mass index, septal diameter and presence of diabetes mellitus were similar between the groups. The mean transmural MPRI was significantly lower in the RT and LT groups compared to HT controls (1.19 ± 0.50 in RT versus 1.23 ± 0.36 in LT versus 2.04 ± 0.32 in HT controls, p < 0.0001), in the subepicardium (1.33 ± 0.57 in RT versus 1.30 ± 0.33 in LT versus 2.01 ± 0.30 in HT controls, p < 0.001), and in the subendocardium (1.19 ± 0.54 in RT versus 1.11 ± 0.31 in LT versus 1.85 ± 0.34 in HT controls, p < 0.0001). Seven (35 %) RT and five (33 %) LT had significant epicardial CAD compared to none in HT controls, p = 0.12. One RT and one LT had LGE suggesting sub-endocardial infarction.ConclusionsRT recipients have impaired myocardial perfusion independent of LVH or diabetes mellitus. The impaired myocardial perfusion in RT is similar to LT without prior renal disease, thus unlikely related to previous CKD. It is not fully explained by the presence of significant epicardial CAD, and therefore most likely represents microvascular CAD.

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Section: Discussionmentioning

confidence: 99%

Myocardial perfusion is impaired in asymptomatic renal and liver transplant recipients: a cardiovascular magnetic resonance study

Parnham

Gleadle

Leong

et al. 2015

Journal of Cardiovascular Magnetic Resonance

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“…8 Longitudinal studies indicate that CMD increases the risk of mortality independent of CAD. 9–11 The exact mechanisms of CMD are unclear, although many risk factors have been proposed to contribute to CMD, such as chronic inflammation, 12 insulin resistance, 13 obesity, 14 and chemotherapy and radiation therapy. 15 …”

Section: Introductionmentioning

confidence: 99%

Quantification of intramyocardial blood volume with 99mTc-RBC SPECT-CT imaging: A preclinical study

Mohy-ud-Din

Boutagy

Stendahl

et al. 2018

Journal of Nuclear Cardiology

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Background Currently, there is no established non-invasive imaging approach to directly evaluate myocardial microcirculatory function in order to diagnose microvascular disease independent of co-existing epicardial disease. In this work, we developed a methodological framework for quantification of intramyocardial blood volume (IMBV) as a novel index of microcirculatory function with SPECT/CT imaging of 99mTc-labeled red blood cells (RBCs). Methods Dual-gated myocardial SPECT/CT equilibrium imaging of 99mTc-RBCs was performed on twelve canines under resting conditions. Five correction schemes were studied: cardiac gating with no other corrections (CG), CG with attenuation correction (CG 1 AC), CG 1 AC with scatter correction (CG 1 AC 1 SC), dual cardiorespiratory gating with AC 1 SC (DG 1 AC 1 SC), and DG 1 AC 1 SC with partial volume correction (DG 1 AC 1 SC 1 PVC). Quantification of IMBV using each approach was evaluated in comparison to those obtained from all corrections. The in vivo SPECT estimates of IMBV values were validated against those obtained from ex vivo microCT imaging of the casted hearts. Results The estimated IMBV with all corrections was 0.15 ± 0.03 for the end-diastolic phase and 0.11 ± 0.03 for the end-systolic phase. The cycle-dependent change in IMBV (ΔIMBV) with all corrections was 23.9 ± 8.6%. Schemes that applied no correction or partial correction resulted in significant over-estimation of IMBV and significant under-underestimation of ΔIMBV. Estimates of IMBV and ΔIMBV using all corrections were consistent with values reported in the literature using invasive techniques. In vivo SPECT estimates of IMBV strongly correlated (R2 ≥ 0.70) with ex vivo measures for the various correction schemes, while the fully corrected scheme yielded the smallest bias. Conclusions Non-invasive quantification of IMBV is feasible using 99mTc-RBCs SPECT/CT imaging, however, requires full compensation of physical degradation factors.

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“… 8 Microvascular CAD has been shown to be associated with reduced survival. 48 Thus, our study may lead to better management of multivessel microvascular CAD and cardiac risk factors in the CKD and post-transplant population.…”

Section: Discussionmentioning

confidence: 87%

Impaired Myocardial Oxygenation Response to Stress in Patients With Chronic Kidney Disease

Parnham

Gleadle

Bangalore

et al. 2015

JAHA

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BackgroundCoronary artery disease and left ventricular hypertrophy are prevalent in the chronic kidney disease (CKD) and renal transplant (RT) population. Advances in cardiovascular magnetic resonance (CMR) with blood oxygen level–dependent (BOLD) technique provides capability to assess myocardial oxygenation as a measure of ischemia. We hypothesized that the myocardial oxygenation response to stress would be impaired in CKD and RT patients.Methods and ResultsFifty-three subjects (23 subjects with CKD, 10 RT recipients, 10 hypertensive (HT) controls, and 10 normal controls without known coronary artery disease) underwent CMR scanning. All groups had cine and BOLD CMR at 3 T. The RT and HT groups also had late gadolinium CMR to assess infarction/replacement fibrosis. The CKD group underwent 2-dimensional echocardiography strain to assess fibrosis. Myocardial oxygenation was measured at rest and under stress with adenosine (140 μg/kg per minute) using BOLD signal intensity. A total of 2898 myocardial segments (1200 segments in CKD patients, 552 segments in RT, 480 segments in HT, and 666 segments in normal controls) were compared using linear mixed modeling. Diabetes mellitus (P=0.47) and hypertension (P=0.57) were similar between CKD, RT, and HT groups. The mean BOLD signal intensity change was significantly lower in the CKD and RT groups compared to HT controls and normal controls (−0.89±10.63% in CKD versus 5.66±7.87% in RT versus 15.54±9.58% in HT controls versus 16.19±11.11% in normal controls, P<0.0001). BOLD signal intensity change was associated with estimated glomerular filtration rate (β=0.16, 95% CI=0.10 to 0.22, P<0.0001). Left ventricular mass index and left ventricular septal wall diameter were similar between the CKD predialysis, RT, and HT groups. None of the CKD patients had impaired global longitudinal strain and none of the RT group had late gadolinium hyperenhancement.ConclusionsMyocardial oxygenation response to stress is impaired in CKD patients and RT recipients without known coronary artery disease, and unlikely to be solely accounted for by the presence of diabetes mellitus, left ventricular hypertrophy, or myocardial scarring. The impaired myocardial oxygenation in CKD patients may be associated with declining renal function. Noncontrast BOLD CMR is a promising tool for detecting myocardial ischemia in the CKD population.

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Reduced Survival in Patients with “Coronary Microvascular Disease”

Cited by 8 publications

References 16 publications

Myocardial perfusion is impaired in asymptomatic renal and liver transplant recipients: a cardiovascular magnetic resonance study

Myocardial perfusion is impaired in asymptomatic renal and liver transplant recipients: a cardiovascular magnetic resonance study

Quantification of intramyocardial blood volume with 99mTc-RBC SPECT-CT imaging: A preclinical study

Impaired Myocardial Oxygenation Response to Stress in Patients With Chronic Kidney Disease

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