Relationship between coronary microvascular dysfunction and left ventricular diastolic function in patients with chest pain and unobstructed coronary arteries

Lam, Jeng; Quah, Jing Xian; Davies, Teifion; Boos, Christopher J.; Nel, Karen; Anstey, Christopher; Stanton, Tony; Greaves, Kim

doi:10.1111/echo.14794

Cited by 11 publications

(5 citation statements)

References 17 publications

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“…Previous studies found that patients with coronary flow velocity reserve < 2 appear to have higher E / e ′ ( P = 0.06) ( 33 ). However, a later study found no association between MBF measured by MCE and diastolic function ( 22 ), consistent with our findings. LAD infarct location has been shown to be independently associated with MVO ( 3 ), consistent with the univariate regression results of this study [LAD as a reference, LCA: OR 0.23 (0.09, 0.58), RCA: OR 0.08 (0.03, 0.23)], but failed to be associated with MBF.…”

Section: Discussionsupporting

confidence: 92%

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A novel risk stratification model for STEMI after primary PCI: global longitudinal strain and deep neural network assisted myocardial contrast echocardiography quantitative analysis

Li¹,

Zeng²,

Zhou³

et al. 2023

Front. Cardiovasc. Med.

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BackgroundIn ST-segment elevation myocardial infarction (STEMI) with the restoration of TIMI 3 flow by percutaneous coronary intervention (PCI), visually defined microvascular obstruction (MVO) was shown to be the predictor of poor prognosis, but not an ideal risk stratification method. We intend to introduce deep neural network (DNN) assisted myocardial contrast echocardiography (MCE) quantitative analysis and propose a better risk stratification model.Methods194 STEMI patients with successful primary PCI with at least 6 months follow-up were included. MCE was performed within 48 h after PCI. The major adverse cardiovascular events (MACE) were defined as cardiac death, congestive heart failure, reinfarction, stroke, and recurrent angina. The perfusion parameters were derived from a DNN-based myocardial segmentation framework. Three patterns of visual microvascular perfusion (MVP) qualitative analysis: normal, delay, and MVO. Clinical markers and imaging features, including global longitudinal strain (GLS) were analyzed. A calculator for risk was constructed and validated with bootstrap resampling.ResultsThe time-cost for processing 7,403 MCE frames is 773 s. The correlation coefficients of microvascular blood flow (MBF) were 0.99 to 0.97 for intra-observer and inter-observer variability. 38 patients met MACE in 6-month follow-up. We proposed A risk prediction model based on MBF [HR: 0.93 (0.91–0.95)] in culprit lesion areas and GLS [HR: 0.80 (0.73–0.88)]. At the best risk threshold of 40%, the AUC was 0.95 (sensitivity: 0.84, specificity: 0.94), better than visual MVP method (AUC: 0.70, Sensitivity: 0.89, Specificity: 0.40, IDI: −0.49). The Kaplan-Meier curves showed that the proposed risk prediction model allowed for better risk stratification.ConclusionThe MBF + GLS model allowed more accurate risk stratification of STEMI after PCI than visual qualitative analysis. The DNN-assisted MCE quantitative analysis is an objective, efficient and reproducible method to evaluate microvascular perfusion.

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Section: Discussionsupporting

confidence: 92%

“…Many studies have confirmed the diagnostic value of MCE quantitative analysis for microvascular dysfunction ( 19 – 22 ). It has the potential to identify pathologic microvascular patterns ( 23 ).…”

Section: Discussionmentioning

confidence: 91%

A novel risk stratification model for STEMI after primary PCI: global longitudinal strain and deep neural network assisted myocardial contrast echocardiography quantitative analysis

Li¹,

Zeng²,

Zhou³

et al. 2023

Front. Cardiovasc. Med.

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“…получили и проанализировали данные MFR, оцененные с помощью магнитно-резонансной томографии, у 163 пациентов с СНсФВ (73 ± 9 лет; 86 [53%] женщин). Значения MFR были значительно ниже у больных с СНсФВ и неблагоприятными сердечно-сосудистыми событиями, чем у пациентов без них (1,93 ± 0,38 против 2,67 ± 0,52; p < 0,001) и являлись предиктором сердечно-сосудистой смерти и госпитализаций по поводу СН [33]. При этом были обнаружены значимые отрицательные корреляции между MFR и глобальной окружной деформацией (r = -0,29; p < 0,001), глобальной продольной деформацией (r = -0,33; p < 0,001), продольной деформацией правого желудочка (r = -0,26; p < 0,001) и уровнями BNP в сыворотке (r = -0,32; p < 0,001) [34].…”

Section: Discussionunclassified

Prognostic value of myocardial flow reserve in patients with heart failure with preserved ejection fraction

et al. 2023

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Aim. To study the prognostic value of myocardial blood flow (MBF) and myocardial flow reserve (MFR) parameters in patients with heart failure with preserved ejection fraction (HFpEF) and non-obstructive coronary artery disease (CAD) in risk stratification of HFpEF progression during a 12-month follow-up.Materials and methods. The study included 58 patients with non-obstructive CAD and HFpEF (LVEF 62 [58; 66]%). Dynamic CZT-SRECT was used to evaluate MFR and MBF at rest (rest-MBF) and stress (stress-MBF). NT-proBNP levels were determined by the enzyme immunoassay. Diastolic dysfunction parameters were measured using 2D transthoracic echocardiography. Left ventricular systolic global longitudinal strain (GLS) was assessed using 2D speckle tracking.Results. After a 12-month follow-up, the patients were retrospectively divided into 2 groups: group 1 (n = 11) included patients with an unfavorable course of HFpEF, group 2 (n = 47) encompassed patients with a favorable course of the disease. In group 1, the level of NT-proBNP was 3.8 times higher than in group 2 (284.5 [183.42; 716.73] and 1,071.4 [272.4; 2,168.1] pg / ml, respectively). MFR values in group 1 were lower by 45.4%(p < 0.001) than in group 2 (1.19 [0.86; 1.55] vs. 2.18 [1.7; 2.55], respectively). In group 1, rest-MBF levels were higher by 23.6% (p = 0.046) and stress-MBF was lower by 28.2% (p = 0.046) than in group 2. The multivariate regression analysis revealed that NT-proBNP levels (odds ratio (OR) 3.23; p = 0.008), GLS (OR 2.27; p = 0.012), and MFR (OR 8.09; p < 0.001) were independent predictors of adverse outcomes in HFpEF. Based on the ROC analysis, MFR levels ≤ 1.62 (AUC = 0.827; p < 0.001), GLS ≤–18 (AUC = 0.756; p = 0.002), and NT-proBNP≥ 760.5 pg / ml (AUC = 0.708; p = 0.040) may be considered as markers of adverse outcomes. However, the combined determination of NT-proBNP and MFR had a greater significance (AUC 0.935; p < 0.001) in risk stratification compared with the monomarker model, while the addition of GLS did not increase the significance of the analysis.Conclusion. Levels of NT-proBNP, GLS, and MFR may be used as non-invasive markers of an adverse course of HFpEF in patients with non-obstructive CAD, while the combined determination of NT-proBNP and MBF increases the prognostic value of the analysis.

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“…In addition, MCE derived MBF reserve and β reserve were highly correlated with CFVR by TTDE in patients with cardiac syndrome X ( 44 ). A recent study also showed that an MBF reserve <2 by MCE classified 37% of patients with chest pain but no obstructive CAD as having CMD ( 60 ). Although there is no consensus regarding the diagnostic criteria, data regarding CMD by MCE is growing as the rapid development of MCE.…”

Section: Basic Principles Of Myocardial Contrast Echocardiography (Mc...mentioning

confidence: 99%

Assessment and Treatment for Coronary Microvascular Dysfunction by Contrast Enhanced Ultrasound

Zhan

Zhong²,

Wu³

2022

Front. Cardiovasc. Med.

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With growing evidence in clinical practice, the understanding of coronary syndromes has gradually evolved out of focusing on the well-established link between stenosis of epicardial coronary artery and myocardial ischemia to the structural and functional abnormalities at the level of coronary microcirculation, known as coronary microvascular dysfunction (CMD). CMD encompasses several pathophysiological mechanisms of coronary microcirculation and is considered as an important cause of myocardial ischemia in patients with angina symptoms without obstructive coronary artery disease (CAD). As a result of growing knowledge of the understanding of CMD assessed by multiple non-invasive modalities, CMD has also been found to be involved in other cardiovascular diseases, including primary cardiomyopathies as well as heart failure with preserved ejection fraction (HFpEF). In the past 2 decades, almost all the imaging modalities have been used to non-invasively quantify myocardial blood flow (MBF) and promote a better understanding of CMD. Myocardial contrast echocardiography (MCE) is a breakthrough as a non-invasive technique, which enables assessment of myocardial perfusion and quantification of MBF, exhibiting promising diagnostic performances that were comparable to other non-invasive techniques. With unique advantages over other non-invasive techniques, MCE has gradually developed into a novel modality for assessment of the coronary microvasculature, which may provide novel insights into the pathophysiological role of CMD in different clinical conditions. Moreover, the sonothrombolysis and the application of artificial intelligence (AI) will offer the opportunity to extend the use of contrast ultrasound theragnostics.

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Relationship between coronary microvascular dysfunction and left ventricular diastolic function in patients with chest pain and unobstructed coronary arteries

Cited by 11 publications

References 17 publications

A novel risk stratification model for STEMI after primary PCI: global longitudinal strain and deep neural network assisted myocardial contrast echocardiography quantitative analysis

A novel risk stratification model for STEMI after primary PCI: global longitudinal strain and deep neural network assisted myocardial contrast echocardiography quantitative analysis

Prognostic value of myocardial flow reserve in patients with heart failure with preserved ejection fraction

Assessment and Treatment for Coronary Microvascular Dysfunction by Contrast Enhanced Ultrasound

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