Study design for a randomized crossover study investigating myocardial strain analysis in patients with coronary artery disease at hyperoxia and normoxemia prior to coronary artery bypass graft surgery (StrECHO-O2)

Fischer, Kady; Ranjan, Rajevan; Friess, Jan-Oliver; Erdoes, Gabor; Mikasi, Jan; Baumann, Ralf; Schoenhoff, Florian; Carrel, Thierry; Brugger, Nicolas; Eberle, Balthasar; Guensch, Dominik P.

doi:10.1016/j.cct.2021.106567

Cited by 4 publications

(5 citation statements)

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“…As seen in Figure 2, at the normoxemic-normocapnic baseline (100/40 mmHg), short breath-holds were able to significantly and transiently recruit coronary blood flow. In controls, a 42% increase (p < 0.001) was observed by 12s of apnea reaching an adjusted mean blood flow of 36 (25-50) ml/min from a steady-state blood flow of 26 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34) ml/min (Table 1, Supplementary Table 2). A significant 27% (p < 0.001) increase was also observed in the swine with stenosis from a baseline flow of 21 (17-26) ml/min, yet the flow response was significantly lower in the stenosis group (p = 0.01, Figure 3).…”

Section: Mean Coronary Vascular Response To An Apneic Stimulusmentioning

confidence: 99%

“…and hyperoxic baseline followed by 30 s of apnea likely best reflect this clinical situation. The fraction of inspired oxygen (FiO 2 ) during the maintenance of anesthesia varies between 30 and 80% in literature as there is no universal consensus about target PaO 2 levels in adults [34][35][36]. In our model, we targeted normoxemic (PaO 2 of 100 mmHg) and hyperoxic (PaO 2 of 300 mmH) states, which are frequently encountered during general anesthesia.…”

Section: Clinical Situations Of Altered Arterial Blood Gasesmentioning

confidence: 99%

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Altered blood gas tensions of oxygen and carbon dioxide confound coronary reactivity to apnea

Fischer

Guensch

Shie

et al. 2022

Front. Anesthesiol.

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PurposeArterial blood gases change frequently during anesthesia and intensive care. Apnea can occur during diagnostic exams and airway and surgical interventions. While the impact of blood gas levels on coronary blood flow is established, their confounding effect on coronary vasoreactivity in response to an apneic stimulus, especially in coronary artery disease, is not known.MethodsSix anesthetized control swine and eleven swine with coronary artery stenosis were examined. Nine different blood gas levels from a combination of arterial partial pressure of oxygen (70, 100, and 300 mmHg) and carbon dioxide (30, 40, and 50 mmHg) were targeted. Apnea was induced by halting controlled positive pressure ventilation for 3–30s, while the left descending coronary artery flow was measured and reported relative to apnea duration, and at the adjusted mean (12s).ResultsAt normoxemic-normocapnic blood gas levels, apnea increased coronary blood flow in proportion to the duration of apnea in the control (r = 0.533, p < 0.001) and stenosed groups (r = 0.566, p < 0.001). This culminated in a 42% (95% CI: 27–58) increase in controls (p < 0.001) and, to a lesser extent, 27% (15–40) in the presence of coronary artery stenosis (p < 0.001). Vasoreactivity was augmented by mild-hypoxemic levels [81% (65–97), and 66% (53–79) increase in flow respectively, p < 0.001 vs. normoxemia], but markedly reduced during hyperoxia (7.5% (−8.2–23) and 0.3% (−12–13), respectively, p < 0.001 vs. normoxemia).ConclusionAlterations of blood oxygen and carbon dioxide affect coronary vascular reactivity induced by apnea in swine, which was attenuated further in the presence of coronary stenosis. Especially hyperoxia significantly reduces coronary blood flow and blunts coronary vascular reactivity.

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Section: Mean Coronary Vascular Response To An Apneic Stimulusmentioning

confidence: 99%

Section: Clinical Situations Of Altered Arterial Blood Gasesmentioning

confidence: 99%

Altered blood gas tensions of oxygen and carbon dioxide confound coronary reactivity to apnea

Fischer

Guensch

Shie

et al. 2022

Front. Anesthesiol.

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“…Exclusion criteria were emergency surgery, acute ischaemia, atrial fibrillation, and severe-grade valvular disease ( Supplementary methods ). 18 …”

Section: Methodsmentioning

confidence: 99%

“…As previously described, after establishing a stable respiratory and haemodynamic equilibrium, standard two-dimensional (2D), 3D, M-mode, and Doppler images were acquired to assess systolic and diastolic function, both at normoxaemia and hyperoxia. 18 Immediately after image acquisition, the following measurements were made by the echocardiographer: tricuspid annular plane systolic excursion (TAPSE), septal and lateral tissue Doppler velocities, E (early) and A (atrial) transmitral inflow velocities derived by pulse waved Doppler (PW), and left ventricular outflow tract velocity time integral. The 3D images were then coded, and the remaining analyses were performed by blinded readers offline, using TOMTEC-Arena (TOMTEC Imaging Systems, Unterschleissheim, Germany).…”

Section: Methodsmentioning

confidence: 99%

Hyperoxia-induced deterioration of diastolic function in anaesthetised patients with coronary artery disease – Randomised crossover trial

et al. 2023

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“…This allocation was primarily based on the classical perfusion territories ( 19 ), with the impact on basal, mid and apex slices determined by the proximal hierarchy of the lesions. A figure detailing this allocation protocol can be visualized in the publication by Fischer et al ( 20 ). The angiographic readers then adjusted the territory classification based on individual coronary anatomy and dominance ( 17 ).…”

Section: Methodsmentioning

confidence: 99%

Combined Analysis of Myocardial Deformation and Oxygenation Detects Inducible Ischemia Unmasked by Breathing Maneuvers in Chronic Coronary Syndrome

Spicher

Fischer

Zimmerli

et al. 2022

Front. Cardiovasc. Med.

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IntroductionIn patients with chronic coronary syndromes, hyperventilation followed by apnea has been shown to unmask myocardium susceptible to inducible deoxygenation. The aim of this study was to assess whether such a provoked response is co-localized with myocardial dysfunction.MethodsA group of twenty-six CAD patients with a defined stenosis (quantitative coronary angiography > 50%) underwent a cardiovascular magnetic resonance (CMR) exam prior to revascularization. Healthy volunteers older than 50 years served as controls (n = 12). Participants hyperventilated for 60s followed by brief apnea. Oxygenation-sensitive images were analyzed for changes in myocardial oxygenation and strain.ResultsIn healthy subjects, hyperventilation resulted in global myocardial deoxygenation (-10.2 ± 8.2%, p < 0.001) and augmented peak circumferential systolic strain (-3.3 ± 1.6%, p < 0.001). At the end of apnea, myocardial signal intensity had increased (+9.1 ± 5.3%, p < 0.001) and strain had normalized to baseline. CAD patients had a similar global oxygenation response to hyperventilation (−5.8 ± 9.6%, p = 0.085) but showed no change in peak strain from their resting state (-1.3 ± 1.6%), which was significantly attenuated in comparison the strain response observed in controls (p = 0.008). With apnea, the CAD patients showed an attenuated global oxygenation response to apnea compared to controls (+2.7 ± 6.2%, p < 0.001). This was accompanied by a significant depression of peak strain (3.0 ± 1.7%, p < 0.001), which also differed from the control response (p = 0.025). Regional analysis demonstrated that post-stenotic myocardium was most susceptible to de-oxygenation and systolic strain abnormalities during respiratory maneuvers. CMR measures at rest were unable to discriminate post-stenotic territory (p > 0.05), yet this was significant for both myocardial oxygenation [area under the curve (AUC): 0.88, p > 0.001] and peak strain (AUC: 0.73, p = 0.023) measured with apnea. A combined analysis of myocardial oxygenation and peak strain resulted in an incrementally higher AUC of 0.91, p < 0.001 than strain alone.ConclusionIn myocardium of patients with chronic coronary syndromes and primarily intermediate coronary stenoses, cine oxygenation-sensitive CMR can identify an impaired vascular and functional response to a vasoactive breathing maneuver stimulus indicative of inducible ischemia.

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Study design for a randomized crossover study investigating myocardial strain analysis in patients with coronary artery disease at hyperoxia and normoxemia prior to coronary artery bypass graft surgery (StrECHO-O2)

Cited by 4 publications

References 47 publications

Altered blood gas tensions of oxygen and carbon dioxide confound coronary reactivity to apnea

Altered blood gas tensions of oxygen and carbon dioxide confound coronary reactivity to apnea

Hyperoxia-induced deterioration of diastolic function in anaesthetised patients with coronary artery disease – Randomised crossover trial

Combined Analysis of Myocardial Deformation and Oxygenation Detects Inducible Ischemia Unmasked by Breathing Maneuvers in Chronic Coronary Syndrome

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