TY - JOUR
T1 - Coronary Microvascular Dysfunction by Myocardial Contrast Echocardiography in Nonelderly Patients Referred for Computed Tomographic Coronary Angiography
AU - Taqui, Sahar
AU - Ferencik, Maros
AU - Davidson, Brian P.
AU - Belcik, J. Todd
AU - Moccetti, Federico
AU - Layoun, Michael
AU - Raber, Jacob
AU - Turker, Mitchell
AU - Tavori, Hagai
AU - Fazio, Sergio
AU - Lindner, Jonathan R.
N1 - Funding Information:
This study was funded by a grant (14-14NSBRI1-0025) to Dr. Lindner from the National Space Biomedical Research Institute of NASA. Dr. Lindner is supported by grants R01-HL078610, R01-HL120046, and P51-OD011092 from the National Institutes of Health. Dr. Ferencik is supported by grant 13FTF16450001 from the American Heart Association. The study was also supported by material support grants from Astellas. This study was funded by a grant ( 14-14NSBRI1-0025) to Dr. Lindner from the National Space Biomedical Research Institute of NASA. Dr. Lindner is supported by grants R01-HL078610, R01-HL120046, and P51-OD011092 from the National Institutes of Health. Dr. Ferencik is supported by grant 13FTF16450001 from the American Heart Association. The study was also supported by material support grants from Astellas.
Publisher Copyright:
© 2019 American Society of Echocardiography
PY - 2019/7
Y1 - 2019/7
N2 - Background: Microvascular dysfunction (MVD) is a potential cause of chest pain in younger individuals. The authors hypothesized that nonelderly patients referred for computed tomographic angiography (CTA) but without significant stenosis would have a high prevalence of MVD by myocardial contrast echocardiography (MCE). Secondary aims were to test whether the presence of nonobstructive coronary artery disease (CAD) or reduced brachial flow-mediated dilation (FMD) predicted MVD. Methods: Subjects ≤60 years of age undergoing CTA were recruited if they had either no evidence of coronary plaque or evidence of mild CAD (<50% stenosis) and at least one high-risk plaque feature. Subjects underwent quantitative perfusion imaging using MCE at rest and during regadenoson vasodilator stress. MVD was defined as global or segmental delay of microvascular refill (≥2 sec) during regadenoson. FMD of the brachial artery was also performed. Results: Of the 29 patients in whom MCE could be performed, 12 (41%) had MVD. These subjects, compared with those with normal microvascular function, had lower hyperemic perfusion (mean, 236 ± 68 vs 354 ± 161 intensity units/sec; P = .02) and microvascular flux rate (mean, 1.6 ± 0.4 vs 2.5 ± 0.9 sec−1; P = .002) on quantitative MCE. The degree of FMD was not significantly different in those with or without MVD (mean, 11 ± 4% vs 9 ± 4%; P = .32), and there was a poor correlation between results on stress MCE and FMD. Only eight of the 29 subjects were classified as having nonobstructive CAD. There were no groupwise differences in the prevalence of MVD function in those with versus without CAD (43% vs 38% for negative and positive findings on CTA, respectively, P = .79). Conclusions: MVD is a common finding in the nonelderly population referred for CTA for evaluation of possible CAD but without obstructive stenosis. Neither the presence of noncritical atherosclerotic disease nor abnormal FMD increases the likelihood for detecting MVD in this population.
AB - Background: Microvascular dysfunction (MVD) is a potential cause of chest pain in younger individuals. The authors hypothesized that nonelderly patients referred for computed tomographic angiography (CTA) but without significant stenosis would have a high prevalence of MVD by myocardial contrast echocardiography (MCE). Secondary aims were to test whether the presence of nonobstructive coronary artery disease (CAD) or reduced brachial flow-mediated dilation (FMD) predicted MVD. Methods: Subjects ≤60 years of age undergoing CTA were recruited if they had either no evidence of coronary plaque or evidence of mild CAD (<50% stenosis) and at least one high-risk plaque feature. Subjects underwent quantitative perfusion imaging using MCE at rest and during regadenoson vasodilator stress. MVD was defined as global or segmental delay of microvascular refill (≥2 sec) during regadenoson. FMD of the brachial artery was also performed. Results: Of the 29 patients in whom MCE could be performed, 12 (41%) had MVD. These subjects, compared with those with normal microvascular function, had lower hyperemic perfusion (mean, 236 ± 68 vs 354 ± 161 intensity units/sec; P = .02) and microvascular flux rate (mean, 1.6 ± 0.4 vs 2.5 ± 0.9 sec−1; P = .002) on quantitative MCE. The degree of FMD was not significantly different in those with or without MVD (mean, 11 ± 4% vs 9 ± 4%; P = .32), and there was a poor correlation between results on stress MCE and FMD. Only eight of the 29 subjects were classified as having nonobstructive CAD. There were no groupwise differences in the prevalence of MVD function in those with versus without CAD (43% vs 38% for negative and positive findings on CTA, respectively, P = .79). Conclusions: MVD is a common finding in the nonelderly population referred for CTA for evaluation of possible CAD but without obstructive stenosis. Neither the presence of noncritical atherosclerotic disease nor abnormal FMD increases the likelihood for detecting MVD in this population.
KW - CT coronary angiography
KW - Microvascular dysfunction
KW - Myocardial contrast echocardiography
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U2 - 10.1016/j.echo.2019.03.001
DO - 10.1016/j.echo.2019.03.001
M3 - Article
C2 - 31103385
AN - SCOPUS:85065577054
SN - 0894-7317
VL - 32
SP - 817
EP - 825
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 7
ER -