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Clinical application of stress myocardial contrast echocardiography in the determination of coronary flow reserve |
LIU Jia-nan, SUN Yu-jia, AN Huan-huan, FANG Xiao-mei, CHEN Li-nan, XIANG Fei, HAN Wei |
The First Affiliated Hospital of Harbin Medical University, Harbin 150000, China |
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Abstract Objective: To explore a non-invasive method for the determination of coronary flow reserve(CFR) by stress myocardial contrast echocardiography(MCE) and its application in evaluating coronary microcirculation dysfunction(CMD). Methods: A total of 161 patients with non-obstructive coronary artery disease hospitalized due to chest pain were enrolled. All patients underwent adenosine triphosphate(ATP) stress MCE, and QLab was used to quantitatively analyze the myocardial plateau signal intensity(A) and signal intensity exchange rate(β) at rest and post-stress. Myocardial blood flow(MBF) is expressed as A×β, and CFR equals stress MBF divided by rest MBF. CMD is defined as CFR<2.0. Multivariate Logistic regression analysis was used to screen the influencing factors of CMD. Results: The incidence of CMD in patients with non-obstructive chest pain was 51.6%. Compared with the normal group, the incidence of diabetes, hyperlipidemia and the proportion of E/e’>15 in CMD was significantly increased. Multivariate Logistic regression analysis showed that E/e’>15 was an independent risk factor for CMD. Conclusion: MCE is an effective noninvasive method for the determination of CFR. The incidence of CMD in patients with non-obstructive chest pain was 51.6%. It was also associated with increased left ventricular end-diastolic pressure.
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Received: 30 December 2019
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[1]Hayat SA, Dwivedi G, Jacobsen A, et al. Effects of left bundle-branch block on cardiac structure, function, perfusion, and perfusion reserve: implications for myocardial contrast echocardiography versus radionuclide perfusion imaging for the detection of coronary artery disease[J]. Circulation, 2008, 117(14): 1832-1841.
[2]Vogel R, Indermühle A, Reinhardt J, et al. The quantification of absolute myocardial perfusion in humans by contrast echocardiography: algorithm and validation[J]. J Am Coll Cardiol, 2005, 45(5): 754-762.
[3]Vogel R, Indermühle A, Meier P, et al. Quantitative stress echocardiography in coronary artery disease using contrast-based myocardial blood flow measurements: prospective comparison with coronary angiography[J]. Heart, 2009, 95(5): 377-384.
[4]Barletta G, Bene MRD. Myocardial perfusion echocardiography and coronary microvascular dysfunction[J]. World J Cardiol, 2015, 7(12): 46-59.
[5]李馨,陈宇,贺声. 心肌造影检测冠状动脉微循环内皮损伤的初步应用研究[J]. 中国临床医学影像杂志,2011,22(1):29-31.
[6]Bierig SM, Mikolajczak P, Herrmann SC, et al. Comparison of myocardial contrast echocardiography derived myocardial perfusion reserve with invasive determination of coronary flow reserve[J]. Eur J Echocardiogr, 2008, 10(2): 250-255.
[7]Harada M, Okura K, Nishizawa S, et al. Detection of coronary artery disease by adenosine triphosphate stress echocardiography: comparison with adenosine triphosphate stress thallium myocardial scintigraphy and coronary angiography[J]. J Cardiol, 1998, 32(3): 163-171.
[8]Cerqueira MD, Weissman NJ, Dilsizian V, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association[J]. J Nucl Cardiol, 2002, 9(2): 240-245.
[9]Dijkmans PA, Senior R, Becher H, et al. Myocardial contrast echocardiography evolving as a clinically feasible technique for accurate, rapid, and safe assessment of myocardial perfusion: the evidence so far[J]. J Am Coll Cardiol, 2006, 48(11): 2168-2177.
[10]Murthy VL, Naya M, Taqueti VR, et al. Effects of gender on coronary microvascular dysfunction and cardiac outcomes[J]. Circulation, 2014, 129(24): 2518-2527.
[11]Mericli M. Estrogen replacement therapy reverses changes in intramural coronary resistance arteries caused by female sex hormone depletion[J]. Cardiovasc Res, 2004, 61(2): 317-324.
[12]Veerareddy S. Gender differences in myogenic tone in superoxide dismutase knockout mouse: animal model of oxidative stress[J]. AJP: Heart Cir Physiol, 2004, 287(1): H40-H45.
[13]Heaps CL, Bowles DK. Gender-specific K\r, +\r, -channel contribution to, adenosine-induced relaxation in coronary arterioles[J]. J Appl Physiol, 2002, 92(2): 550-558.
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[14]Stauffer BL, Westby CM, Greiner JJ, et al. Sex differences in endothelin-1-mediated vasoconstrictor tone in middle-aged and older adults[J]. Am J Physiol Regul Integr Comp Physiol, 2010, 298(2): R261-265.
[15]Mann MC, Exner DV, Hemmelgarn BR, et al. Impact of gender on the cardiac autonomic response to angiotensin Ⅱ in healthy humans[J]. J Appl Physiol, 2012, 112(6): 1001-1007.
[16]Murthy VL, Carli MFD. Non-invasive quantification of coronary vascular dysfunction for diagnosis and management of coronary artery disease[J]. J Nucl Cardiol, 2012, 19(5): 1060-1072.
[17]诸葛瑞琪,周荣,倪新海. 冠状动脉微血管功能障碍临床诊疗新进展[J]. 中国循环杂志,2016,31(3):307-310.
[18]Huang R, Abdelmoneim SS, Nhola LF, et al. Relationship between HgbA1c and myocardial blood flow reserve in patients with type 2 diabetes mellitus: noninvasive assessment using real-time myocardial perfusion echocardiography[J]. J Diabet Res, 2014, 2014: 1-8.
[19]Elhabyan AK, Reyes BJ, Hallak O, et al. Subendocardial ischemia without coronary artery disease: Is elevated left ventricular end diastolic pressure the culprit?[J]. Cur Med Res Opin, 2004, 20(5): 773-777.
[20]Hillis GS, MoLler JE, Pellikka PA, et al. Noninvasive estimation of left ventricular filling pressure by e/e’ is a powerful predictor of survival after acute myocardial infarction[J]. J Am Coll Cardiol, 2004, 43(3): 360-367.
[21]Jespersen L, Abildstr MSZ, Hvelplund A. Persistent angina: highly prevalent and associated with long-term anxiety, depression, low physical functioning, and quality of life in stable angina pectoris[J]. Clin Res Cardiol, 2013, 102(8): 571-581. |
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