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- Copyright © 2021 Daria Frestad Bechsgaard and Eva Prescott. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract
Hindawi Journal of Interventional Cardiology Volume 2021, Article ID 6689312, 8 pages https://doi.org/10.1155/2021/6689312 Review Article Transthoracic Assessment of Coronary Flow Velocity Reserve: A Practical Approach to Diagnostic Testing in Patients with Angina and No Obstructive Coronary Artery Disease 1 2 Daria Frestad Bechsgaard and Eva Prescott Department of Cardiology, North Zealand University Hospital, University of Copenhagen, Dyrehavevej 29, Hillerød 3400, Denmark Department of Cardiology, Bispebjerg University Hospital, University of Copenhagen, Bispebjerg Bakke 23, Copenhagen 2400, Denmark Correspondence should be addressed to Daria Frestad Bechsgaard; daria.frestad@gmail.com Received 5 October 2020; Revised 16 February 2021; Accepted 18 March 2021; Published 29 March 2021 Academic Editor: Todd J. Anderson Copyright © 2021 Daria Frestad Bechsgaard and Eva Prescott. ,is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. More than half of the patients with symptoms suggestive of myocardial ischemia presenting at invasive angiography have no obstructive coronary artery disease (CAD). A large proportion of these patients have ischemia caused by coronary microvascular dysfunction, a condition associated with adverse cardiovascular prognosis. Measurement of coronary flow velocity reserve by transthoracic Doppler echocardiography is a feasible and reproducible method for the evaluation of coronary microvascular function. ,is review provides a practical overview of the method in a clinical setting of angina and noobstructive CAD, including technical details and prognostic significance. well-documented prognostic significance [7]. ,e main 1. Introduction focus of this review is to provide a practical overview of the ,e discrepancy between angina symptoms, positive stress TTDE-guided evaluation of coronary microvascular func- tests, and no evidence of flow-limiting stenosis on invasive tion, including technical details and common pitfalls. angiography is a common diagnostic challenge, more prevalent in women than in men [1–3]. No evidence of 2. The Concept of Coronary Flow obstructive coronary artery disease (CAD) often results in Velocity Reserve no diagnosis and limited treatment options, yet follow-up has revealed an increased risk of cardiovascular events in ,e coronary arterial system comprises a network of vessels these patients compared with an age- and sex-matched with distinct functional properties. Epicardial arteries are reference population [2, 4]. Over the last two decades, ab- conductance vessels with capacitance function offering little normalities of cardiac microvascular function have received resistance to coronary blood flow. Prearterioles and arte- increased attention, including coronary microvascular rioles are resistance vessels sensitive to changes in shear dysfunction (CMD), as the possible explanation for the stress and perfusion pressure, responsible for the regulation continued symptoms and adverse cardiovascular prognosis and distribution of coronary blood flow. ,eir main function in these patients [5, 6]. CMD is a dysfunction of the coronary is to prevent myocardial ischemia by matching the oxygen resistance vessels, causing a mismatch between coronary supply with the dynamics of myocardial oxygen demand. blood supply and myocardial oxygen demand. Transthoracic ,e energy production in the normal heart primarily de- Doppler echocardiography (TTDE) is an established method pends on oxidative phosphorylation; thus, an increase in of assessment of coronary microvascular function with a cardiac activity demands for an adequate increase in oxygen 2 Journal of Interventional Cardiology supply. Because the myocardium already extracts more than (Figure 2). ,e artery is identified using Doppler flow 70% of the oxygen delivered, this can only be met by an mapping. Color gain can be adjusted to obtain the optimal image quality. Moreover, if visualization is challenging, increase in coronary blood flow. Under physiological con- ditions, the mechanism of autoregulation allows for up to a intravenous contrast enhancement in refracted doses can be 5-fold increase in coronary blood flow to meet the oxygen used. Coronary flow velocity is measured by using a pulsed- demand with increased cardiac activity [8]. wave Doppler as a laminar flow signal directed toward the Coronary microvascular vessels are beyond the resolu- transducer. ,e ultrasound beam should be aligned as tion of the current angiographic systems; however, their parallel to the coronary flow as technically possible. Angle function can be assessed indirectly, e.g., through measure- correction for coronary flow velocity measurements is not ments of steady-state coronary blood flow velocities during routinely applied due to CFVR being a ratio; however, it is rest and pharmacologically induced hyperemia using TTDE. essential that the ultrasound beam is kept under the same angle during both rest and hyperemia to avoid measurement In the absence of significant obstructive CAD, the ratio of hyperemic to resting coronary flow velocities (m/s), coro- errors. ,e pattern of coronary flow is biphasic with the highest flow during diastole. Both 2D color Doppler and nary flow velocity reserve (CFVR), is an established phys- iological estimate of coronary microvascular function pulsed-wave Doppler images should be stored frequently (Figure 1) [9]. ,e measured increase in coronary flow throughout the examination to document probe positioning velocity equals the increase in total myocardial flow if and sampling angle and to capture the peak flow velocities epicardial vessel diameter is constant. TTDE CFVR is during rest and hyperemia. In addition, heart rate and blood measured on a continuous scale, and cutoffs of 2 or 2.5 have pressure should be documented frequently during rest, been used and are associated with adverse cardiovascular hyperemia, and once after discontinuation of the outcomes in angina patients with no obstructive CAD [10]. vasodilator. 3. Technical Considerations 3.1. Vasodilators. ,e most common vasodilators used for TTDE CFVR evaluation are adenosine, dipyridamole, and TTDE assessment of coronary microvascular function is summarized in Table 1. Coronary flow velocities can be regadenoson. Adenosine (0.14 mg/kg/minute; infusion) induces microvascular dilatation through activation of measured in all three major coronary arteries, and the choice of the vessel is often determined by feasibility. ,ere are no A2A receptors [17]. ,is results in a 3- to 4-fold increase large-scale studies comparing CFVR in all three vessels in in coronary blood flow in a normal epicardial vessel. Due unselected patient cohorts; however, the existing literature to the short half-life of adenosine (<10 seconds), there is suggests the highest CFVR feasibility rates (up to 100%) in no need for an antidote and most side effects resolve in a the left anterior descending artery (LAD), followed by the few seconds after discontinuation of the adenosine in- right and circumflex coronary arteries [11, 12]. ,e following fusion. ,e most common side effects are flushing, chest tightness, and shortness of breath. Less common but more review is, therefore, focused on the LAD-CFVR evaluation. Proximal to distal segments of LAD can be visualized by serious side effects are AV block and bronchospasm [18]. In some patients, shortness of breath during adenosine a 2D color Doppler in a modified parasternal short-axis view, parasternal long-axis view, and foreshortened apical infusion can be dominating, leading to an increased chest movement and higher risk of probe dispositioning and four- or two-chamber views, using a 2.7–8 MHz transducer, with the patient laid in a stable left lateral decubitus position measure error. Dipyridamole (0.84 mg/kg; infusion) in- [13]. ,e color Doppler velocity range is set between 10 and hibits reuptake of endogenic adenosine and has a similar 25 cm/s, and the baseline color scale is set between 1.00 and effect on coronary microcirculation. ,e side effect profile 2.50 kHz, depending on low or high flow velocities, re- is, however, slightly different. ,e most common side spectively [11, 14, 15]. effects are dizziness, chest and abdominal discomfort, and Several factors may affect the quality and validity of a headache [19]. Dipyridamole has a significantly longer half-life, and administration of an antidote (aminophyl- CFVR assessment. Use of adenosine, dipyridamole, or regadenoson as a stressor requires 24-hour abstinence from line; 50–250 mg) is often necessary. Like adenosine, the selective A2A receptor agonist regadenoson (0.4 mg; rapid drinks and food containing significant amount of methyl- xanthines (e.g., coffee, tea, soda, energy drinks, chocolate, injection) dilates the coronary microvasculature by acting and banana) which block adenosine receptors. [16] Medi- on the smooth muscle cells. ,e most common side effects cations containing dipyridamole should be paused for at are shortness of breath, headache, and flushing, which least 48 hours, and medications affecting myocardial per- resolve within 15 minutes of administration. Persisting fusion or myocardial metabolic activity (e.g., nitrates, adverse reactions can be attenuated using aminophylline. β-blockers, and antihypertensives) should be paused for at ,ese three vasodilators assess the nonendothelial de- least 24 hours. ,orough patient preparations, including pendent pathway of coronary microvascular function in breathing exercises and comfortable positioning, are of the absence of epicardial coronary stenosis, although the effect is also to some part mediated by endothelial release essence to prevent probe displacement due to body move- ments or increased breathing activity during hyperemia. of nitric oxide [20]. Furthermore, adenosine and dipyr- idamole have previously been considered equal to achieve Identification, alignment, and fixation of the vessel are the most important and time-consuming steps in the process hyperemia and are used interchangeably in TTDE [21]. Journal of Interventional Cardiology 3 Peak diastolic CFV hyperemia CFVR = Peak diastolic CFV rest LAD Rest Hyperemia Figure 1: Coronary flow velocity reserve (CFVR) measured in the left anterior descending artery (LAD). Table 1: Noninvasive assessment of coronary microvascular function by transthoracic Doppler echocardiography. Summary of noninvasive assessment of coronary microvascular function by transthoracic Doppler echocardiography Physiological pathway: nonendothelial dependent Preferred coronary artery: left anterior descending artery Measurement: coronary flow velocity reserve (CFVR) ratio of hyperemic to resting coronary flow velocities (m/s); continuous scale Cutoff for coronary microvascular dysfunction: CFR <2.0 Common vasodilators: adenosine (0.14 mg/kg/minute; intravenous infusion); dipyridamole (0.84 mg/kg; intravenous infusion); and regadenoson (0.4 mg; intravenous injection) Patient preparation: absence from methylxanthines and medications affecting myocardial perfusion or myocardial metabolic activity; breathing exercises Examination steps: (i) Identification of the coronary flow signal using a 2D color Doppler or intravenous contrast enhancement in case of poor visualization (ii) Alignment of the coronary flow signal of the ultrasound beam as parallel to the coronary flow as possible (iii) Maintenance of probe position and measuring angle throughout the examination (iv) Documentation of characteristic flow curves during rest and hyperemia (v) CFVR quality considerations [11] Common pitfalls: (i) Loss of coronary flow signal/change in measuring angle due to patient/probe displacement (ii) Alternating peak flow velocities due to coronary tortuosity/multiple vessels (iii) Noise artefacts mimicking/blurring coronary flow signal (a) (b) (c) (d) Figure 2: 2D color Doppler view of the left anterior descending artery (LAD) demonstrating the importance of artery identification and alignment for accurate CFVR estimation. (a) Optimal visualization of the LAD segment in a foreshortened two-chamber view. Suboptimal artery identification compromising quality of CFVR evaluation: (b) only a short segment of the artery visible; (c) tortuous artery; and (d) multiple vessels in the same frame. Simultaneous assessment of left ventricular regional wall using an intravenous contrast agent [11]. Smaller studies motion can be performed during dipyridamole and have reported feasibility rates between 66% and 100% adenosine infusions [22]. [23–27]. ,e feasibility is lower in the circumflex and right coronary arteries. Common factors affecting feasibility are operator experience and patient-related factors (high BMI, 3.2. Feasibility and Variability. Published reports show that diabetes, and presence of nonobstructive atherosclerosis) TTDE CFVR in the LAD is highly reproducible in experi- [11]. Good repeatability (repeated examinations) of CFVR in enced hands. In a large study of angina patients with no the LAD has previously been reported for both healthy obstructive CAD (n � 947), CFVR of the LAD was feasible in volunteers and various patient populations [6, 23, 28–31]. 97% of patients, with only 6% of all examinations performed Low intra- and interreader variations have been reported by 4 Journal of Interventional Cardiology Furthermore, noise from the pericardial space (fluid or fat) several research groups, suggesting good reproducibility (repeated readings) of CFVR [6, 28, 32]. ,e good repeat- can sometimes mimic coronary flow, producing unchar- acteristic flow curves. ,ese errors lead to nonfeasible ex- ability and reproducibility of TTDE CFVR supports the use of CFVR in serial evaluations in both clinical and research aminations and, if not recognized, to under- or settings, as well as an outcome measure. overestimation of CFVR. TTDE CFVR in the LAD is closely correlated with CFVR measured using an intracoronary Doppler guidewire in 3.4. Factors Associated with CFVR. According to the current patients undergoing angiography for suspected obstructive European guidelines, CFVR<2 indicates impaired coronary CAD [23, 25–27]. A few studies have explored the agreement microvascular function [36]. ,e current cutoff is based on between TTDE CFVR and the current noninvasive gold studies investigating a broad spectrum of patients with standard for the evaluation of coronary microvascular various risk factor profiles and stages of CAD, ranging from function, positron emission tomography, in various patient normal epicardial arteries to obstructive CAD [15]. CFVR populations, reporting a wide range of correlation coeffi- has previously been associated with several risk factors, cients (ranging between 0.27 and 0.91), and there is no clear including age, hypertension, diabetes, smoking status, agreement between the methods [28, 30, 31]. However, also resting heart rate, and dyslipidemia [37–43]. However, re- test-retest properties of positron emission tomography are cent studies investigating women with angina and no ob- suboptimal with a CoV of approximately 20% in healthy structive CAD have come to a conclusion that conventional individuals [33]. Other noninvasive methods include cardiac cardiovascular risk factors account for little of the variation magnetic resonance imaging and CT-perfusion. ,ese have, in CFVR in these patients [37, 39, 44]. A CFVR cutoff of 2 however, not yet been standardized or validated for use in has also been associated with significant CAD and regional diagnosing coronary microvascular function. Small studies myocardial ischemia [45–48]. A few studies have reported have found nonsignificant correlations between coronary the usefulness of TTDE CFVR to assess the functional microvascular function assessed using TTDE and cardiac significance of intermediate coronary artery stenosis magnetic resonance perfusion imaging, suggesting perhaps [48, 49]. Currently, there is a knowledge gap on the asso- that techniques measuring coronary flow and myocardial ciation between CFVR and plaque burden in patients with perfusion are not interchangeable in the evaluation of nonobstructive CAD. coronary microvascular function [34, 35]. 4. Prognostic Value of CFVR 3.3. Factors Affecting the Quality of Coronary Flow Velocity Increasing amount of literature suggests that CMD evaluated Measurement. Several patient- and non-patient-related by TTDE CFVR predicts adverse cardiovascular outcomes in factors may influence the quality and validity of CFVR patients without obstructive CAD. In a meta-analysis per- measurements (Figures 2–4). To date, there is no consensus formed by our group, including 4 prognostic studies evaluating on the quality score for TTDE CFVR. ,e iPOWER (Im- patients with stable angina and no obstructive CAD (4.516 prove Diagnosis and Treatment of Women with Angina patients; 284 events), the pooled relative risk for cardiovascular Pectoris and Microvessel Disease) research group has sug- events (incident fatal and nonfatal coronary heart disease) was gested a semiquantitative quality score, based on a large, 4.57 (95% CI 3.43–6.08) [7, 50–53]. A similar prognostic value unselected sample of women (n � 947) with angina and no of CFVR assessed by PET has been reported [7, 54]. obstructive disease [11]. ,e score (0 [nonfeasible], 1 [low quality], 2 [medium quality], and 3 [high quality]) was based 5. Clinical Application of TTDE CFVR on 4 main criteria, including (1) vessel identification, (2) maintenance of probe position throughout the examination, Angina patients without obstructive CAD are often (3) visibility and configuration of coronary flow in the 2D underdiagnosed and undertreated and at higher risk of color Doppler mode, and (4) characteristics of flow curves in hospital readmissions, repeated invasive diagnostic proce- the pulsed-wave mode [11]. Identification of a single vessel dures, depression and vital exhaustion, reduced quality of without confounding side branches, good visibility and life, and premature exit from the workforce [55–57]. parallel alignment of beam direction to the vessel flow, Evaluation of coronary microvascular function using TTDE consistent probe positioning throughout the entire exami- CFVR in these patients is recommended by ESC guidelines nation, and characteristic biphasic flow curves gradually (Class IIb recommendation); however, despite TTDE being a increasing during hyperemia with well-defined peaks would noninvasive, low-cost, and radiation-free method, it is not classify as a high-quality examination. routinely implemented in clinical practice due to its limited ,e most common pitfall during CFVR assessment is the availability [36]. TTDE is an operator-dependent imaging loss of coronary flow signal or significant shift in mea- modality; thus, the quality of CFVR largely depends on surement angle due to patient or probe displacement (e.g., operator skills and experience. TTDE CFVR performed by uncomfortable positioning) or increased chest movements an experienced operator is feasible, reproducible, and cor- due to side effects of the stress agent, underscoring the relates well with the invasive gold standard. Increasing importance of proper patient preparation. Another pitfall is knowledge and awareness of the adverse prognosis associ- alternating peak flow velocities due to arterial tortuosity or ated with myocardial ischemia in the absence of flow-lim- multiple vessels measured by the pulsed wave (Figure 2). iting CAD warrants a wider use of noninvasive diagnostic Journal of Interventional Cardiology 5 (a) (b) (c) Figure 3: Examples of different qualities of coronary flow velocity curves at rest (upper level) and peak hyperemia (lower level). (a) Well- defined and reproducible flow curves. (b) Blurred and inconsistent flow curves (e.g., due to chest movements). (c) Poorly defined flow curves (e.g., due to probe displacement leading to partial loss of coronary flow signal). evidence on the effect of therapy on CMD associated with these conditions is largely lacking. LAD Noise 6. Conclusions ,e noninvasive assessment of coronary microvascular function by TTDE CFVR in the LAD is an established method with documented prognostic significance. Com- pared with other noninvasive methods (e.g., cardiac mag- netic resonance imaging or positron emission tomography), TTDE CFVR is an inexpensive, readily available, non- radiative procedure and can be performed simultaneously with diagnostic transthoracic echocardiography as an add- on examination. CFVR by TTDE is feasible and repro- ducible; however, the method is technically challenging and requires extensive operator experience. ,ere is currently no agreement upon the quality score for CFVR. Large, multi- center trials are warranted to establish the value of TTDE Figure 4: Example of noise artifact compromising coronary flow CFVR in cardiovascular risk stratification in patients with no signal, making coronary flow velocity curves blurred and poorly obstructive CAD. Furthermore, the role of TTDE CFVR in reproducible. Noise artifacts can occur from surrounding struc- guiding symptom management and evaluation of prevention tures (e.g., vessels, epicardial fat, and flow in the left ventricular and potential treatment therapies is yet to be established. cavity) and can sometimes mimic coronary flow as they usually increase during hyperemia. Data Availability techniques, including TTDE, in clinical evaluation of cor- No data were used in this study. onary microvascular function. Evaluation of coronary microvascular function can Conflicts of Interest benefit angina patients in terms of a diagnosis and symptom management. Currently, there is no evidence-based treat- ,e authors declare no conflicts of interest. ment of CMD; however, management of lifestyle factors and risk factors may have a beneficial effect [55]. According to References the recent CorMica (Coronary Microvascular Angina) trial, a patient-centered approach, including evaluation of coro- [1] M. R. Patel, E. D. Peterson, D. Dai et al., “Low diagnostic yield of elective coronary angiography,” New England Journal of nary microcirculation as an add-on procedure to diagnostic Medicine, vol. 362, no. 10, pp. 886–895, 2010. invasive angiography, linked together with medical therapy [2] C. N. Bairey Merz, C. J. Pepine, M. N. Walsh, and J. L. Fleg, (antianginal and prevention therapies, including lifestyle “Ischemia and No obstructive coronary artery disease modification), is feasible and improves angina in patients (INOCA),” Circulation, vol. 135, no. 11, pp. 1075–1092, 2017. with no obstructive CAD [58]. Looking beyond angina [3] M. R. Patel, D. Dai, A. F. Hernandez et al., “Prevalence and patients with nonobstructive CAD, CMD can be present in predictors of nonobstructive coronary artery disease identi- other clinical settings, including myocardial diseases (e.g., fied with coronary angiography in contemporary clinical hypertrophic or dilated cardiomyopathy and amyloidosis), practice,” American Heart Journal, vol. 167, no. 6, aortic stenosis, and obstructive CAD [59]. However, pp. 846–852, 2014. 6 Journal of Interventional Cardiology [4] L. Jespersen, A. Hvelplund, S. Z. Abildstrom et al., “Stable [19] S.-D. Lee, W.-C. Huang, N.-J. Peng, and C. Hu, “Dipyr- angina pectoris with no obstructive coronary artery disease is idamole-induced adverse effects in myocardial perfusion associated with increased risks of major adverse cardiovas- scans: dynamic evaluation,” IJC Heart & Vasculature, vol. 14, cular events,” European Heart Journal, vol. 33, no. 6, pp. 14–19, 2016. pp. 734–744, 2012. [20] P. Smits, S. B. Williams, D. E. Lipson, P. Banitt, G. A. Rongen, [5] C. N. Merz, S. F. Kelsey, C. J. Pepine et al., “,e women’s and M. A. Creager, “Endothelial release of nitric oxide ischemia syndrome evaluation (WISE) study: protocol design, contributes to the vasodilator effect of adenosine in humans,” methodology and feasibility report,” Journal of the American Circulation, vol. 92, no. 8, pp. 2135–2141, 1995. College of Cardiology, vol. 33, no. 6, pp. 1453–1461, 1999. [21] H. E. Lim, W. J. Shim, H. Rhee et al., “Assessment of coronary [6] E. Prescott, S. Z. Abildstrøm, A. Aziz et al., “Improving di- flow reserve with transthoracic doppler echocardiography: agnosis and treatment of women with angina pectoris and comparison among adenosine, standard-dose dipyridamole, microvascular disease: the iPOWER study design and ratio- and high-dose dipyridamole,” Journal of the American Society nale,” American Heart Journal, vol. 167, no. 4, pp. 452–458, of Echocardiography, vol. 13, no. 4, pp. 264–270, 2000. [22] P. A. Pellikka, A. Arruda-Olson, F. A. Chaudhry et al., [7] P. Brainin, D. Frestad, and E. Prescott, “,e prognostic value “Guidelines for performance, interpretation, and application of coronary endothelial and microvascular dysfunction in of stress echocardiography in ischemic heart disease: from the subjects with normal or non-obstructive coronary artery American society of echocardiography,” Journal of the disease: a systematic review and meta-analysis,” International American Society of Echocardiography, vol. 33, no. 1, pp. 1–41, Journal of Cardiology, vol. 254, pp. 1–9, 2018. [8] F. Crea, G. A. Lanza, and P. G. Camici, Coronary Micro- [23] C. Caiati, C. Montaldo, N. Zedda et al., “Validation of a new vascular Dysfunction, Springer, New York, NY, USA, 2014. noninvasive method (contrast-enhanced transthoracic second [9] K. L. Gould and K. Lipscomb, “Effects of coronary stenoses on harmonic echo doppler) for the evaluation of coronary flow coronary flow reserve and resistance,” 4e American Journal reserve,” Journal of the American College of Cardiology, of Cardiology, vol. 34, no. 1, pp. 48–55, 1974. vol. 34, no. 4, pp. 1193–1200, 1999. [10] A. I. Loffler ¨ and J. M. Bourque, “Coronary microvascular [24] S. M. Kim, W. J. Shim, H. E. Lim et al., “Assessment of dysfunction, microvascular angina, and management,” Cur- coronary flow reserve with transthoracic Doppler echocar- rent Cardiology Reports, vol. 18, pp. 1–7, 2016. diography: comparison with intracoronary Doppler method,” [11] M. M. Michelsen, A. Pena, N. D. Mygind et al., “Coronary Journal of Korean Medical Science, vol. 15, no. 2, pp. 139–145, flow velocity reserve assessed by transthoracic doppler: the iPOWER study: factors influencing feasibility and quality,” [25] D. J. R. Hildick-Smith, R. Maryan, and L. M. Shapiro, “As- Journal of the American Society of Echocardiography, vol. 29, sessment of coronary flow reserve by adenosine transthoracic no. 7, pp. 709–716, 2016. echocardiography: validation with intracoronary doppler,” [12] J. Vegsundvag, ˚ E. Holte, R. Wiseth, K. Hegbom, and T. Hole, Journal of the American Society of Echocardiography, vol. 15, “Coronary flow velocity reserve in the three main coronary no. 9, pp. 984–990, 2002. arteries assessed with transthoracic Doppler: a comparative [26] T. Hozumi, K. Yoshida, T. Akasaka et al., “Noninvasive as- study with quantitative coronary angiography,” Journal of the sessment of coronary flow velocity and coronary flow velocity American Society of Echocardiography, vol. 24, no. 7, reserve in the left anterior descending coronary artery by pp. 758–767, 2011. doppler echocardiography,” Journal of the American College of [13] M. Krzanowski, W. Bodzon, ´ and P. P. Dimitrow, “Imaging of Cardiology, vol. 32, no. 5, pp. 1251–1259, 1998. all three coronary arteries by transthoracic echocardiography. [27] H. Lethen, H. P. Tries, J. Brechtken, S. Kersting, and An illustrated guide,” Cardiovascular Ultrasound, vol. 1, no. 1, H. Lambertz, “Comparison of transthoracic doppler echo- p. 16, 2003. cardiography to intracoronary doppler guidewire measure- [14] T. Wada, K. Hirata, Y. Shiono et al., “Coronary flow velocity ments for assessment of coronary flow reserve in the left reserve in three major coronary arteries by transthoracic anterior descending artery for detection of restenosis after echocardiography for the functional assessment of coronary coronary angioplasty,” 4e American Journal of Cardiology, artery disease: a comparison with fractional flow reserve,” vol. 91, no. 4, pp. 412–417, 2003. European Heart Journal-Cardiovascular Imaging, vol. 15, [28] M. Saraste, J. W. Koskenvuo, J. Knuuti et al., “Coronary flow no. 4, pp. 399–408, 2014. reserve: measurement with transthoracic Doppler echocar- [15] P. Meimoun and C. Tribouilloy, “Non-invasive assessment of diography is reproducible and comparable with positron coronary flow and coronary flow reserve by transthoracic emission tomography,” Clinical Physiology, vol. 21, no. 1, doppler echocardiography: a magic tool for the real world,” pp. 114–122, 2001. European Journal of Echocardiography, vol. 9, no. 4, [29] M. Galderisi, S. Cicala, A. D’Errico, O. De Divitiis, and pp. 449–457, 2008. G. De Simone, “Nebivolol improves coronary flow reserve in [16] C. E. Muller ¨ and K. A. Jacobson, “Xanthines as adenosine hypertensive patients without coronary heart disease,” Journal receptor antagonists,” Handbook of Experimental Pharma- of Hypertension, vol. 22, no. 11, pp. 2201–2208, 2004. cology, vol. 200, pp. 151–199, 2011. [30] M. M. Michelsen, N. D. Mygind, A. Pena et al., “Transthoracic [17] T. W. Hein, W. Wang, B. Zoghi, M. Muthuchamy, and L. Kuo, doppler echocardiography compared with positron emission “Functional and molecular characterization of receptor tomography for assessment of coronary microvascular dys- subtypes mediating coronary microvascular dilation to function: the iPOWER study,” International Journal of Car- adenosine,” Journal of Molecular and Cellular Cardiology, vol. 33, no. 2, pp. 271–282, 2001. diology, vol. 228, pp. 435–443, 2017. [31] R. H. Olsen, L. R. Pedersen, M. Snoer et al., “Coronary flow [18] R. Saab and F. G. Hage, “Vasodilator stress agents for myocardial perfusion imaging,” Journal of Nuclear Cardiol- velocity reserve by echocardiography: feasibility, reproduc- ogy, vol. 24, no. 2, pp. 434–438, 2017. ibility and agreement with PET in overweight and obese Journal of Interventional Cardiology 7 patients with stable and revascularized coronary artery dis- women’s ischemia syndrome evaluation (WISE),” Clinical ease,” Cardiovascular Ultrasound, vol. 14, no. 1, p. 22, 2016. Cardiology, vol. 30, no. 2, pp. 69–74, 2007. [32] M. Snoer, T. Monk-Hansen, R. H. Olsen et al., “Coronary flow [45] M. Daimon, H. Watanabe, H. Yamagishi et al., “Physiologic reserve as a link between diastolic and systolic function and assessment of coronary artery stenosis without stress tests: exercise capacity in heart failure,” European Heart Journal- noninvasive analysis of phasic flow characteristics by trans- Cardiovascular Imaging, vol. 14, no. 7, p. 677, 2012. thoracic doppler echocardiography,” Journal of the American [33] C. Byrne, A. Kjaer, N. E. Olsen, J. L. Forman, and P. Hasbak, Society of Echocardiography, vol. 18, no. 9, pp. 949–955, 2005. “Test-retest repeatability and software reproducibility of [46] P. Voci, F. Pizzuto, E. Mariano, P. E. Puddu, P. A. Chiavari, and F. Romeo, “Measurement of coronary flow reserve in the myocardial flow measurements using rest/adenosine stress Rubidium-82 PET/CT with and without motion correction in anterior and posterior descending coronary arteries by healthy young volunteers,” Journal of Nuclear Cardiology, transthoracic doppler ultrasound,” 4e American Journal of 2020. Cardiology, vol. 90, no. 9, pp. 988–991, 2002. [34] L. E. J. ,omson, J. Wei, M. Agarwal et al., “Cardiac magnetic [47] Y. Matsumura, T. Hozumi, H. Watanabe et al., “Cut-off value resonance myocardial perfusion reserve index is reduced in of coronary flow velocity reserve by transthoracic doppler women with coronary microvascular dysfunction,” Circula- echocardiography for diagnosis of significant left anterior tion: Cardiovascular Imaging, vol. 8, no. 4, 2015. descending artery stenosis in patients with coronary risk [35] N. D. Mygind, A. Pena, M. Mide Michelsen et al., “Myocardial factors,” 4e American Journal of Cardiology, vol. 92, no. 12, first pass perfusion assessed by cardiac magnetic resonance pp. 1389–1393, 2003. and coronary microvascular dysfunction in women with [48] P. Meimoun, T. Benali, S. Sayah et al., “Evaluation of left angina and no obstructive coronary artery disease,” Scandi- anterior descending coronary artery stenosis of intermediate navian Journal of Clinical and Laboratory Investigation, severity using transthoracic coronary flow reserve and vol. 79, no. 4, pp. 238–246, 2019. dobutamine stress echocardiography,” Journal of the Amer- [36] J. Knuuti, W. Wijns, A. Saraste et al., “2019 ESC Guidelines for ican Society of Echocardiography, vol. 18, no. 12, pp. 1233– the diagnosis and management of chronic coronary syn- 1240, 2005. dromes,” European Heart Journal, vol. 41, no. 3, pp. 407–477, [49] H. Okayama, T. Sumimoto, G. Hiasa et al., “Assessment of 2020. intermediate stenosis in the left anterior descending coronary [37] N. D. Mygind, M. M. Michelsen, A. Pena et al., “Coronary artery with contrast-enhanced transthoracic doppler echo- microvascular function and cardiovascular risk factors in cardiography,” Coronary Artery Disease, vol. 14, no. 3, women with angina pectoris and no obstructive coronary pp. 247–254, 2003. artery disease: the iPOWER study,” Journal of the American [50] K. Nakanish, S. Fukuda, K. Shimada et al., “Impaired coronary Heart Association, vol. 5, no. 3, 2016. flow reserve as a marker of microvascular dysfunction to [38] C. J. Pepine, R. D. Anderson, B. L. Sharaf et al., “Coronary predict long-term cardiovascular outcomes, acute coronary microvascular reactivity to adenosine predicts adverse out- syndrome and the development of heart failure,” Circulation come in women evaluated for suspected ischemia,” Journal of Journal, vol. 76, no. 8, pp. 1958–1964, 2012. the American College of Cardiology, vol. 55, no. 25, [51] E. Balazs, ´ K. S. Pint´er, A. Egyed, M. Csanady, ´ T. Forster, and A. Nemes, “,e independent long-term prognostic value of pp. 2825–2832, 2010. [39] J. D. Sara, R. J. Widmer, Y. Matsuzawa, R. J. Lennon, coronary flow velocity reserve in female patients with chest L. O. Lerman, and A. Lerman, “Prevalence of coronary mi- pain and negative coronary angiograms (Results from the crovascular dysfunction among patients with chest pain and SZEGED study),” International Journal of Cardiology, nonobstructive coronary artery disease,” JACC: Cardiovas- vol. 146, no. 2, pp. 259–261, 2011. cular Interventions, vol. 8, no. 11, pp. 1445–1453, 2015. [52] J. A. Lowenstein, C. Caniggia, G. Rousse et al., “Coronary flow [40] R. Sicari, F. Rigo, L. Cortigiani, S. Gherardi, M. Galderisi, and velocity reserve during pharmacologic stress echocardiogra- E. Picano, “Additive prognostic value of coronary flow reserve phy with normal contractility adds important prognostic in patients with chest pain syndrome and normal or near- value in diabetic and nondiabetic patients,” Journal of the American Society of Echocardiography, vol. 27, no. 10, normal coronary arteries,” 4e American Journal of Cardi- ology, vol. 103, no. 5, pp. 626–631, 2009. pp. 1113–1119, 2014. [53] L. Cortigiani, F. Rigo, S. Gherardi et al., “Coronary flow re- [41] S. A. L. Ahmari, T. J. Bunch, K. Modesto et al., “Impact of individual and cumulative coronary risk factors on coronary serve during dipyridamole stress echocardiography predicts flow reserve assessed by dobutamine stress echocardiogra- mortality,” JACC: Cardiovascular Imaging, vol. 5, no. 11, phy,” 4e American Journal of Cardiology, vol. 101, no. 12, pp. 1079–1085, 2012. pp. 1694–1699, 2008. [54] V. L. Murthy, M. Naya, C. R. Foster et al., “Improved cardiac [42] B. Tuccillo, M. Accadia, S. Rumolo et al., “Factors predicting risk assessment with noninvasive measures of coronary flow coronary flow reserve impairment in patients evaluated for reserve,” Circulation, vol. 124, no. 20, pp. 2215–2224, 2011. [55] V. Kunadian, A. Chieffo, P. G. Camici et al., “An EAPCI chest pain: an ultrasound study,” Journal of Cardiovascular Medicine, vol. 9, no. 3, pp. 251–255, 2008. expert consensus document on ischaemia with non-ob- structive coronary arteries in collaboration with European [43] D.-H. Lee, H.-J. Youn, Y.-S. Choi et al., “Coronary flow re- serve is a comprehensive indicator of cardiovascular risk society of cardiology working group on coronary patho- factors in subjects with chest pain and normal coronary physiology & microcirculation endorsed by coronary vaso- angiogram,” Circulation Journal, vol. 74, no. 7, pp. 1405–1414, motor disorders international study group,” European Heart 2010. Journal, vol. 41, no. 37, pp. 3504–3520, 2020. [44] T. R. Wessel, C. B. Arant, S. P. McGorray et al., “Coronary [56] D. F. Bechsgaard, I. Gustafsson, M. M. Michelsen et al., “Vital microvascular reactivity is only partially predicted by ath- exhaustion in women with chest pain and no obstructive coronary artery disease: the iPOWER study,” Evidence Based erosclerosis risk factors or coronary artery disease in women evaluated for suspected ischemia: results from the NHLBI Mental Health, 2020. 8 Journal of Interventional Cardiology [57] L. Jespersen, S. Z. Abildstrom, A. Hvelplund et al., “Symptoms of angina pectoris increase the probability of disability pen- sion and premature exit from the workforce even in the absence of obstructive coronary artery disease,” European Heart Journal, vol. 34, no. 42, pp. 3294–3303, 2013. [58] T. J. Ford, B. Stanley, R. Good et al., “Stratified medical therapy using invasive coronary function testing in angina,” Journal of the American College of Cardiology, vol. 72, no. 23, pp. 2841–2855, 2018. [59] F. Crea, P. G. Camici, and C. N. Bairey Merz, “Coronary microvascular dysfunction: an update,” European Heart Journal, vol. 35, no. 17, pp. 1101–1111, 2014.
Journal
Journal of Interventional Cardiology – Hindawi Publishing Corporation
Published: Mar 29, 2021