Echocardiographic and hemodynamic determinants of right coronary artery flow reserve and phasic flow pattern in advanced non-ischemic cardiomyopathy

<p>Abstract</p> <p>Background</p> <p>In patients with advanced non-ischemic cardiomyopathy (NIC), right-sided cardiac disturbances has prognostic implications. Right coronary artery (RCA) flow pattern and flow reserve (CFR) are not well known in this setting. The purpose of this study was to assess, in human advanced NIC, the RCA phasic flow pattern and CFR, also under right-sided cardiac disturbances, and compare with left coronary circulation. As well as to investigate any correlation between the cardiac structural, mechanical and hemodynamic parameters with RCA phasic flow pattern or CFR.</p> <p>Methods</p> <p>Twenty four patients with dilated severe NIC were evaluated non-invasively, even by echocardiography, and also by cardiac catheterization, inclusive with Swan-Ganz catheter. Intracoronary Doppler (Flowire) data was obtained in RCA and left anterior descendent coronary artery (LAD) before and after adenosine. Resting RCA phasic pattern (diastolic/systolic) was compared between subgroups with and without pulmonary hypertension, and with and without right ventricular (RV) dysfunction; and also with LAD. RCA-CFR was compared with LAD, as well as in those subgroups. Pearson's correlation analysis was accomplished among echocardiographic (including LV fractional shortening, mass index, end systolic wall stress) more hemodynamic parameters with RCA phasic flow pattern or RCA-CFR.</p> <p>Results</p> <p>LV fractional shortening and end diastolic diameter were 15.3 ± 3.5 % and 69.4 ± 12.2 mm. Resting RCA phasic pattern had no difference comparing subgroups with vs. without pulmonary hypertension (1.45 vs. 1.29, p = NS) either with vs. without RV dysfunction (1.47 vs. 1.23, p = NS); RCA vs. LAD was 1.35 vs. 2.85 (p < 0.001). It had no significant correlation among any cardiac mechanical or hemodynamic parameter with RCA-CFR or RCA flow pattern. RCA-CFR had no difference compared with LAD (3.38 vs. 3.34, p = NS), as well as in pulmonary hypertension (3.09 vs. 3.10, p = NS) either in RV dysfunction (3.06 vs. 3.22, p = NS) subgroups. </p> <p>Conclusion</p> <p>In patients with chronic advanced NIC, RCA phasic flow pattern has a mild diastolic predominance, less marked than in LAD, with no effects from pulmonary artery hypertension or RV dysfunction. There is no significant correlation between any cardiac mechanical-structural or hemodynamic parameter with RCA-CFR or RCA phasic flow pattern. RCA flow reserve is still similar to LAD, independently of those right-sided cardiac disturbances.</p

Characterization of peri-infarct zone by CMR is a robust predictor of major adverse events and is strongly associated with systemic inflammatory response post-myocardial infarction

[No abstract available

Value of adenosine infusion for infarct size determination using real-time myocardial contrast echocardiography

BACKGROUND: Myocardial contrast echocardiography has been used for determination of infarct size (IS) in experimental models. However, with intermittent harmonic imaging, IS seems to be underestimated immediately after reperfusion due to areas with preserved, yet dysfunctional, microvasculature. The use of exogenous vasodilators showed to be useful to unmask these infarcted areas with depressed coronary flow reserve. This study was undertaken to assess the value of adenosine for IS determination in an open-chest canine model of coronary occlusion and reperfusion, using real-time myocardial contrast echocardiography (RTMCE). METHODS: Nine dogs underwent 180 minutes of coronary occlusion followed by reperfusion. PESDA (Perfluorocarbon-Exposed Sonicated Dextrose Albumin) was used as contrast agent. IS was determined by RTMCE before and during adenosine infusion at a rate of 140 mcg·Kg(-1)·min(-1). Post-mortem necrotic area was determined by triphenyl-tetrazolium chloride (TTC) staining. RESULTS: IS determined by RTMCE was 1.98 ± 1.30 cm(2 )and increased to 2.58 ± 1.53 cm(2 )during adenosine infusion (p = 0.004), with good correlation between measurements (r = 0.91; p < 0.01). The necrotic area determined by TTC was 2.29 ± 1.36 cm(2 )and showed no significant difference with IS determined by RTMCE before or during hyperemia. A slight better correlation between RTMCE and TTC measurements was observed during adenosine (r = 0.99; p < 0.001) then before it (r = 0.92; p = 0.0013). CONCLUSION: RTMCE can accurately determine IS in immediate period after acute myocardial infarction. Adenosine infusion results in a slight better detection of actual size of myocardial damage

Right coronary artery spectral Doppler coronary flow velocity signal in baseline (A) and hyperemic (B) conditions

<p><b>Copyright information:</b></p><p>Taken from "Echocardiographic and hemodynamic determinants of right coronary artery flow reserve and phasic flow pattern in advanced non-ischemic cardiomyopathy"</p><p>http://www.cardiovascularultrasound.com/content/5/1/31</p><p>Cardiovascular Ultrasound 2007;5():31-31.</p><p>Published online 26 Sep 2007</p><p>PMCID:PMC2137923.</p><p></p> S = systolic, D = diastolic, portions of phasic coronary flow. APV = time-averaged peak coronary flow velocity. DSVR = diastolic/systolic flow velocity ratio

Baseline spectral Doppler coronary flow velocity signal in right coronary artery (A) and left anterior descending coronary artery (B)

<p><b>Copyright information:</b></p><p>Taken from "Echocardiographic and hemodynamic determinants of right coronary artery flow reserve and phasic flow pattern in advanced non-ischemic cardiomyopathy"</p><p>http://www.cardiovascularultrasound.com/content/5/1/31</p><p>Cardiovascular Ultrasound 2007;5():31-31.</p><p>Published online 26 Sep 2007</p><p>PMCID:PMC2137923.</p><p></p> S = systolic, D = diastolic, portions of phasic coronary flow. APV = time-averaged peak coronary flow velocity. DSVR = diastolic/systolic flow velocity ratio

Box-plot representing the RCA vs LAD comparison respecting the coronary flow reserve, showing no significant difference

<p><b>Copyright information:</b></p><p>Taken from "Echocardiographic and hemodynamic determinants of right coronary artery flow reserve and phasic flow pattern in advanced non-ischemic cardiomyopathy"</p><p>http://www.cardiovascularultrasound.com/content/5/1/31</p><p>Cardiovascular Ultrasound 2007;5():31-31.</p><p>Published online 26 Sep 2007</p><p>PMCID:PMC2137923.</p><p></p> LAD – left anterior descending coronary artery; N – number of patients; RCA – right coronary artery

Box-plot representing the RCA phasic coronary flow pattern (D/S) according the RV ejection fraction, showing no difference between RV non-dysfunctional vs

<p><b>Copyright information:</b></p><p>Taken from "Echocardiographic and hemodynamic determinants of right coronary artery flow reserve and phasic flow pattern in advanced non-ischemic cardiomyopathy"</p><p>http://www.cardiovascularultrasound.com/content/5/1/31</p><p>Cardiovascular Ultrasound 2007;5():31-31.</p><p>Published online 26 Sep 2007</p><p>PMCID:PMC2137923.</p><p></p> dysfunctional subgroups. APV – time-averaged peak coronary flow velocity; D/S – diastolic/systolic APV ratio; N – number of patients; RCA – right coronary artery; RV EF – right ventricular ejection fraction