22 research outputs found

    Inflammation, Coronary Flow Reserve, and Microvascular Dysfunction Moving Beyond Cardiac Syndrome X∗

    Get PDF

    Ranolazine in Symptomatic Diabetic Patients Without Obstructive Coronary Artery Disease: Impact on Microvascular and Diastolic Function

    Get PDF
    Background: Treatments for patients with myocardial ischemia in the absence of angiographic obstructive coronary artery disease are limited. In these patients, particularly those with diabetes mellitus, diffuse coronary atherosclerosis and microvascular dysfunction is a common phenotype and may be accompanied by diastolic dysfunction. Our primary aim was to determine whether ranolazine would quantitatively improve exercise‐stimulated myocardial blood flow and cardiac function in symptomatic diabetic patients without obstructive coronary artery disease. Methods and Results: We conducted a double‐blinded crossover trial with 1:1 random allocation to the order of ranolazine and placebo. At baseline and after each 4‐week treatment arm, left ventricular myocardial blood flow and coronary flow reserve (CFR; primary end point) were measured at rest and after supine bicycle exercise using 13N‐ammonia myocardial perfusion positron emission tomography. Resting echocardiography was also performed. Multilevel mixed‐effects linear regression was used to determine treatment effects. Thirty‐five patients met criteria for inclusion. Ranolazine did not significantly alter rest or postexercise left ventricular myocardial blood flow or CFR. However, patients with lower baseline CFR were more likely to experience improvement in CFR with ranolazine (r=−0.401, P=0.02) than with placebo (r=−0.188, P=0.28). In addition, ranolazine was associated with an improvement in E/septal e′ (P=0.001) and E/lateral e′ (P=0.01). Conclusions: In symptomatic diabetic patients without obstructive coronary artery disease, ranolazine did not change exercise‐stimulated myocardial blood flow or CFR but did modestly improve diastolic function. Patients with more severe baseline impairment in CFR may derive more benefit from ranolazine. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01754259

    Novel Imaging Approaches for the Diagnosis of Stable Ischemic Heart Disease in Women

    Get PDF
    Conventional recommendations for diagnostic testing for the evaluation of stable ischemic heart disease in women have largely paralleled those in men. Although they are designed primarily for the identification of obstructive coronary artery disease (CAD), traditional approaches can lead to overtesting in women without differentiating who is truly at risk. Several unique factors related to the presentation, diagnosis, and underlying pathophysiology of stable ischemic heart disease in women necessitate a more specific approach to the assessment of their risk, complete with separate guidelines when appropriate. This overview highlights how advanced noninvasive imaging tools, including cardiac computed tomography angiography, positron emission tomography, and cardiac magnetic resonance imaging, are enabling very sensitive assessments of anatomic atherosclerotic plaque burden, macrovessel- and microvessel-related ischemia, and myocardial fibrosis, respectively. Moving forward, effective diagnostic testing will need to identify women at high risk of adverse cardiovascular events (not anatomically obstructive CAD per se) without overtesting those at low risk. Judicious application of novel imaging approaches will be critical to broadening the definitions of CAD and ischemia to better reflect the whole spectrum of pathological phenotypes in women, including nonobstructive CAD and coronary microvascular dysfunction, and aid in the development of needed evidence-based strategies for their management

    Coronary arterial function and disease in women with no obstructive coronary arteries

    No full text
    Ischemic heart disease (IHD) is the leading cause of mortality in women. While traditional cardiovascular risk factors play an important role in the development of IHD in women, women may experience sex-specific IHD risk factors and pathophysiology, and thus female-specific risk stratification is needed for IHD prevention, diagnosis, and treatment. Emerging data from the past 2 decades have significantly improved the understanding of IHD in women, including mechanisms of ischemia with no obstructive coronary arteries and myocardial infarction with no obstructive coronary arteries. Despite this progress, sex differences in IHD outcomes persist, particularly in young women. This review highlights the contemporary understanding of coronary arterial function and disease in women with no obstructive coronary arteries, including coronary anatomy and physiology, mechanisms of ischemia with no obstructive coronary arteries and myocardial infarction with no obstructive coronary arteries, noninvasive and invasive diagnostic strategies, and management of IHD
    corecore