Abstract only
Background:
Coronary vasomotor dysfunction identifies patients at risk for cardiac death. We sought to determine the association between global coronary flow reserve (CFR, an integrated ...measure of coronary vasomotor function) and adverse cardiovascular events, in patients referred for coronary angiography with or without subsequent revascularization.
Methods and Results:
Consecutive patients (n=329) without prior coronary artery bypass surgery (CABG), heart failure, or left ventricular (LV) systolic dysfunction referred for invasive coronary angiography after stress testing with myocardial perfusion positron emission tomography (PET) were followed (median 3.1 years) for cardiovascular death and heart failure admission. Extent and severity of coronary angiographic stenosis was estimated using the CAD prognostic index (CADPI) and CFR measured noninvasively by PET. A subset of patients (n=193) underwent early revascularization, defined as CABG and/or percutaneous coronary intervention (PCI) within 90 days after PET. After adjusting for clinical risk score, LV ejection fraction, LV ischemia, CADPI, and time-dependent early revascularization with CABG and/or PCI, CFR remained independently associated with events (hazard ratio for unit decrease in CFR, 2.02; 95% CI 1.20-3.40, p=0.008). In adjusted analysis, there was a significant interaction (p=0.04) between CFR and early revascularization by CABG, such that patients with impaired CFR who underwent CABG (n=39), but not PCI (n=154), experienced event rates comparable to those with preserved CFR, independently of revascularization.
Conclusions:
CFR associated with adverse cardiovascular outcomes independently of angiographic severity, and modified the effect of early revascularization. Diffuse atherosclerosis and microvascular dysfunction may contribute to the pathophysiology of cardiovascular death and heart failure, and impact upon the outcomes of revascularization.
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•Evolving data support that inflammation, especially via IL-6, may be a key mediator of cardiovascular outcomes including heart failure, but what is the impact of residual ...inflammatory risk on coronary and cardiac function?•In patients with cardiometabolic disease enrolled in the prospective, multicenter ancillary study of CIRT (CIRT-CFR), impaired coronary flow reserve was independently associated with markers of increased inflammation and myocardial strain despite well-controlled glycemic, lipid, and hemodynamic profiles.•Inflammation modified the relationship between coronary flow reserve and myocardial strain, disrupting the association between cardiac blood flow and function.•Residual inflammatory risk was linked to abnormalities detected on sensitive imaging markers of coronary blood flow and myocardial function. Future studies are needed to investigate whether an early inflammation-mediated reduction in coronary flow reserve that captures microvascular ischemia may lead to heart failure in patients with cardiometabolic disease.
Inflammation is a key determinant of cardiovascular outcomes, but its role in heart failure is uncertain. In patients with cardiometabolic disease enrolled in the prospective, multicenter ancillary study of CIRT (Cardiovascular Inflammation Reduction Trial), CIRT-CFR (Coronary Flow Reserve to Assess Cardiovascular Inflammation), impaired coronary flow reserve was independently associated with increased inflammation and myocardial strain despite well-controlled lipid, glycemic, and hemodynamic profiles. Inflammation modified the relationship between CFR and myocardial strain, disrupting the association between cardiac blood flow and function. Future studies are needed to investigate whether an early inflammation-mediated reduction in CFR capturing microvascular ischemia may lead to heart failure in patients with cardiometabolic disease. (Cardiovascular Inflammation Reduction Trial CIRT; NCT01594333; Coronary Flow Reserve to Assess Cardiovascular Inflammation CIRT-CFR; NCT02786134)
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
IntroductionCoronary microvascular dysfunction (CMD), defined as impaired coronary flow reserve (CFR) in the absence of flow-limiting CAD, is associated with an increased risk of adverse events. ...Previous studies investigating the relationship between CMD and all-cause mortality have excluded patients with malignancy.HypothesisWe sought to test the prognostic usefulness of CMD, here reflecting a marker of vascular health, in patients with thoracic malignancy referred clinically for cardiac stress positron emission tomography (PET).MethodsConsecutive patients with thoracic malignancy who underwent cardiac PET, including CFR assessment, for evaluation of chest pain/dyspnea or pre-operative assessment from 2006 to 2017 were studied retrospectively. Patients with a history of CAD, LVEF <45%, or abnormal myocardial perfusion on PET were excluded.ResultsAmong the 191 patients (median age 66.4 years, 68.5% female, mean CFR 2.02) in the final cohort, 46% had breast cancer, 23% had lung cancer, 14% had mesothelioma, 11% had lymphoma (with thoracic involvement), and 7% had esophageal cancer. 32% had metastatic disease at the time of cancer diagnosis. 89% underwent surgery, 53% were treated with chemotherapy, and 63% were treated with chest irradiation. 36% percent had recurrence of their disease. There was no difference in mean CFR between cancer type or treatment groups. The median time between cancer diagnosis and PET was 4.48 years. Over a median follow-up of 6.68 years after PET, the lowest CFR tertile was associated with higher all-cause mortality after adjusting for age, sex, diabetes, BMI, metastatic disease, recurrent disease, time between cancer diagnosis and PET, and treatment with chemotherapy, chest irradiation, or surgery (HR 2.68; 95% CI 1.55 - 4.63; p<0.001) (Figure).ConclusionsIn patients with thoracic malignancy, CMD was independently associated with worse outcomes. CFR may have utility as a marker of risk among patients with malignancy.
IntroductionBMI is an imperfect marker of cardiovascular prognosis. Coronary microvascular dysfunction (CMD) is prevalent in obese patients and a better discriminator of risk than BMI, but the ...association between CMD and body composition is not well understood. Using a novel neural networks algorithm for body composition analysis, we sought to investigate the relationship between CMD and subcutaneous fat, visceral fat, skeletal muscle and cardiovascular outcomes across a range of BMIs.MethodsConsecutive patients (N=400) undergoing evaluation for CAD with cardiac stress positron emission tomography demonstrating normal perfusion, preserved LVEF and available abdominal CT imaging were followed over a median of 6 years for events (MACE), including death and hospitalization for myocardial infarction or heart failure. Stress and rest myocardial blood flows were quantified and coronary flow reserve (CFR) estimated from their ratio. Subcutaneous fat (SF), visceral fat (VF), and skeletal muscle (SM) areas (cm) were extracted at the L3 CT slice level using a validated, fully automated neural networks algorithm. Patients with known cancer or planned bariatric surgery at time of imaging were excluded.ResultsMedian age of the cohort was 63, 70.5% were female and 50% nonwhite. Compared with the nonobese, obese patients (50%, BMI 30-68.4 kg/m) had higher SF (394.5 vs 202.9), VF (201.8 vs 119.3) and SM (130.5 vs 112.2, p<0.001 for all). Increased SF and decreased SM correlated modestly with CMD (r=0.15 and -0.11, respectively, p<0.03 for both). After adjusting for BMI, age, sex, race, diabetes, hypertension, dyslipidemia, renal function and LVEF, CMD remained significantly associated with SM but not SF or VF (OR 1.12 per -10cm SM for CFR<2, p=0.008). In fully adjusted analysis, both CMD and SM, but not SF or VF, were independently associated with MACE HR 1.63 (1.10-2.40) per -1 CFR and 1.17 (1.07-1.27) per -10cm SM, respectively).ConclusionsDecreased skeletal muscle, but not increased fat area was associated with CMD and adverse outcomes independently of BMI and traditional risk factors. Characterization of skeletal muscle mass in obese individuals may provide a missing link to better understanding at-risk vs “metabolically healthy” obese phenotypes.
Purpose
While it is well known that patients with chronic kidney disease (CKD) are at increased risk for the development and progression of atherosclerosis, it is not known whether arterial ...inflammation is increased in mild CKD. The aim of this study was to compare arterial inflammation using
18
F-FDG PET/CT in patients with CKD and in matched controls.
Methods
This restrospective study included 128 patients undergoing FDG PET/CT imaging for clinical indications, comprising 64 patients with stage 3 CKD and 64 control patients matched by age, gender, and cancer history. CKD was defined according to guidelines using a calculated glomerular filtration rate (eGFR). Arterial inflammation was measured in the ascending aorta as FDG uptake on PET. Background FDG uptake (venous, subcutaneous fat and muscle) were recorded. Coronary artery calcification (CAC) was assessed using the CT images. The impact of CKD on arterial inflammation and CAC was then assessed.
Results
Arterial inflammation was higher in patients with CKD than in matched controls (standardized uptake value, SUV: 2.41 ± 0.49 vs. 2.16 ± 0.43;
p
= 0.002). Arterial SUV correlated inversely with eGFR (
r
= −0.299,
p
= 0.001). Venous SUV was also significantly elevated in patients with CKD, while subcutaneous fat and muscle tissue SUVs did not differ between groups. Moreover, arterial SUV remained significantly elevated in patients with CKD compared to controls after correcting for muscle and fat background, and also remained significant after adjusting for clinical risk factors. Further, CKD was associated with arterial inflammation (SUV) independent of the presence of subclinical atherosclerosis (CAC).
Conclusion
Moderate CKD is associated with increased arterial inflammation beyond that of controls. Further, the increased arterial inflammation is independent of presence of subclinical atherosclerosis. Current risk stratification tools may underestimate the presence of atherosclerosis in patients with CKD and thereby the risk of cardiovascular events.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, SIK, UILJ, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
Methods In our prospective, double-blind clinical trial, diabetic patients with angina and/or dyspnea were randomized to ranolazine or placebo for 4 weeks, underwent a 3-day washout, then crossed ...over to the alternative treatment.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background To assess arterial inflammation, using 18-F-fluorodeoxyglucose positron emission tomography/computed tomography imaging (FDG-PET/CT), in patients with chronic kidney disease (CKD).
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Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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