Data on coronary flow reserve (CFR) in patients with syndrome X are still controversial. Furthermore, a non-invasive evaluation of epicardial and microvascular flow reserve in these patients has never been performed. In 17 patients with syndrome X and in 17 age and sex-matched controls, CFR in the mid left anterior descending (LAD) coronary artery was evaluated by transthoracic color and pulse wave Doppler, using a 7 mHz probe (Sequoia, Siemens). Peak diastolic LAD flow was calculated at rest and at peak adenosine (140 µg/kg/min i.v. in 90 sec). Myocardial contrast echo (MCE) was performed at rest and during adenosine by real time Cadence Pulse Sequencing (CPS) and i.v. Sonovue® (Bracco) (5 ml at 1 ml/min) and microvascular blood volume (A), velocity (β) and flow (Axβ) by replenishing curves (y=A(1-eβt)). CFR was measured both by Doppler echo as adenosine/rest velocity ratio, and by MCE as microvascular volume (A), velocity (β) and flow (Axβ) adenosine/rest ratio. Compared to controls, patients with syndrome X demonstrated lower LAD CFR, β MFR and Axβ MFR (p<0.01, p<0.005 and p<0.005 respectively). Among syndrome X patients, those with angina and ST-segment depression during adenosine test had even lower LAD CFR, β MFR and Axβ MFR compared with those with no-symptoms (p<0.0001, p<0.0001, p<0.005 respectively). LAD CFR demonstrated a significant linear correlation with β MFR (r=.92, p<.0001) and Axβ MFR (r=.77, p<.0001). In conclusion, CFR in the LAD, successfully evaluated by transthoracic Doppler echo and MCE, is significantly reduced in syndrome X patients and even more in those with angina pectoris and ST-segment depression during adenosine test. Thus, non-invasive evaluation of CFR by echo is feasible and it provides information on the severity of the microvascular impairment.

Galiuto, L., Sestito, A., Barchetta, S., Sgueglia, G. A., Infusino, F., La Rosa, C., Lanza, G. A., Crea, F., Noninvasive evaluation of flow reserve in the left anterior descending coronary artery in patients with cardiac syndrome X, <<THE AMERICAN JOURNAL OF CARDIOLOGY>>, 2007; (Maggio): 1378-1383 [http://hdl.handle.net/10807/32917]

Noninvasive evaluation of flow reserve in the left anterior descending coronary artery in patients with cardiac syndrome X

Galiuto, Leonarda;Sestito, Alfonso;Barchetta, Sabrina;Sgueglia, Gregory Angelo;Infusino, Fabio;Lanza, Gaetano Antonio;Crea, Filippo
2007

Abstract

Data on coronary flow reserve (CFR) in patients with syndrome X are still controversial. Furthermore, a non-invasive evaluation of epicardial and microvascular flow reserve in these patients has never been performed. In 17 patients with syndrome X and in 17 age and sex-matched controls, CFR in the mid left anterior descending (LAD) coronary artery was evaluated by transthoracic color and pulse wave Doppler, using a 7 mHz probe (Sequoia, Siemens). Peak diastolic LAD flow was calculated at rest and at peak adenosine (140 µg/kg/min i.v. in 90 sec). Myocardial contrast echo (MCE) was performed at rest and during adenosine by real time Cadence Pulse Sequencing (CPS) and i.v. Sonovue® (Bracco) (5 ml at 1 ml/min) and microvascular blood volume (A), velocity (β) and flow (Axβ) by replenishing curves (y=A(1-eβt)). CFR was measured both by Doppler echo as adenosine/rest velocity ratio, and by MCE as microvascular volume (A), velocity (β) and flow (Axβ) adenosine/rest ratio. Compared to controls, patients with syndrome X demonstrated lower LAD CFR, β MFR and Axβ MFR (p<0.01, p<0.005 and p<0.005 respectively). Among syndrome X patients, those with angina and ST-segment depression during adenosine test had even lower LAD CFR, β MFR and Axβ MFR compared with those with no-symptoms (p<0.0001, p<0.0001, p<0.005 respectively). LAD CFR demonstrated a significant linear correlation with β MFR (r=.92, p<.0001) and Axβ MFR (r=.77, p<.0001). In conclusion, CFR in the LAD, successfully evaluated by transthoracic Doppler echo and MCE, is significantly reduced in syndrome X patients and even more in those with angina pectoris and ST-segment depression during adenosine test. Thus, non-invasive evaluation of CFR by echo is feasible and it provides information on the severity of the microvascular impairment.
Inglese
Galiuto, L., Sestito, A., Barchetta, S., Sgueglia, G. A., Infusino, F., La Rosa, C., Lanza, G. A., Crea, F., Noninvasive evaluation of flow reserve in the left anterior descending coronary artery in patients with cardiac syndrome X, <<THE AMERICAN JOURNAL OF CARDIOLOGY>>, 2007; (Maggio): 1378-1383 [http://hdl.handle.net/10807/32917]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10807/32917
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