| Assessment of microcirculatory remodeling with intracoronary flow velocity and pressure measurements: validation with endomyocardial sampling in cardiac allografts. | |
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MedLine Citation:
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PMID: 19805652 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Intracoronary physiology techniques have been validated extensively for the assessment of epicardial stenoses but not for the lone study of coronary microcirculation. We performed a comparison between 4 intracoronary physiological indices with the actual structural microcirculatory changes documented in transplanted hearts. METHODS AND RESULTS: In 17 cardiac allograft patients without coronary stenoses, ECG, intracoronary Doppler flow velocity, and aortic pressure were digitally recorded before and during maximal hyperemia with a dedicated system. Postprocessing of data yielded 4 indices of microcirculatory status: coronary flow velocity reserve (2.13+/-0.59), instantaneous hyperemic diastolic velocity pressure slope (2.33+/-1.25 cm x s x (-1)mm Hg(-1)), coronary resistance index (1.65+/-0.88 mm Hg x cm(-1) x s(-1)), and coronary resistance reserve (2.36+/-0.65). Quantitative morphometry was performed in endomyocardial biopsies during the same hospital intake; arteriolar obliteration (76.57+/-6.95%) and density (2.00+/-1.22 arterioles per 1 mm(2)) and capillary density (645+/-179 capillaries per 1 mm(2)) were measured. Univariate regression analysis between intracoronary measurements and histological findings revealed that instantaneous hyperemic diastolic velocity-pressure slope correlated with arteriolar obliteration (r=0.58, P=0.014) and capillary density (r=0.60, P=0.012). Statistical adjustment revealed an independent contribution of arteriolar obliteration (beta=0.61, P=0.0009) and capillary density (beta=-0.60, P=0.0008) to instantaneous hyperemic diastolic velocity-pressure slope values, resulting in an excellent predictive model (r=0.84, P=0.0002). Coronary resistance index correlated only with capillary density (r=0.70, P=0.019). Relative indices (coronary flow velocity reserve and coronary resistance reserve) did not correlate significantly with arteriolar obliteration, capillary density, or arteriolar density. CONCLUSIONS: Intracoronary indices derived from pressure and flow, particularly instantaneous hyperemic diastolic velocity-pressure slope, appear to be superior to coronary flow velocity reserve in detecting structural microcirculatory changes. Both arteriolar obliteration and capillary rarefaction seem to influence microcirculatory hemodynamics independently. |
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Authors:
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Javier Escaned; Alex Flores; Pablo García-Pavía; Javier Segovia; Jesús Jimenez; Paloma Aragoncillo; Clara Salas; Fernando Alfonso; Rosana Hernández; Dominick J Angiolillo; Pilar Jiménez-Quevedo; Camino Bañuelos; Luis Alonso-Pulpón; Carlos Macaya |
Publication Detail:
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Type: Comparative Study; Journal Article; Validation Studies Date: 2009-10-05 |
Journal Detail:
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Title: Circulation Volume: 120 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2009 Oct |
Date Detail:
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Created Date: 2009-10-20 Completed Date: 2009-11-13 Revised Date: 2010-08-03 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 1561-8 Citation Subset: AIM; IM |
Affiliation:
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Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain. escaned@secardiologia.es |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Arterioles / pathology Blood Flow Velocity* Blood Pressure* Capillaries / pathology Coronary Circulation* Diastole Endocardium / pathology Female Heart Transplantation* Humans Hyperemia / physiopathology Male Microvessels / physiopathology* Middle Aged Myocardium / pathology Predictive Value of Tests Transplantation, Homologous Vascular Resistance Young Adult |
| Comments/Corrections | |
Comment In:
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Circulation. 2010 Jul 27;122(4):e404; author reply e405
[PMID:
20660811
]
Circulation. 2009 Oct 20;120(16):1555-7 [PMID: 19805646 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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