Article
Peripheral Vascular Disease
Jonathan A. Mailey, Julie S. Moore, Paul F. Brennan, Min Jing, Agnes Awuah, James A. D. McLaughlin, M. Andrew Nesbit, Tara C. B. Moore, Mark S. Spence
Summary: Coronary microvascular dysfunction (CMD) can be observed non-invasively in the bulbar conjunctiva, which suggests that conjunctival vascular imaging may serve as a non-invasive tool for diagnosing CMD and enhancing conventional cardiovascular risk assessment.
MICROVASCULAR RESEARCH
(2023)
Article
Pharmacology & Pharmacy
Filippo Crea, Rocco A. Montone
Summary: This article provides updated evidence on the pathophysiological mechanisms underlying coronary microvascular dysfunction (CMD) across different cardiovascular diseases, aiming to pave the way for further research and the development of novel strategies for a precision medicine approach.
VASCULAR PHARMACOLOGY
(2023)
Article
Medicine, General & Internal
Vincenzo Sucato, Giuseppina Novo, Cristina Madaudo, Luca Di Fazio, Giuseppe Vadala, Nicola Caronna, Alessandro D'Agostino, Salvatore Evola, Antonino Tuttolomondo, Alfredo Ruggero Galassi
Summary: The aim of this study was to evaluate subclinical alterations of cardiac mechanics using speckle-tracking echocardiography and compare them with coronary angiography indices in patients with ischemia with no obstructive coronary artery (INOCA) and microvascular angina (MVA). The results showed that patients with INOCA had statistically significant changes in longitudinal strain analysis, particularly a significant reduction in GLS. Both TIMI frame count (TFC) and longitudinal strain appear to be reliable, sensitive and easily accessible methods for studying coronary microcirculation alterations and characterizing patients with INOCA and microvascular angina.
JOURNAL OF CLINICAL MEDICINE
(2023)
Article
Cardiac & Cardiovascular Systems
Caitlin E. M. Vink, Tim P. van de Hoef, M. J. W. Goette, E. C. Eringa, Yolande Appelman
Summary: INOCA, a subtype of ischemic heart disease, is more common in women. MBV may be reduced in INOCA patients, potentially due to conditions like diabetes and obesity.
FRONTIERS IN CARDIOVASCULAR MEDICINE
(2021)
Article
Cardiac & Cardiovascular Systems
Utkarsh Dutta, Aish Sinha, Ozan M. Demir, Howard Ellis, Haseeb Rahman, Divaka Perera
Summary: In patients with angina and nonobstructed coronary arteries, the use of CTFC as a diagnostic tool for CMD and CED is not accurate and should be reevaluated according to the study findings.
JOURNAL OF THE AMERICAN HEART ASSOCIATION
(2023)
Review
Peripheral Vascular Disease
Daria Frestad Bechsgaard, Eva Prescott
Summary: Recent findings have shown that a significant proportion of patients with angina and no obstructive CAD suffer from CMD, which is associated with poor cardiovascular outcomes. Despite the feasibility and availability of non-invasive and invasive evaluation of coronary microvascular function, CMD remains underdiagnosed and undertreated. Patient-tailored treatment approaches guided by complete evaluation of epicardial anatomy and macro- and microvascular function may help improve symptom burden and quality of life outcomes. More research is needed to determine the long-term impact of these patient-tailored therapies on risk reduction in CMD.
CURRENT ATHEROSCLEROSIS REPORTS
(2021)
Review
Peripheral Vascular Disease
Vincenzo Sucato, Egle Corrado, Girolamo Manno, Francesco Amata, Gabriella Testa, Giuseppina Novo, Alfredo R. Galassi
Summary: The review summarizes studies investigating blood biomarkers related to coronary microvascular dysfunction (CMD) and microvascular angina (MVA). By analyzing biomarkers into 3 groups based on the main mechanisms of CMD, the review considers mixed mechanisms and biomarkers not included in the 3 major categories. This exploration may lead to easier diagnosis and screening of CMD with reduced risks and costs associated with invasive procedures.
Article
Cardiac & Cardiovascular Systems
Lilian Grigorian-Shamagian, Juan Francisco Oteo, Alejandro Gutierrez-Barrios, Omar Abdul-Jawad Altisent, Ignacio Amat-Santos, Agustin Fernandez Cisnal, Jessica Roa, Carlos Arellano Serrano, Edgar Fadeuilhe, Carlos Cortes, Ricardo Sanz-Ruiz, Maria Eugenia Vazquez-Alvarez, Felipe Diez Delhoyo, Maria Tamargo, Javier Soriano, Jaime Elizaga, Francisco Fernandez-Aviles, Enrique Gutierrez
Summary: This study evaluated the prevalence and clinical profile of endothelial dysfunction in patients with INOCA in Spain, as well as the predictors and prognostic impact of endothelial dysfunction. The results showed that approximately 45% of patients had endothelial dysfunction, which was associated with worsening symptoms and increased rates of adverse events.
INTERNATIONAL JOURNAL OF CARDIOLOGY
(2023)
Review
Cardiac & Cardiovascular Systems
Puja K. Mehta, Jingwen Huang, Rebecca D. Levit, Waddah Malas, Nida Waheed, C. Noel Bairey Merz
Summary: INOCA, a chronic coronary syndrome, is increasingly recognized as a significant contributor to adverse cardiovascular outcomes, including myocardial infarction and heart failure with preserved ejection fraction (HFpEF). Although occurring in both genders, women are more affected by INOCA and may experience angina, hospitalizations, and reduced quality of life. Abnormal coronary vascular function and microvascular dysfunction are common in INOCA patients, with treatment focusing on risk factor control, ischemia improvement, atherosclerosis progression reduction, and angina and quality of life improvement.
Review
Cardiac & Cardiovascular Systems
Marco Giuseppe Del Buono, Rocco A. Montone, Massimiliano Camilli, Salvatore Carbone, Jagat Narula, Carl J. Lavie, Giampaolo Niccoli, Filippo Crea
Summary: CMD encompasses multiple pathogenetic mechanisms involving coronary micro-circulation and plays a major role in myocardial ischemia in patients with angina without obstructive coronary artery disease, as well as in various other cardiovascular conditions. Despite the lack of specific treatment, further research is needed to provide personalized therapies for this diverse group of patients.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
(2021)
Article
Cardiac & Cardiovascular Systems
Christopher L. Schumann, Roshin C. Mathew, John-Henry L. Dean, Yang Yang, Pelbreton C. Balfour, Peter W. Shaw, Austin A. Robinson, Michael Salerno, Christopher M. Kramer, Jamieson M. Bourque
Summary: The study found that patients with INOCA have a significant impact on quality of life, with increased physical limitations, angina frequency, and reduced quality of life. These patients report increased time missed from work and work limitations, indicating a substantial economic impact. CMD is a common cause of INOCA, but it is not associated with increased morbidity.
JACC-CARDIOVASCULAR IMAGING
(2021)
Review
Cardiac & Cardiovascular Systems
Nathaniel R. Smilowitz, Olga Toleva, Alaide Chieffo, Divaka Perera, Colin Berry
Summary: Coronary microvascular disease (CMD) can lead to myocardial ischemia in various clinical scenarios. Routine testing for CMD is supported in patients with ischemia and nonobstructive coronary artery disease. Invasive testing using Doppler or thermodilution measures can determine coronary flow reserve and microvascular resistance. Comprehensive testing can improve symptoms, quality of life, and patient satisfaction by establishing a diagnosis and guiding targeted medical therapy and lifestyle changes. CMD testing may also be useful in other cardiovascular conditions such as acute myocardial infarction, angina after coronary revascularization, heart failure with preserved ejection fraction, Takotsubo syndrome, and after heart transplantation. Educating healthcare providers about CMD is crucial for improving patient-centered outcomes in ischemic heart disease.
CIRCULATION-CARDIOVASCULAR INTERVENTIONS
(2023)
Review
Cardiac & Cardiovascular Systems
Francesco Spione, Victor Arevalos, Rami Gabani, Manel Sabate, Salvatore Brugaletta
Summary: Up to 60-70% of patients undergoing invasive coronary angiography due to angina and demonstrable myocardial ischemia do not have obstructive coronary disease. Among these patients, nearly 50% suffer from coronary microvascular angina, which is associated with a poor prognosis. Recent studies have made progress in the diagnosis and treatment of this condition.
FRONTIERS IN CARDIOVASCULAR MEDICINE
(2022)
Review
Biochemistry & Molecular Biology
Jerremy Weerts, Sanne G. J. Mourmans, Arantxa Barandiaran Aizpurua, Blanche L. M. Schroen, Christian Knackstedt, Etto Eringa, Alfons J. H. M. Houben, Vanessa P. M. van Empel
Summary: Heart failure with preserved ejection fraction (HFpEF) is a disease with increasing incidence and no effective treatment. Coronary microvascular dysfunction plays a key role in the pathophysiology of HFpEF, possibly due to a low-grade pro-inflammatory state caused by systemic comorbidities. The presence or absence of peripheral microvascular dysfunction in HFpEF may reflect whether it is predominantly a cardiac or a systemic disease.
Article
Dermatology
Stefano Piaserico, Evangelia Papadavid, Annagrazia Cecere, Gloria Orlando, Konstantrinos Theodoropoulos, Pelagia Katsimbri, George Makavos, Penelope Rafouli-Stergiou, Sabino Iliceto, Mauro Alaibac, Francesco Tona, Ignatios Ikonomidis
Summary: Severe psoriasis is associated with an increased cardiovascular risk, and coronary microvascular dysfunction (CMD) has been shown to predict a poor cardiovascular prognosis. This study evaluated the prevalence and predictors of CMD in a large cohort of patients with psoriasis without clinical cardiovascular disease. The results showed that higher PASI, longer disease duration, the presence of psoriatic arthritis, and hypertension were independently associated with CMD.
JOURNAL OF INVESTIGATIVE DERMATOLOGY
(2023)
Article
Cardiac & Cardiovascular Systems
Andrew-Hyun Lee, Austin Chin Chwan Ng, Andy Sze Chiang Yong, Karice Hyun, David Brieger, Leonard Kritharides, Vincent Chow
Summary: The number of TAVI procedures in New South Wales increased tenfold between 2013 and 2017 statewide, with mortality rates comparable to international cohorts at short and medium-term follow-up. Heart failure, chronic kidney disease, and requirement for ventilation post-TAVI were independent predictors of in-hospital death and at 180 days.
HEART LUNG AND CIRCULATION
(2021)
Article
Engineering, Mechanical
P. R. S. Vijayaratnam, D. Fulker, Y. C. Kim, J. Brandt, J. Yi, A. S. C. Yong, L. Kritharides, A. Simmons, T. J. Barber
Summary: Myocardial bridging is a congenital anomaly where a coronary artery segment passes under heart muscle instead of resting on the heart's surface. Although usually benign, it has been associated with adverse clinical events. A study using an in vitro model replicated bridging conditions and found that dynamic stenoses may lead to arterial dysfunction.
EXPERIMENTS IN FLUIDS
(2021)
Article
Cardiac & Cardiovascular Systems
Kunwardeep S. Bhatia, Hari P. Sritharan, Justin Chia, Jonathan Ciofani, Daniel Nour, Karina Chui, Sheran Vasanthakumar, Pavithra Jayadeva, Dhanvee Kandadai, Usaid Allahwala, Rohan Bhagwandeen, David B. Brieger, Christopher Y. P. Choong, Anthony Delaney, Girish Dwivedi, Benjamin Harris, Graham Hillis, Bernard Hudson, George Javorsky, Nigel Jepson, Logan Kanagaratnam, George Kotsiou, Astin Lee, Sidney T. H. Lo, Andrew I. MacIsaac, Brendan M. McQuillan, Isuru Ranasinghe, Antony Walton, James Weaver, William Wilson, Andy Yong, John Zhu, William van Gaal, Leonard Kritharides, Clara Chow, Ravinay Bhindi
Summary: This observational cohort study conducted in 21 Australian hospitals found that cardiac complications were uncommon in COVID-19 patients requiring hospitalization, but elevated troponin levels were common. New onset atrial arrhythmias and troponin elevation were more common in patients 65 years and older.
HEART LUNG AND CIRCULATION
(2021)
Article
Cardiac & Cardiovascular Systems
Rajan Rehan, Elise Kempler, Kath McMaster, Gabrielle Larnach, David Amos, Alex Elder, Ruth Arnold, Craig Juergens, Sanjay Patel, James Weaver, Martin Ng, Probal Roy, Andy Yong, David Brieger, Leonard Kritharides, Mark Adams, Harry C. Lowe
Summary: This study examined the outcomes and complications of high-risk PCI patients referred and operated on. The results showed that these patients underwent lengthy procedures with high radiation doses after referral, but had a low rate of complications and excellent clinical outcomes.
HEART LUNG AND CIRCULATION
(2022)
Letter
Medicine, General & Internal
Kunwardeep S. Bhatia, William van Gaal, Leonard Kritharides, Clara K. Chow, Ravinay Bhindi
MEDICAL JOURNAL OF AUSTRALIA
(2021)
Letter
Cardiac & Cardiovascular Systems
David C. Tong, Jason E. Bloom, Stephen Quinn, Arthur Nasis, Chin Hiew, Philip Roberts-Thomson, Heath Adams, Rumes Sriamareswaran, Nay M. Htun, William Wilson, Dion Stub, William van Gaal, Laurie Howes, Allysha Yeap, Brian Yip, Sam Wu, Padeepa Perera, Nicholas Collins, Andy Yong, Ravinay Bhindi, Robert Whitbourn, Astin Lee, Manuja Premaratne, Kaleab Asrress, Melanie Freeman, John Amerena, Jamie Layland
Article
Engineering, Biomedical
Branko G. Celler, Mark Butlin, Ahmadreza Argha, Isabella Tan, Andy Yong, Alberto Avolio
Summary: Non-invasive blood pressure measurements often underestimate systolic blood pressure and overestimate diastolic blood pressure. The study found that Korotkoff sounds accurately detect the onset of blood flow and closely coincide with diastolic blood pressure.
IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING
(2021)
Article
Cardiac & Cardiovascular Systems
Christopher C. Y. Wong, Ashkan Javadzadegan, Cuneyt Ada, Jerrett K. Lau, Ravinay Bhindi, William F. Fearon, Leonard Kritharides, Martin K. C. Ng, Andy S. C. Yong
Summary: This study aimed to evaluate the relationship between wall shear stress (WSS), functionally significant epicardial coronary stenoses, and microcirculatory dysfunction. The results showed that fractional flow reserve and instantaneous wave-free ratio independently predicted the total burden of low WSS and maximum lesion WSS in coronary arteries, while microcirculatory dysfunction was not associated with WSS.
JOURNAL OF THE AMERICAN HEART ASSOCIATION
(2022)
Letter
Cardiac & Cardiovascular Systems
Christopher C. Y. Wong, Andy S. C. Yong, Anthony Keech, Cuneyt Ada, Kaivan Vaidya, Rachel F. O'Connell, Jamie Layland, Harvey White, William Fearon, Martin K. C. Ng
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
(2022)
Review
Biology
Rajan Rehan, James Weaver, Andy Yong
Summary: Vasospastic angina (VSA) is an underestimated cause of chest pain, characterized by temporary vasoconstriction of the coronary arteries. Its complex pathophysiology involves endothelial dysfunction and smooth muscle hypercontractility, leading to a wide range of clinical manifestations. Invasive provocation testing using acetylcholine or ergonovine is considered the gold standard for diagnosis, but protocols vary across institutions. Conventional pharmacological therapy relies on calcium channel blockers and nitrates, with limited options for refractory VSA. Global efforts to standardize diagnostic and therapeutic guidelines are expected to improve patient outcomes.
Article
Cardiac & Cardiovascular Systems
Christopher Yu, Silvan Meier, Dina Bestawros, David Sun, Joseph Trieu, Andy S. C. Yong, Christopher C. Y. Wong, John Yiannikas, Leonard Kritharides, John F. Beltrame, Christopher Naoum
Summary: This study found that the degree of hsTropT elevation can predict the likelihood of abnormal CMR scan in patients with suspected myocardial infarction without obstructive coronary arteries. Additionally, early CMR imaging and the use of a hsTropT cutoff value can improve the predictive ability for abnormal scans.
CANADIAN JOURNAL OF CARDIOLOGY
(2023)
Article
Cardiac & Cardiovascular Systems
Samer Noaman, David M. Kaye, Shane Nanayakkara, Anthony M. Dart, Andy S. C. Yong, Martin Ng, Donna Vizi, Stephen J. Duffy, Nicholas Cox, William Chan
Summary: This study aimed to evaluate microcirculatory resistance (MR) and myocardial metabolic adaptations in patients with suspected coronary microvascular dysfunction (CMD) at rest and in response to increased cardiac workload. Microcirculatory assessment and transcardiac blood sampling were conducted during graded exercise with adenosine-mediated hyperaemia in patients with objective ischaemia and/or myocardial injury and non-obstructive coronary artery disease. The results showed that patients with suspected CMD exhibited distinct microcirculatory resistive and myocardial metabolic profiles at rest and in response to exercise.
Article
Cardiac & Cardiovascular Systems
Daniel Munhoz, Carlos Collet, Takuya Mizukami, Andy Yong, Antonio Maria Leone, Ashkan Eftekhari, Brian Ko, Bruno R. da Costa, Colin Berry, Damien Collison, Divaka Perera, Evald Hoj Christiansen, Fernando Rivero, Frederik M. Zimmermann, Hirohiko Ando, Hitoshi Matsuo, Masafumi Nakayama, Javier Escaned, Jeroen Sonck, Koshiro Sakai, Julien Adjedj, Liyew Desta, Lokien X. van Nunen, Nick E. J. West, Stephane Fournier, Tatyana Storozhenko, Tetsuya Amano, Thomas Engstrom, Thomas Johnson, Toshiro Shinke, Simone Biscaglia, William F. Fearon, Ziad Ali, Bernard De Bruyne, Nils P. Johnson
Summary: This study aims to evaluate the predictive capacity of pullback pressure gradient (PPG) for post-PCI fractional flow reserve (FFR). The study protocol involves a prospective, large-scale, controlled, multicenter design. A total of 982 patients are expected to be enrolled, and physiological assessment will be performed using FFR pullbacks. The secondary objectives of the study include clinical outcomes and patient-reported outcomes in patients with focal vs. diffuse CAD defined by PPG.
AMERICAN HEART JOURNAL
(2023)
Article
Cardiac & Cardiovascular Systems
Takeshi Nishi, Tadashi Murai, Katsuhisa Waseda, Atsushi Hirohata, Andy S. C. Yong, Martin K. C. Ng, Tetsuya Amano, Emanuele Barbato, Tsunekazu Kakuta, William F. Fearon
Summary: This study revealed that patients with high IMR and FFR > 0.80 had a higher rate of adverse events, while those with low IMR showed lower rates of primary outcome events. Therefore, assessing microvascular function post-PCI is crucial for risk stratification in patients undergoing PCI.
IJC HEART & VASCULATURE
(2021)
