Rominder Grover1, Jonathon A Leipsic2, John Mooney1, Shaw-Hua Kueh1, Mickael Ohana1, Bjarne L Nørgaard3, Ashkan Eftekhari3, Jeroen J Bax4, Darra T Murphy1, Cameron J Hague1, Michael A Seidman5, Philipp Blanke1, Tara Sedlak6, Stephanie L Sellers7. 1. Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, Canada. 2. Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, Canada; Centre for Heart Lung Innovation, St Paul's Hospital and University of British Columbia, Vancouver, Canada; Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada. Electronic address: jleipsic@providencehealth.bc.ca. 3. Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark. 4. Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands. 5. Centre for Heart Lung Innovation, St Paul's Hospital and University of British Columbia, Vancouver, Canada; Department of Pathology, St Paul's Hospital, Vancouver, Canada. 6. Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada; Leslie Diamond Women's Heart Health Clinic, Vancouver General Hospital, Vancouver, Canada. 7. Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, Canada; Centre for Heart Lung Innovation, St Paul's Hospital and University of British Columbia, Vancouver, Canada.
Abstract
BACKGROUND: Microvascular angina (MVA) is an incompletely understood clinical entity. Computational analysis of coronary Computed Tomography Angiography (CTA) has shown an association between low coronary lumen volume to myocardial mass (V/M) ratio and lower Fractional Flow Reserve values, independent of plaque measures. We hypothesized that low V/M ratio may be present in patients with MVA. METHODS: A retrospective case-control analysis was performed using patients fulfilling guideline criteria for MVA with controls matched for age, gender, coronary risk factors and atherosclerotic plaque burden. V/M was extracted off site (Heartflow Inc; Redwood City, CA) employing allometric scaling laws that allow the definition of the coronary circulation beyond the epicardium. FFRCT values were calculated in the major epicardial coronary arteries for each group. RESULTS: A total of 30 patients with MVA and 32 matched controls were included in the study. Mean total coronary lumen volume (2302 mm3 ± 109 vs 2978 mm3 ± 134, p < 0.001) and mean myocardial mass (90.4 g ± 13.7 vs 100.4 g ± 20.1, p = 0.029) were lower in MVA patients compared to controls. Mean V/M ratio was significantly lower in MVA compared to controls (25.6 mm3/g ± 5.9 vs 30.0 mm3/g ± 6.5, p = 0.007; c-statistic 0.69). V/M ratio did not differ significantly between subclasses of angina severity (p = 0.747). No difference in mean nadir FFRCT values was found between MVA and control groups in the LAD (0.86 ± 0.07 vs 0.83 ± 0.07, p = 0.154), LCX (0.90 ± 0.05 vs 0.90 ± 0.06, p = 0.240) and RCA (0.90 ± 0.04 vs 0.90 ± 0.03, p = 0.773) vessels. CONCLUSION: Patients with microvascular angina demonstrate a significantly lower coronary CTA-derived coronary volume/myocardial mass ratio than asymptomatic controls.
BACKGROUND:Microvascular angina (MVA) is an incompletely understood clinical entity. Computational analysis of coronary Computed Tomography Angiography (CTA) has shown an association between low coronary lumen volume to myocardial mass (V/M) ratio and lower Fractional Flow Reserve values, independent of plaque measures. We hypothesized that low V/M ratio may be present in patients with MVA. METHODS: A retrospective case-control analysis was performed using patients fulfilling guideline criteria for MVA with controls matched for age, gender, coronary risk factors and atherosclerotic plaque burden. V/M was extracted off site (Heartflow Inc; Redwood City, CA) employing allometric scaling laws that allow the definition of the coronary circulation beyond the epicardium. FFRCT values were calculated in the major epicardial coronary arteries for each group. RESULTS: A total of 30 patients with MVA and 32 matched controls were included in the study. Mean total coronary lumen volume (2302 mm3 ± 109 vs 2978 mm3 ± 134, p < 0.001) and mean myocardial mass (90.4 g ± 13.7 vs 100.4 g ± 20.1, p = 0.029) were lower in MVApatients compared to controls. Mean V/M ratio was significantly lower in MVA compared to controls (25.6 mm3/g ± 5.9 vs 30.0 mm3/g ± 6.5, p = 0.007; c-statistic 0.69). V/M ratio did not differ significantly between subclasses of angina severity (p = 0.747). No difference in mean nadir FFRCT values was found between MVA and control groups in the LAD (0.86 ± 0.07 vs 0.83 ± 0.07, p = 0.154), LCX (0.90 ± 0.05 vs 0.90 ± 0.06, p = 0.240) and RCA (0.90 ± 0.04 vs 0.90 ± 0.03, p = 0.773) vessels. CONCLUSION:Patients with microvascular angina demonstrate a significantly lower coronary CTA-derived coronary volume/myocardial mass ratio than asymptomatic controls.
Authors: Kenneth R Holmes; Tim A Fonte; Jonathan Weir-McCall; Malcolm Anastasius; Philipp Blanke; Geoffrey W Payne; Jen Ellis; Darra T Murphy; Charles Taylor; Jonathon A Leipsic; Stephanie L Sellers Journal: Eur Radiol Date: 2019-06-21 Impact factor: 5.315
Authors: Daniëlle C J Keulards; Stephane Fournier; Marcel van 't Veer; Iginio Colaiori; Jo M Zelis; Mohamed El Farissi; Frederik M Zimmermann; Carlos Collet; Bernard De Bruyne; Nico H J Pijls Journal: Heart Date: 2020-05-29 Impact factor: 5.994
Authors: Domingo E Uceda; Amit K Dey; Sundus S Lateef; Khaled Abdelrahman; Milena Aksentijevich; Aarthi S Reddy; Harry Choi; Justin A Rodante; Martin P Playford; David A Bluemke; Wunan Zhou; Marcus Y Chen; Joel M Gelfand; Nehal N Mehta Journal: J Invest Dermatol Date: 2020-10-01 Impact factor: 8.551