The Experts below are selected from a list of 3741 Experts worldwide ranked by ideXlab platform

Derek J. Hausenloy - One of the best experts on this subject based on the ideXlab platform.

  • Invasive Assessment of the Coronary Microcirculation in Reperfused ST-Segment-Elevation Myocardial Infarction Patients: Where Do We Stand?
    Circulation. Cardiovascular interventions, 2017
    Co-Authors: Heerajnarain Bulluck, Nicolas Foin, Jack Wei Chieh Tan, Adrian F. Low, Murat Sezer, Derek J. Hausenloy
    Abstract:

    For patients presenting with an acute ST-segment-elevation myocardial infarction, the most effective therapy for reducing myocardial infarct size and preserving left ventricular systolic function is primary percutaneous Coronary intervention (PPCI). However, mortality and morbidity remain significant. This is partly attributed to the development of microvascular obstruction, which occurs in around 50% of ST-segment-elevation myocardial infarction patients post-PPCI, and it is associated with adverse left ventricular remodeling and worse clinical outcomes. Although microvascular obstruction can be detected by cardiac imaging techniques several hours post-PPCI, it may be too late to intervene at that time. Therefore, being able to predict the development of microvascular obstruction at the time of PPCI may identify high-risk patients who might benefit from further adjuvant intraCoronary therapies, such as thrombolysis, vasodilators, glycoprotein IIb/IIIa inhibitors, and anti-inflammatory agents that may reduce microvascular obstruction. Recent studies have shown that invasive Coronary physiology measurements performed during PPCI can be used to assess the Coronary Microcirculation. In this article, we provide an overview of the various invasive methods currently available to assess the Coronary Microcirculation in the setting of ST-segment-elevation myocardial infarction, and how they could potentially be used in the future for tailoring therapies to those most at risk.

A Macisaac - One of the best experts on this subject based on the ideXlab platform.

  • vasodilatory capacity of the Coronary Microcirculation is preserved in selected patients with non st segment elevation myocardial infarction
    Circulation-cardiovascular Interventions, 2013
    Co-Authors: Jamie Layland, David Carrick, Margaret Mcentegart, Nadeem Ahmed, Alexander R Payne, John D Mcclure, Arvind Sood, Ross Mcgeoch, A Macisaac
    Abstract:

    Background—The use of fractional flow reserve in patients with non–ST-segment–elevation myocardial infarction (NSTEMI) is a controversial issue. We undertook a study to assess the vasodilatory capacity of the Coronary Microcirculation in patients with NSTEMI when compared with a model of preserved Microcirculation (stable angina [SA] cohort: culprit and nonculprit vessel) and acute microcirculatory dysfunction (ST-segment–elevation myocardial infarction [STEMI] cohort). We hypothesized that the vasodilatory response of the Microcirculation would be preserved in NSTEMI. Methods and Results—A total of 140 patients undergoing single vessel percutaneous Coronary intervention were included: 50 stable angina, 50 NSTEMI, and 40 STEMI. The index of microvascular resistance (IMR), fractional flow reserve, and Coronary flow reserve were measured before stenting in the culprit vessel and in an angiographically normal nonculprit vessel in patients with SA. The resistive reserve ratio, a measure of the vasodilatory ca...

Milan Zdravkovic - One of the best experts on this subject based on the ideXlab platform.

  • Role of Coronary Microcirculation in No-Reflow Phenomenon in Myocardial Infarction with ST Segment Elevation
    Microcirculation, 2020
    Co-Authors: Z. Vasiljevic-pokrajcic, G. Krljanac, Dejan Trifunovic, Milan Zdravkovic
    Abstract:

    The principal cause of myocardial infarction with ST segment elevation (STEMI) is thrombotic occlusion of the (epicardial) Coronary artery, leading to the ischaemic myocardial necrosis. The concept of “full reperfusion” encompasses not only sufficient blood flow through epicardial Coronary arteries, but also through Coronary Microcirculation. No-reflow, defined as low or no distal perfusion despite the removal of epicardial occlusion. The cause of this phenomena is complex and multifactorial with functional and anatomical microvascular obstruction as the common pathophysiological background. No-reflow significantly increases infarct size, LV remodelling, leading to heart failure and overall poor clinical outcomes. We present a case report of typical patient with no-reflow and summarize contemporary knowledge regarding its basic pathophysiology, clinical presentation, invasive and non-invasive diagnostic modalities, clinical consequences and basic therapeutic strategies.

  • Coronary Microcirculation in Heart Failure with Preserved Systolic Function.
    Current pharmaceutical design, 2018
    Co-Authors: Zorana Vasiljevic, Dejan Trifunovic, Milan Zdravkovic, Gordana Krljanac, Ratko Lasica, Milika Asanin
    Abstract:

    BACKGROUND The Heart Failure with Preserved Ejection Fraction (HFpEF) is defined as the preserved left ventricular ejection fraction (LVEF) with the signs of heart failure, elevated natriuretic peptides, and either the evidence of the structural heart disease or diastolic dysfunction. The importance of this form of heart failure was increased after studies where the mortality rates and readmission to the hospital were founded similar as in patients with HF and reduced EF (HFrEF). Coronary microvascular ischemia, cardiomyocyte injury and stiffness could be important factors in the pathophysiology of HFpEF. METHODS The goal of this work is to analyse the relationship of HFpEF and Coronary Microcirculation in previous studies. RESULTS The useful diagnostic marker of Coronary Microcirculation in HFpEF may be the parameters measured by transthoracic echocardiography (TTE), the Coronary flow reserve (CFR), as well as fractional flow reserve (FFR) and quantitative myocardial contrast echocardiography (MCE). Cardiac magnetic resonance (CMR) imaging represents the diagnostic gold standard in HFpEF. Coronary microvascular dysfunction in the absence of obstructive Coronary artery disease (CAD) is poorly understood and may be more prevalent amongst women than men. Troponin level may be important in risk stratification of HEpEF patients. CONCLUSION There are no precise answers with respect to the pathophysiological mechanism, nor are there any precise practical clinical assessment of and diagnostic method for Coronary microvascular dysfunction and diastolic dysfunction. In accordance with that, there is no well-established treatment for HFpEF.

Jamie Layland - One of the best experts on this subject based on the ideXlab platform.

  • Invasive assessment of the Coronary Microcirculation in the catheter laboratory.
    International journal of cardiology, 2015
    Co-Authors: Jamie Layland, Nitesh Nerlekar, Sonny Palmer, Colin Berry, Keith G. Oldroyd
    Abstract:

    Historically much of our understanding of the Coronary circulation has been centered towards the epicardial vessels. However, recent work has highlighted the importance of the Coronary Microcirculation across a broad spectrum of clinical conditions in influencing patient outcomes. Therefore an ability to measure microvascular function is most valuable. While evaluation of the epicardial Coronary circulation is widely understood, interrogation of the Coronary Microcirculation is more complex. Many methods are available to assess the integrity of the Microcirculation in the catheter laboratory. This review will discuss the physiology of the Coronary Microcirculation and evaluate the utility of available invasive techniques.

  • vasodilatory capacity of the Coronary Microcirculation is preserved in selected patients with non st segment elevation myocardial infarction
    Circulation-cardiovascular Interventions, 2013
    Co-Authors: Jamie Layland, David Carrick, Margaret Mcentegart, Nadeem Ahmed, Alexander R Payne, John D Mcclure, Arvind Sood, Ross Mcgeoch, A Macisaac
    Abstract:

    Background—The use of fractional flow reserve in patients with non–ST-segment–elevation myocardial infarction (NSTEMI) is a controversial issue. We undertook a study to assess the vasodilatory capacity of the Coronary Microcirculation in patients with NSTEMI when compared with a model of preserved Microcirculation (stable angina [SA] cohort: culprit and nonculprit vessel) and acute microcirculatory dysfunction (ST-segment–elevation myocardial infarction [STEMI] cohort). We hypothesized that the vasodilatory response of the Microcirculation would be preserved in NSTEMI. Methods and Results—A total of 140 patients undergoing single vessel percutaneous Coronary intervention were included: 50 stable angina, 50 NSTEMI, and 40 STEMI. The index of microvascular resistance (IMR), fractional flow reserve, and Coronary flow reserve were measured before stenting in the culprit vessel and in an angiographically normal nonculprit vessel in patients with SA. The resistive reserve ratio, a measure of the vasodilatory ca...

David Carrick - One of the best experts on this subject based on the ideXlab platform.

  • vasodilatory capacity of the Coronary Microcirculation is preserved in selected patients with non st segment elevation myocardial infarction
    Circulation-cardiovascular Interventions, 2013
    Co-Authors: Jamie Layland, David Carrick, Margaret Mcentegart, Nadeem Ahmed, Alexander R Payne, John D Mcclure, Arvind Sood, Ross Mcgeoch, A Macisaac
    Abstract:

    Background—The use of fractional flow reserve in patients with non–ST-segment–elevation myocardial infarction (NSTEMI) is a controversial issue. We undertook a study to assess the vasodilatory capacity of the Coronary Microcirculation in patients with NSTEMI when compared with a model of preserved Microcirculation (stable angina [SA] cohort: culprit and nonculprit vessel) and acute microcirculatory dysfunction (ST-segment–elevation myocardial infarction [STEMI] cohort). We hypothesized that the vasodilatory response of the Microcirculation would be preserved in NSTEMI. Methods and Results—A total of 140 patients undergoing single vessel percutaneous Coronary intervention were included: 50 stable angina, 50 NSTEMI, and 40 STEMI. The index of microvascular resistance (IMR), fractional flow reserve, and Coronary flow reserve were measured before stenting in the culprit vessel and in an angiographically normal nonculprit vessel in patients with SA. The resistive reserve ratio, a measure of the vasodilatory ca...