Pub Date : 2019-01-01Epub Date: 2019-12-31DOI: 10.31487/j.cdm.2019.01.01
Janet Wei, Sawan Jalnakupur, Sherwin Dela Cruz, Galen Cook Wiens, Manish Motwani, Xiao Zhang, John W Petersen, Puja K Mehta, Chrisandra Shufelt, Behzad Sharif, Eileen Handberg, George Sopko, Andre Rogatko, Carl J Pepine, Daniel S Berman, Louise E Thomson, C Noel Bairey Merz
Background: Stress cardiac magnetic resonance (CMR) imaging with myocardial perfusion reserve index (MPRI) measurement has emerged as a noninvasive method for assessing coronary microvascular dysfunction (CMD) in the absence of obstructive coronary artery disease (CAD). Pharmacologic stress with adenosine or regadenoson is typically used with comparable coronary vasodilation, but higher unadjusted MPRI has been reported with regadenoson in healthy men. This difference has not been assessed in symptomatic or healthy women.
Methods: In a prospective cohort study, 139 symptomatic women with suspected CMD and no obstructive CAD underwent stress CMR and invasive coronary flow reserve (CFR) testing. Adenosine was the default vasodilator (n=99), while regadenoson was used if history of asthma or prior adenosine intolerance (n=40). Stress CMR was also performed in 40 age-matched healthy controls using adenosine (n=20) and regadenoson (n=20). Unpaired t-tests and analysis of covariance were performed to compare MPRI with adenosine and regadenoson in the symptomatic women and healthy controls.
Results: Compared to regadenoson cases, adenosine cases had lower invasive CFR (2.64±0.62 vs 2.94±0.68, p=0.01) and pharmacologic heart rate change (28±16 vs 38±15 bpm, p=0.0008). Unadjusted MPRI was lower in the adenosine compared to regadenoson cases (1.73±0.38 vs 2.27±0.59, p<0.0001). When adjusted for heart rate, rate-pressure-product, and invasive CFR, MPRI remained lower in the adenosine cases (p<0.0001). Invasive CFR to adenosine correlated with adenosine MPRI (r 0.17, p=0.02) but not regadenoson MPRI (r -0.14, p=0.19). There was no significant difference in MPRI in the controls who received adenosine vs regadenoson (2.27±0.33 vs 2.38±0.44, p=0.36).
Conclusion: In women undergoing stress CMR for suspected CMD, those who received adenosine had lower MPRI than those who received regadenoson. However, there were no differences in MPRI in the healthy controls. These findings suggest there may be physiologic differences in adenosine and regadenoson response in the coronary microcirculation of symptomatic women.
背景：测量心肌灌注储备指数（MPRI）的负荷心脏磁共振（CMR）成像已成为评估无阻塞性冠状动脉疾病（CAD）的冠状动脉微血管功能障碍（CMD）的一种无创方法。使用腺苷或雷公藤多甙进行药理应激时，冠状动脉血管扩张效果通常相当，但有报道称，健康男性使用雷公藤多甙时，未经调整的 MPRI 较高。这种差异尚未在有症状或健康的女性中进行评估：在一项前瞻性队列研究中，139 名疑似有 CMD 且无阻塞性 CAD 的无症状女性接受了负荷 CMR 和有创冠状动脉血流储备（CFR）测试。腺苷是默认的血管扩张剂（n=99），如果有哮喘病史或之前对腺苷不耐受，则使用雷加登罗松（n=40）。此外，还使用腺苷（20 人）和雷加登罗松（20 人）对 40 名年龄匹配的健康对照者进行了应激 CMR。通过非配对 t 检验和协方差分析，比较了有症状妇女和健康对照组使用腺苷和雷加登罗松的 MPRI：与雷加登罗松病例相比，腺苷病例的有创CFR（2.64±0.62 vs 2.94±0.68，P=0.01）和药理心率变化（28±16 vs 38±15 bpm，P=0.0008）更低。与雷公藤多苷病例相比，腺苷病例未经调整的 MPRI 更低（1.73±0.38 vs 2.27±0.59，P=0.01）：在因怀疑患有 CMD 而接受压力 CMR 的女性中，接受腺苷治疗的患者的 MPRI 低于接受雷加登罗松治疗的患者。然而，健康对照组的 MPRI 没有差异。这些研究结果表明，有症状的女性冠状动脉微循环对腺苷和雷加登罗松的反应可能存在生理差异。
{"title":"Adenosine vs Regadenoson Pharmacologic Stress Differs in Women with Suspected Coronary Microvascular Dysfunction: A Report from the Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) Study.","authors":"Janet Wei, Sawan Jalnakupur, Sherwin Dela Cruz, Galen Cook Wiens, Manish Motwani, Xiao Zhang, John W Petersen, Puja K Mehta, Chrisandra Shufelt, Behzad Sharif, Eileen Handberg, George Sopko, Andre Rogatko, Carl J Pepine, Daniel S Berman, Louise E Thomson, C Noel Bairey Merz","doi":"10.31487/j.cdm.2019.01.01","DOIUrl":"10.31487/j.cdm.2019.01.01","url":null,"abstract":"<p><strong>Background: </strong>Stress cardiac magnetic resonance (CMR) imaging with myocardial perfusion reserve index (MPRI) measurement has emerged as a noninvasive method for assessing coronary microvascular dysfunction (CMD) in the absence of obstructive coronary artery disease (CAD). Pharmacologic stress with adenosine or regadenoson is typically used with comparable coronary vasodilation, but higher unadjusted MPRI has been reported with regadenoson in healthy men. This difference has not been assessed in symptomatic or healthy women.</p><p><strong>Methods: </strong>In a prospective cohort study, 139 symptomatic women with suspected CMD and no obstructive CAD underwent stress CMR and invasive coronary flow reserve (CFR) testing. Adenosine was the default vasodilator (n=99), while regadenoson was used if history of asthma or prior adenosine intolerance (n=40). Stress CMR was also performed in 40 age-matched healthy controls using adenosine (n=20) and regadenoson (n=20). Unpaired t-tests and analysis of covariance were performed to compare MPRI with adenosine and regadenoson in the symptomatic women and healthy controls.</p><p><strong>Results: </strong>Compared to regadenoson cases, adenosine cases had lower invasive CFR (2.64±0.62 vs 2.94±0.68, p=0.01) and pharmacologic heart rate change (28±16 vs 38±15 bpm, p=0.0008). Unadjusted MPRI was lower in the adenosine compared to regadenoson cases (1.73±0.38 vs 2.27±0.59, <i>p</i><0.0001). When adjusted for heart rate, rate-pressure-product, and invasive CFR, MPRI remained lower in the adenosine cases (<i>p</i><0.0001). Invasive CFR to adenosine correlated with adenosine MPRI (r 0.17, p=0.02) but not regadenoson MPRI (r -0.14, p=0.19). There was no significant difference in MPRI in the controls who received adenosine vs regadenoson (2.27±0.33 vs 2.38±0.44, p=0.36).</p><p><strong>Conclusion: </strong>In women undergoing stress CMR for suspected CMD, those who received adenosine had lower MPRI than those who received regadenoson. However, there were no differences in MPRI in the healthy controls. These findings suggest there may be physiologic differences in adenosine and regadenoson response in the coronary microcirculation of symptomatic women.</p>","PeriodicalId":72528,"journal":{"name":"Cardiovascular disorder and medicine","volume":"2019 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9997839/pdf/nihms-1865295.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9106048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"« Doing our own thing » : la légende Postcard de Glasgow et l’attitude de la jeune Écosse","authors":"Laurence Estanove","doi":"10.4000/books.ms.1677","DOIUrl":"https://doi.org/10.4000/books.ms.1677","url":null,"abstract":"","PeriodicalId":72528,"journal":{"name":"Cardiovascular disorder and medicine","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88483370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L’archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d’enseignement et de recherche français ou étrangers, des laboratoires publics ou privés. Guérillas urbaines : la politique (sans posture) des premiers punks de San Francisco Michael Stewart Foley
{"title":"Guérillas urbaines : la politique (sans posture) des premiers punks de San Francisco","authors":"Michael Stewart Foley","doi":"10.4000/BOOKS.MS.1657","DOIUrl":"https://doi.org/10.4000/BOOKS.MS.1657","url":null,"abstract":"HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L’archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d’enseignement et de recherche français ou étrangers, des laboratoires publics ou privés. Guérillas urbaines : la politique (sans posture) des premiers punks de San Francisco Michael Stewart Foley","PeriodicalId":72528,"journal":{"name":"Cardiovascular disorder and medicine","volume":"118 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82444569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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{"title":"Comment échapper à l’ennui : la scène punk suisse face au dilemme des mobilisations (1976-1982)","authors":"P. Raboud","doi":"10.4000/books.ms.1577","DOIUrl":"https://doi.org/10.4000/books.ms.1577","url":null,"abstract":"","PeriodicalId":72528,"journal":{"name":"Cardiovascular disorder and medicine","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85401866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Introduction. Punk is Dead, Long Live Punk and Post-Punk !","authors":"Paul M. Edwards, Élodie Grossi, P. Schor","doi":"10.4000/books.ms.1537","DOIUrl":"https://doi.org/10.4000/books.ms.1537","url":null,"abstract":"","PeriodicalId":72528,"journal":{"name":"Cardiovascular disorder and medicine","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85330339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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