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Reduced atrial blood flow in patients with coronary artery disease
William H Maisel1, William G Stevenson, Laurence M Epstein
1Department of Medicine, Brigam and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA. wmaisel@partners.org
Insights
New angiographic measures, atrial frame count (AFC) and atrial perfusion score (APS), reveal reduced atrial blood flow (ABF) in coronary artery disease (CAD) patients. This finding is linked to overall CAD severity, not just proximal stenosis.
Area of Science:
- Cardiology
- Vascular Biology
- Diagnostic Imaging
Background:
- Existing methods like TIMI frame count assess ventricular coronary blood flow but lack atrial equivalents.
- Atrial coronary artery blood flow (ABF) measurement is crucial for understanding atrial health and disease.
- Developing novel angiographic techniques for ABF assessment is necessary.
Purpose of the Study:
- To introduce and validate two new angiographic measures: atrial frame count (AFC) and atrial perfusion score (APS).
- To investigate whether ABF differs between patients with and without coronary artery disease (CAD).
Main Methods:
- AFC measures dye transit time to distal atrial arteries during angiography.
- APS assesses microvascular atrial perfusion.
- Measurements were taken in 36 patients undergoing coronary artery bypass grafting (CABG), valve surgery, or controls.
Main Results:
- Higher AFC (reduced ABF) observed in CAD patients undergoing CABG compared to valve surgery or control groups (P < 0.05).
- APS was significantly reduced in 63% of CAD patients versus 5% of non-CAD patients (P < 0.001).
- CAD severity independently predicted decreased ABF (P < 0.03).
Conclusions:
- Atrial blood flow (ABF) is quantifiable using AFC and APS.
- Patients with CAD undergoing CABG exhibit significantly reduced ABF compared to those without CAD.
- Reduced ABF in CAD patients correlates with overall disease severity, irrespective of proximal epicardial stenosis.
Background:
The thrombolysis in myocardial infarction (TIMI) frame count and TIMI perfusion grade are measures of epicardial and microvascular ventricular coronary artery blood flow, respectively. Similar angiographic methods for measuring atrial coronary artery blood flow have not been developed.
Objective:
To utilize two new angiographic measures of atrial blood flow (ABF), the atrial frame count (AFC) and the atrial perfusion score (APS), to determine whether ABF differs between patients with and without coronary artery disease (CAD).
Methods:
The AFC was defined as the number of frames for dye to reach standardized, distal atrial arterial landmarks during coronary angiography. The APS was utilized as a measure of microvascular atrial perfusion. AFCs were measured in 36 patients prior to isolated coronary artery bypass grafting (CABG), isolated valve surgery or in control patients (with neither CAD nor valvular disease).
Results:
Sinus node artery and left atrial branch AFCs were higher (that is, ABF was reduced) in patients with CAD undergoing CABG than in those undergoing valve surgery (P < 0.05) or in control patients (P < 0.05). The APS was reduced in 63% of CAD patients but in only 5% of those without CAD (P < 0.001). The severity of CAD was a significant predictor of decreased ABF independent of the degree of proximal epicardial stenosis (P < 0.03).
Conclusions:
ABF is measurable with the AFC and APS. A significant reduction in ABF is present in patients with CAD undergoing CABG compared to patients without CAD. This reduction appears to be related to the overall severity of CAD independent of the degree of proximal stenosis.