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The Influence of Epicardial Resistance on Microvascular Resistance Reserve.
Mahendiran, Thabo; Bertolone, Dario; Viscusi, Michele Mattia; Gallinoro, Emanuele; Keulards, Danielle C J; Collet, Carlos; Sonck, Jeroen; Wilgenhof, Adriaan; Pijls, Nico H J; De Bruyne, Bernard.
Afiliación
  • Mahendiran T; Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.
  • Bertolone D; Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
  • Viscusi MM; Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
  • Gallinoro E; Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
  • Keulards DCJ; Department of Cardiology, Catharina Hospital Eindhoven, the Netherlands.
  • Collet C; Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
  • Sonck J; Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
  • Wilgenhof A; Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Clinical and Molecular Medicine-Sapienza University, Rome, Italy.
  • Pijls NHJ; Department of Cardiology, Catharina Hospital Eindhoven, the Netherlands.
  • De Bruyne B; Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland. Electronic address: bernard.de.bruyne@olvz-aalst.be.
J Am Coll Cardiol ; 84(6): 512-521, 2024 Aug 06.
Article en En | MEDLINE | ID: mdl-38754704
ABSTRACT

BACKGROUND:

The optimal index of microvascular function should be specific for the microvascular compartment. Yet, coronary flow reserve (CFR), despite being widely used to diagnose coronary microvascular dysfunction (CMD), is influenced by both epicardial and microvascular resistance. Conversely, microvascular resistance reserve (MRR) adjusts for fractional flow reserve (FFR), and thus is theoretically independent of epicardial resistance.

OBJECTIVES:

The authors tested the hypothesis that MRR, unlike CFR, is not influenced by increasing epicardial resistance, and thus is a more specific index of microvascular function.

METHODS:

In a cohort of 16 patients who had undergone proximal left anterior descending artery stenting, we created 4 grades of artificial stenosis (no stenosis, mild, moderate, and severe) using a coronary angioplasty balloon inflated to different degrees within the stent. For each stenosis grade, we calculated CFR and MRR using continuous thermodilution (64 measurements of each) to assess their response to changing epicardial resistance.

RESULTS:

Graded balloon inflation resulted in a significant sequential decrease in mean FFR (no stenosis 0.82 ± 0.05; mild 0.72 ± 0.04; moderate 0.61 ± 0.05; severe 0.48 ± 0.09; P < 0.001). This translated into a linear decrease in mean hyperemic coronary flow (no stenosis 170.5 ± 66.8 mL/min; mild 149.8 ± 58.8 mL/min; moderate 124.4 ± 53.0 mL/min; severe 94.0 ± 45.2 mL/min; P < 0.001). CFR exhibited a marked linear decrease with increasing stenosis (no stenosis 2.5 ± 0.9; mild 2.2 ± 0.8; moderate 1.8 ± 0.7; severe 1.4 ± 0.6), corresponding to a decrease of 0.3 for a decrease in FFR of 0.1 (P < 0.001). In contrast, MRR exhibited a negligible decrease across all stenosis grades (no stenosis 3.0 ± 1.0; mild 3.0 ± 1.0; moderate 2.9 ± 1.0; severe 2.8 ± 1.0), corresponding to a decrease of just 0.05 for a decrease in FFR of 0.1 (P < 0.001).

CONCLUSIONS:

MRR, unlike CFR, is minimally influenced by epicardial resistance, and thus should be considered the more specific index of microvascular function. This suggests that MRR can also reliably evaluate microvascular function in patients with significant epicardial disease.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Pericardio / Resistencia Vascular / Reserva del Flujo Fraccional Miocárdico / Microcirculación Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Am Coll Cardiol Año: 2024 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Pericardio / Resistencia Vascular / Reserva del Flujo Fraccional Miocárdico / Microcirculación Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Am Coll Cardiol Año: 2024 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Estados Unidos