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Wong CC, Yong AS. Quantitative Flow Ratio-Guided Revascularization: Equally Effective Between the Sexes. JACC. ASIA 2024; 4:213-215. [PMID: 38463682 PMCID: PMC10920045 DOI: 10.1016/j.jacasi.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Affiliation(s)
- Christopher C.Y. Wong
- Department of Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Andy S.C. Yong
- Department of Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
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Macek P, Michałek-Zrąbkowska M, Dziadkowiec-Macek B, Poręba M, Martynowicz H, Mazur G, Gać P, Poręba R. Obstructive Sleep Apnea as a Predictor of a Higher Risk of Significant Coronary Artery Disease Assessed Non-Invasively Using the Calcium Score. Life (Basel) 2023; 13:life13030671. [PMID: 36983827 PMCID: PMC10058620 DOI: 10.3390/life13030671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/05/2023] Open
Abstract
The aim of this study was to assess the coronary artery calcium score in patients with obstructive sleep apnea (OSA). The study group (group A) consisted of 62 patients with diagnosed obstructive sleep apnea (mean age: 59.12 ± 9.09 years, mean AHI index in polysomnography: 20.44 ± 13.22/h), and 62 people without diagnosed obstructive sleep apnea (mean age 59.50 ± 10.74 years) constituted the control group (group B). The risk of significant coronary artery disease was assessed in all patients, based on the measurement of the coronary artery calcium score (CACS) using computed tomography. The following cut-off points were used to assess the risk of significant coronary artery disease: CACS = 0—no risk, CACS 1–10—minimal risk, CACS 11–100—low risk, CACS 101–400—moderate risk, and CACS > 400—high risk. Group A was characterized by statistically significantly higher CACS than group B (550.25 ± 817.76 vs. 92.59 ± 164.56, p < 0.05). No risk of significant coronary artery disease was statistically significantly less frequent in group A than in group B (0.0% vs. 51.6%, p < 0.05). A high risk of significant coronary artery disease was statistically significantly more frequent in group A than in group B (40.3% vs. 4.8%, p < 0.05). In group A, patients with severe OSA and patients with moderate OSA had statistically significantly higher CACS than patients with mild OSA (910.04 ± 746.31, 833.35 ± 1129.87, 201.66 ± 192.04, p < 0.05). A statistically significant positive correlation was found between the AHI and CACS (r = 0.34, p < 0.05). The regression analysis showed that OSA, male gender, older age, type 2 diabetes, peripheral arterial disease, and smoking were independent risk factors for higher CACS values. AHI ≥ 14.9 was shown to be a predictor of a high risk of significant coronary artery disease with a sensitivity and specificity of 62.2% and 80.0%, respectively. In summary, obstructive sleep apnea should be considered an independent predictive factor of a high risk of significant coronary artery disease (based on the coronary artery calcium score).
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Affiliation(s)
- Piotr Macek
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland
| | - Monika Michałek-Zrąbkowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland
| | - Barbara Dziadkowiec-Macek
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland
| | - Małgorzata Poręba
- Department of Paralympic Sports, Wroclaw University of Health and Sport Sciences, Witelona 25a, 51-617 Wroclaw, Poland
| | - Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland
| | - Paweł Gać
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 7, 50-368 Wroclaw, Poland
- Correspondence: or
| | - Rafał Poręba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland
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3
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Sueda S, Sakaue T. Sex-related differences in coronary vasomotor disorders: Comparisons between Western and Japanese populations. J Cardiol 2023; 81:161-167. [PMID: 35534347 DOI: 10.1016/j.jjcc.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/19/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
Sex-related differences in the prevalence of cardiac disorders have been elucidated beyond races. Angina/ischemia with nonobstructive coronary artery disease (AINOCA) is often observed in females. Coronary microvascular dysfunction (CMD) and coronary epicardial spasm (CES) are the principal cause of AINOCA. The clinical outcomes of Western patients with CMD were less satisfactory than expected, while the prognosis of Japanese patients with CES treated with medications including calcium channel blockers was favorable. However, the incidence and clinical features of coronary spasm endotypes were different between Western and Japanese populations. Furthermore, sex-related differences in the clinical manifestations and outcomes of patients with different spasm endotypes remain uncertain beyond race. In this article, we will review the sex differences in Japanese AINOCA patients with coronary vasomotor disorders, including CMD and CES, and compare them with those of Western patients.
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Affiliation(s)
- Shozo Sueda
- Department of Cardiology, Ehime Prefectural Niihama Hospital, Niihama City, Ehime Prefecture, Japan.
| | - Tomoki Sakaue
- Department of Cardiology, Yawatahama City General Hospital, Yawatahama City, Ehime Prefecture, Japan
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4
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Prognostic significance of severe coronary microvascular dysfunction post-PCI in patients with STEMI: A systematic review and meta-analysis. PLoS One 2022; 17:e0268330. [PMID: 35576227 PMCID: PMC9109915 DOI: 10.1371/journal.pone.0268330] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/27/2022] [Indexed: 11/20/2022] Open
Abstract
Coronary microvascular dysfunction (CMVD) is common and associated with poorer outcomes in patients with ST Segment Elevation Myocardial Infarction (STEMI). The index of microcirculatory resistance (IMR) and the index of hyperemic microvascular resistance (HMR) are both invasive indexes of microvascular resistance proposed for the diagnosis of severe CMVD after primary percutaneous coronary intervention (pPCI). However, these indexes are not routinely assessed in STEMI patients. Our main objective was to clarify the association between IMR or HMR and long-term major adverse cardiovascular events (MACE), through a systematic review and meta-analysis of observational studies. We searched Medline, PubMed, and Google Scholar for studies published in English until December 2020. The primary outcome was a composite of cardiovascular death, non-cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and rehospitalization for heart failure occurring after at least 6 months following CMVD assessment. We identified 6 studies, reporting outcomes in 1094 patients (mean age 59.7 ± 11.4 years; 18.2% of patients were women) followed-up from 6 months to 7 years. Severe CMVD, defined as IMR > 40 mmHg or HMR > 3mmHg/cm/sec was associated with MACE with a pooled HR of 3.42 [2.45; 4.79]. Severe CMVD is associated with an increased risk of long-term adverse cardiovascular events in patients with STEMI. Our results suggest that IMR and HMR are useful for the early identification of severe CMVD in patients with STEMI after PCI, and represent powerful prognostic assessments as well as new therapeutic targets for clinical intervention.
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Noirclerc N, Marliere S, Bakhti A, Mangin L, Cassar E, Vautrin E, Piliero N, Ormezzano O, Bouvaist H, Riou L, Vanzetto G, Belle L, Barone-Rochette G. Impact of a micro-net mesh technology covering stent on coronary microvascular dysfunction in patients with high thrombus burden. Catheter Cardiovasc Interv 2021; 99:397-404. [PMID: 34057279 DOI: 10.1002/ccd.29782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/26/2021] [Accepted: 05/10/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Highly thrombotic coronary lesions continue to be a serious and clinically significant problem that is not effectively and completely addressed by current technology. OBJECTIVES We aimed to investigate whether a micro-net mesh (MNM) technology covering stent could preserve the index of microcirculatory resistance (IMR) after percutaneous coronary intervention (PCI) in patients with high thrombus burden. METHODS AND RESULTS Fifty-two patients with non-ST elevation myocardial infarction or ST Elevation Myocardial Infarction and high thrombus burden (TIMI thrombus grade ≥ 3) were randomized into two groups, PCI with a MNM covering stent (MNM group, n = 25) and PCI with any commercially available stent (DES group, n = 27). As the primary endpoint, IMR was measured immediately after PCI using a pressure-temperature sensor-tipped coronary wire. The secondary endpoint was left ventricular ejection fraction (LVEF) at 6 months of follow-up. The IMR in the MNM group was significantly lower in comparison to the DES group (33.2 [21.3, 48.9] vs. 57.2 [39.9, 98.0], p = 0.005). No significant differences were observed in baseline LVEF (54.5 ± 10.2% vs. 53.1 ± 6.87%, p = .57), while LVEF was significantly improved at follow-up in the MNM group (61.1 ± 7.1% vs. 53.9 ± 6.35%, p = .0001). CONCLUSION MNM technology significantly improved coronary microvascular dysfunction after PCI in patient with acute coronary syndrome and appears as a useful technological option for thrombus management.
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Affiliation(s)
| | | | - Akader Bakhti
- Department of Cardiology, Hospital Center, Annecy-Genevois, France
| | - Lionel Mangin
- Department of Cardiology, Hospital Center, Annecy-Genevois, France
| | - Emmanuel Cassar
- Department of Cardiology, Hospital Center, Annecy-Genevois, France
| | - Estelle Vautrin
- Department of Cardiology, University Hospital, Grenoble-Alpes, France
| | - Nicolas Piliero
- Department of Cardiology, University Hospital, Grenoble-Alpes, France
| | - Olivier Ormezzano
- Department of Cardiology, University Hospital, Grenoble-Alpes, France.,University Grenoble alpes, INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France
| | - Helene Bouvaist
- Department of Cardiology, University Hospital, Grenoble-Alpes, France
| | - Laurent Riou
- University Grenoble alpes, INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France
| | - Gerald Vanzetto
- Department of Cardiology, University Hospital, Grenoble-Alpes, France.,University Grenoble alpes, INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France.,French Alliance Clinical Trial, French Clinical Research Infrastructure Network, Paris, France
| | - Loic Belle
- Department of Cardiology, Hospital Center, Annecy-Genevois, France
| | - Gilles Barone-Rochette
- Department of Cardiology, University Hospital, Grenoble-Alpes, France.,University Grenoble alpes, INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France.,French Alliance Clinical Trial, French Clinical Research Infrastructure Network, Paris, France
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6
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Sirajuddin A, Mirmomen SM, Kligerman SJ, Groves DW, Burke AP, Kureshi F, White CS, Arai AE. Ischemic Heart Disease: Noninvasive Imaging Techniques and Findings. Radiographics 2021; 41:990-1021. [PMID: 34019437 PMCID: PMC8262179 DOI: 10.1148/rg.2021200125] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Ischemic heart disease is a leading cause of death worldwide and comprises a large proportion of annual health care expenditure. Management of ischemic heart disease is now best guided by the physiologic significance of coronary artery stenosis. Invasive coronary angiography is the standard for diagnosing coronary artery stenosis. However, it is expensive and has risks including vascular access site complications and contrast material–induced nephropathy. Invasive coronary angiography requires fractional flow reserve (FFR) measurement to determine the physiologic significance of a coronary artery stenosis. Multiple noninvasive cardiac imaging modalities can also anatomically delineate or functionally assess for significant coronary artery stenosis, as well as detect the presence of myocardial infarction (MI). While coronary CT angiography can help assess the degree of anatomic stenosis, its inability to assess the physiologic significance of lesions limits its specificity. Physiologic significance of coronary artery stenosis can be determined by cardiac MR vasodilator or dobutamine stress imaging, CT stress perfusion imaging, FFR CT, PET myocardial perfusion imaging (MPI), SPECT MPI, and stress echocardiography. Clinically unrecognized MI, another clear indicator of physiologically significant coronary artery disease, is relatively common and is best evaluated with cardiac MRI. The authors illustrate the spectrum of imaging findings of ischemic heart disease (coronary artery disease, myocardial ischemia, and MI); highlight the advantages and disadvantages of the various noninvasive imaging methods used to assess ischemic heart disease, as illustrated by recent clinical trials; and summarize current indications and contraindications for noninvasive imaging techniques for detection of ischemic heart disease. Online supplemental material is available for this article. Published under a CC BY 4.0 license.
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Affiliation(s)
- Arlene Sirajuddin
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
| | - S Mojdeh Mirmomen
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
| | - Seth J Kligerman
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
| | - Daniel W Groves
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
| | - Allen P Burke
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
| | - Faraz Kureshi
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
| | - Charles S White
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
| | - Andrew E Arai
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
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7
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Thermodilution-Based Invasive Assessment of Absolute Coronary Blood Flow and Microvascular Resistance: Quantification of Microvascular (Dys)Function? J Interv Cardiol 2020; 2020:5024971. [PMID: 33293902 PMCID: PMC7688370 DOI: 10.1155/2020/5024971] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/09/2020] [Accepted: 10/23/2020] [Indexed: 02/04/2023] Open
Abstract
During the last two decades, there has been a sharp increase in both interest and knowledge about the coronary microcirculation. Since these small vessels are not visible by the human eye, physiologic measurements should be used to characterize their function. The invasive methods presently used (coronary flow reserve (CFR) and index of microvascular resistance (IMR)) are operator-dependent and mandate the use of adenosine to induce hyperemia. In recent years, a new thermodilution-based method for measurement of absolute coronary blood flow and microvascular resistance has been proposed and initial procedural problems have been overcome. Presently, the technique is easy to perform using the Rayflow infusion catheter and the Coroventis software. The method is accurate, reproducible, and completely operator-independent. This method has been validated noninvasively against the current golden standard for flow assessment: Positron Emission Tomography-Computed Tomography (PET-CT). In addition, absolute flow and resistance measurements have proved to be safe, both periprocedurally and at long-term follow-up. With an increasing number of studies being performed, this method has great potential for better understanding and quantification of microvascular disease.
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8
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Safi H, Bourantas CV, Ramasamy A, Zanchin T, Bär S, Tufaro V, Jin C, Torii R, Karagiannis A, Reiber JHC, Mathur A, Onuma Y, Windecker S, Lansky A, Maehara A, Serruys PW, Stone P, Baumbach A, Stone GW, Räber L. Predictive value of the QFR in detecting vulnerable plaques in non-flow limiting lesions: a combined analysis of the PROSPECT and IBIS-4 study. Int J Cardiovasc Imaging 2020; 36:993-1002. [PMID: 32152810 DOI: 10.1007/s10554-020-01805-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/22/2020] [Indexed: 01/07/2023]
Abstract
Studies have shown that the quantitative flow ratio (QFR), recently introduced to assess lesion severity from coronary angiography, provides useful prognostic information; however the additive value of this technique over intravascular imaging in detecting lesions that are likely to cause events is yet unclear. We analysed data acquired in the PROSPECT and IBIS-4 studies, in particular the baseline virtual histology-intravascular ultrasound (VH-IVUS) and angiographic data from 17 non-culprit lesions with a presumable vulnerable phenotype (i.e., thin or thick cap fibroatheroma) that caused major adverse cardiac events or required revascularization (MACE) at 5-year follow-up and from a group of 78 vulnerable plaques that remained quiescent. The segments studied by VH-IVUS were identified in coronary angiography and the QFR was estimated. The additive value of 3-dimensional quantitative coronary angiography (3D-QCA) and of the QFR in predicting MACE at 5 year follow-up beyond plaque characteristics was examined. It was found that MACE lesions had a greater plaque burden (PB) and smaller minimum lumen area (MLA) on VH-IVUS, a longer length and a smaller minimum lumen diameter (MLD) on 3D-QCA and a lower QFR compared with lesions that remained quiescent. By univariate analysis MLA, PB, MLD, lesion length on 3D-QCA and QFR were predictors of MACE. In multivariate analysis a low but normal QFR (> 0.80 to < 0.97) was the only independent prediction of MACE (HR 3.53, 95% CI 1.16-10.75; P = 0.027). In non-flow limiting lesions with a vulnerable phenotype, QFR may provide additional prognostic information beyond plaque morphology for predicting MACE throughout 5 years.
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Affiliation(s)
- Hannah Safi
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK. .,Institute of Cardiovascular Sciences, University College London, London, UK. .,William Harvey Research Institute, Queen Mary University London, London, UK.
| | - Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,William Harvey Research Institute, Queen Mary University London, London, UK
| | - Thomas Zanchin
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Sarah Bär
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Vincenzo Tufaro
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Chongying Jin
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, UK
| | - Alexios Karagiannis
- CTU Bern, Institute of Social and Preventive Medicine, Bern University, Bern, Switzerland
| | | | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,William Harvey Research Institute, Queen Mary University London, London, UK
| | - Yoshinubo Onuma
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Alexandra Lansky
- Institute of Cardiovascular Sciences, University College London, London, UK.,Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Akiko Maehara
- Department of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY, USA
| | - Patrick W Serruys
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, UK
| | - Peter Stone
- Cardiovascular Division, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,William Harvey Research Institute, Queen Mary University London, London, UK
| | - Gregg W Stone
- Department of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY, USA
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
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9
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Abstract
PURPOSE OF REVIEW This review discusses similarities and differences between cardiac positron emission tomography (PET), absolute myocardial blood flow, and flow reserve with invasive fractional flow reserve (FFR). RECENT FINDINGS Fundamentally, cardiac PET measures absolute myocardial blood flow whereas FFR provides a relative flow reserve. Cardiac PET offers a non-invasive and therefore lower risk alternative, able to image the entire left ventricle regardless of coronary anatomy. While cardiac PET can provide unique information about the subendocardium, FFR pullbacks offer unparalleled spatial resolution. Both diagnostic tests provide a highly repeatable and technically successful index of coronary hemodynamics that accounts for the amount of distal myocardial mass, albeit only indirectly with FFR. The randomized evidence base for FFR and its associated cost effectiveness remains unsurpassed. Cardiac PET and FFR have been intertwined since the very development of FFR over 25 years ago. Recent work has emphasized the ability of both techniques to guide revascularization decisions by high-quality physiology. In the past few years, cardiac PET has expanded its evidence base regarding clinical outcomes, whereas FFR has solidified its position in randomized studies as the invasive reference standard.
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Affiliation(s)
- Nils P. Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030 USA
- Memorial Hermann Hospital, Houston, TX USA
| | - K. Lance Gould
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030 USA
- Memorial Hermann Hospital, Houston, TX USA
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10
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Westra J, Tu S, Campo G, Qiao S, Matsuo H, Qu X, Koltowski L, Chang Y, Liu T, Yang J, Andersen BK, Eftekhari A, Christiansen EH, Escaned J, Wijns W, Xu B, Holm NR. Diagnostic performance of quantitative flow ratio in prospectively enrolled patients: An individual patient‐data meta‐analysis. Catheter Cardiovasc Interv 2019; 94:693-701. [PMID: 30963676 DOI: 10.1002/ccd.28283] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 03/29/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Shengxian Tu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy
- Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| | - Shubin Qiao
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu City, Japan
| | - Xinkai Qu
- Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Lukasz Koltowski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Yunxiao Chang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Tommy Liu
- Department of Cardiology, Hagaziekenhuis, The Hague, The Netherlands
| | | | | | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | | | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Ireland
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
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11
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Collet C, Onuma Y, Sonck J, Asano T, Vandeloo B, Kornowski R, Tu S, Westra J, Holm NR, Xu B, de Winter RJ, Tijssen JG, Miyazaki Y, Katagiri Y, Tenekecioglu E, Modolo R, Chichareon P, Cosyns B, Schoors D, Roosens B, Lochy S, Argacha JF, van Rosendael A, Bax J, Reiber JHC, Escaned J, De Bruyne B, Wijns W, Serruys PW. Diagnostic performance of angiography-derived fractional flow reserve: a systematic review and Bayesian meta-analysis. Eur Heart J 2018; 39:3314-3321. [DOI: 10.1093/eurheartj/ehy445] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/31/2018] [Indexed: 01/09/2023] Open
Affiliation(s)
- Carlos Collet
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Yoshinobu Onuma
- Cardialysis BV, Rotterdam, The Netherlands
- Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Jeroen Sonck
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Taku Asano
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Bert Vandeloo
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Belinson Hospital Affiliated to the “Sackler” Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Robbert J de Winter
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Jan G Tijssen
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | | | - Yuki Katagiri
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | | | - Rodrigo Modolo
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Ply Chichareon
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Bernard Cosyns
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Daniel Schoors
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Bram Roosens
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Stijn Lochy
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | | | | | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, The Netherlands
| | - Johan H C Reiber
- Division of Image Processing (LKEB), Department of Radiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Medis Medical Imaging Systems, Leiden, The Netherlands
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain
| | | | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Saolta University Healthcare Group, Galway, Ireland
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12
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Quantitative flow ratio derived from diagnostic coronary angiography in assessment of patients with intermediate coronary stenosis: a wire-free fractional flow reserve study. Clin Res Cardiol 2018; 107:858-867. [DOI: 10.1007/s00392-018-1258-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/17/2018] [Indexed: 10/28/2022]
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13
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Lachmann V, Heimann M, Jung C, Zeus T, Verde PE, Kelm M, Bönner F. Feasibility, safety and effectiveness in measuring microvascular resistance with regadenoson. Clin Hemorheol Microcirc 2018; 71:299-310. [PMID: 30103305 DOI: 10.3233/ch-180386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIMThe study aims to test whether simultaneous measurement of fractional flow reserve (FFR), coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) is feasible, safe and effective during regadenoson-induced hyperemia.METHODS AND RESULTSFFR, CFR and IMR were measured simultaneously during regadenoson (Rapiscan 400 μg) -induced hyperemia in 50 patients with stable coronary artery disease with a SYNTAX score of <22. Simultaneous measurement of FFR, CFR and IMR was technically feasible in all cases (50/50). No side effects occurred and even patients fulfilling classical contraindications for the use of adenosine (10/50) could be included. Regadenoson-induced hyperemia remained stable after maximal pressure drop for more than 35 sec as measured by systemic aortic and distal coronary pressure. There was a significant drop in transit mean time from baseline to hyperemia of more than 50% (1.0 ± 0.6 s vs. 0.4 ± 0.2 s, p < 0.01). Patients' mean IMR value was 23.4, and IMR values above 75th percentile significantly correlated with metformin demanding diabetes mellitus with OR 21.76 and nicotine abuse with OR 10.28.CONCLUSIONA single intravenous regadenoson bolus via peripheral line increases coronary blood flow without harmful systemic side effects enabling interventionists to simultaneously assess FFR, CFR and IMR in patients with stable coronary artery disease.
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Affiliation(s)
- Vera Lachmann
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Düsseldorf, Medical Faculty, Germany
| | - Marc Heimann
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Düsseldorf, Medical Faculty, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Düsseldorf, Medical Faculty, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Düsseldorf, Medical Faculty, Germany
| | - Pablo Emilio Verde
- Coordination Center for Clinical Trials, Heinrich Heine University Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Düsseldorf, Medical Faculty, Germany.,Cardiovascular Research Institute Düsseldorf (CARID), Medical Faculty, University Düsseldorf, Germany
| | - Florian Bönner
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Düsseldorf, Medical Faculty, Germany
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14
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Fahrni G, Wolfrum M, De Maria GL, Cuculi F, Dawkins S, Alkhalil M, Patel N, Forfar JC, Prendergast BD, Choudhury RP, Channon KM, Banning AP, Kharbanda RK. Index of Microcirculatory Resistance at the Time of Primary Percutaneous Coronary Intervention Predicts Early Cardiac Complications: Insights From the OxAMI (Oxford Study in Acute Myocardial Infarction) Cohort. J Am Heart Assoc 2017; 6:JAHA.116.005409. [PMID: 29113999 PMCID: PMC5721736 DOI: 10.1161/jaha.116.005409] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Early risk stratification after primary percutaneous coronary intervention (PPCI) for ST‐segment–elevation myocardial infarction is currently challenging. Identification of a low‐risk group may improve triage of patients to alternative clinical pathways and support early hospital discharge. Our aim was to assess whether the index of microcirculatory resistance (IMR) at the time of PPCI can identify patients at low risk of early major cardiac complications and to compare its performance against guideline‐recommended risk scores. Methods and Results IMR was measured using a pressure–temperature sensor wire. Cardiac complications were defined as the composite of cardiac death, cardiogenic shock, pulmonary edema, malignant arrhythmias, cardiac rupture, and presence of left ventricular thrombus either before hospital discharge or within 30‐day follow‐up. In total, 261 patients undergoing PPCI who were eligible for coronary physiology assessment were prospectively enrolled. Twenty‐two major cardiac complications were reported. Receiver operating characteristic curve analysis confirmed the utility of IMR in predicting complications and showed significantly better performance than coronary flow reserve, the Primary Angioplasty in Myocardial Infarction II (PAMI‐II), and Zwolle score (P≤0.006). Low microvascular resistance (IMR ≤40) was measured in 159 patients (61%) of the study population and identified all patients who were free of major cardiac complications (sensitivity: 100%; 95% CI, 80.5–100%). Conclusions IMR immediately at the end of PPCI for ST‐segment–elevation myocardial infarction reliably predicts early major cardiac complications and performed significantly better than recommended risk scores. These novel data have implications for early risk stratification after PPCI.
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Affiliation(s)
- Gregor Fahrni
- Oxford Heart Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Mathias Wolfrum
- Oxford Heart Centre, Oxford University Hospitals, Oxford, United Kingdom.,Department of Internal Medicine/Cardiology, Angiology, Magdeburg University Hospital, Magdeburg, Germany
| | | | - Florim Cuculi
- Oxford Heart Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Sam Dawkins
- Oxford Heart Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Mohammad Alkhalil
- Radcliffe Department of Medicine, Oxford Acute Vascular Imaging Centre, University of Oxford, United Kingdom
| | - Niket Patel
- Oxford Heart Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - John C Forfar
- Oxford Heart Centre, Oxford University Hospitals, Oxford, United Kingdom
| | | | - Robin P Choudhury
- Radcliffe Department of Medicine, Oxford Acute Vascular Imaging Centre, University of Oxford, United Kingdom
| | - Keith M Channon
- Oxford Heart Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Adrian P Banning
- Oxford Heart Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Rajesh K Kharbanda
- Oxford Heart Centre, Oxford University Hospitals, Oxford, United Kingdom
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15
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Jin X, Mi W. Adenosine for postoperative analgesia: A systematic review and meta-analysis. PLoS One 2017; 12:e0173518. [PMID: 28333936 PMCID: PMC5363816 DOI: 10.1371/journal.pone.0173518] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 02/21/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose Perioperative infusion of adenosine has been suggested to reduce the requirement for inhalation anesthetics, without causing serious adverse effects in humans. We conducted a meta-analysis of randomized controlled trials evaluating the effect of adenosine on postoperative analgesia. Methods We retrieved articles in computerized searches of Scopus, Web of Science, PubMed, EMBASE, and Cochrane Library databases, up to July 2016. We used adenosine, postoperative analgesia, and postoperative pain(s) as key words, with humans, RCT, and CCT as filters. Data of eligible studies were extracted, which included pain scores, cumulative opioid consumption, adverse reactions, and vital signs. Overall incidence rates, relative risk (RR), and 95% confidence intervals (CI) were calculated employing fixed-effects or random-effects models, depending on the heterogeneity of the included trials. Results In total, 757 patients from 9 studies were included. The overall effect of adenosine on postoperative VAS/VRS scores and postoperative opioid consumption was not significantly different from that of controls (P >0.1). The occurrence of PONV and pruritus was not statistically significantly different between an adenosine and nonremifentanil subgroup (P >0.1), but the rate of PONV occurrence was greater in the remifentanil subgroup (P <0.01). Time to first postoperative analgesic requirement in the adenosine group was not significantly difference from that of the saline group (SMD = 0.07, 95%CI: −0.28 to 0.41, P = 0.71); but this occurred significantly later than with remifentanil (SMD = 1.10, 95%CI: 2.48 to 4.06, P < 0.01). Time to hospital discharge was not significantly different between the control and adenosine groups (P = 0.78). The perioperative systolic blood pressure was significantly lower in the adenosine than in the control group in the mannitol subgroup (P < 0.01). The incidence of bradycardia, transient first- degree atrioventricular block, and tachycardia was not significantly different between the adenosine and control groups (P > 0.1). Conclusion Adenosine has no analgesic effect or prophylactic effect against PONV, but reduce systolic blood pressure and heart rates. Adenosine may benefit patients with hypertension, ischemic heart disease, and tachyarrhythmia, thereby improving cardiac function.
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Affiliation(s)
- Xin Jin
- Department of Anesthesiology, Chinese PLA General Hospital, Beijing, China
- * E-mail:
| | - Weidong Mi
- Department of Anesthesiology, Chinese PLA General Hospital, Beijing, China
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16
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Carrick D, Haig C, Ahmed N, Carberry J, Yue May VT, McEntegart M, Petrie MC, Eteiba H, Lindsay M, Hood S, Watkins S, Davie A, Mahrous A, Mordi I, Ford I, Radjenovic A, Oldroyd KG, Berry C. Comparative Prognostic Utility of Indexes of Microvascular Function Alone or in Combination in Patients With an Acute ST-Segment-Elevation Myocardial Infarction. Circulation 2016; 134:1833-1847. [PMID: 27803036 PMCID: PMC5131697 DOI: 10.1161/circulationaha.116.022603] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 10/05/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Primary percutaneous coronary intervention is frequently successful at restoring coronary artery blood flow in patients with acute ST-segment-elevation myocardial infarction; however, failed myocardial reperfusion commonly passes undetected in up to half of these patients. The index of microvascular resistance (IMR) is a novel invasive measure of coronary microvascular function. We aimed to investigate the pathological and prognostic significance of an IMR>40, alone or in combination with a coronary flow reserve (CFR≤2.0), in the culprit artery after emergency percutaneous coronary intervention for acute ST-segment-elevation myocardial infarction. METHODS Patients with acute ST-segment-elevation myocardial infarction were prospectively enrolled during emergency percutaneous coronary intervention and categorized according to IMR (≤40 or >40) and CFR (≤2.0 or >2.0). Cardiac magnetic resonance imaging was acquired 2 days and 6 months after myocardial infarction. All-cause death or first heart failure hospitalization was a prespecified outcome (median follow-up, 845 days). RESULTS IMR and CFR were measured in the culprit artery at the end of percutaneous coronary intervention in 283 patients with ST-segment-elevation myocardial infarction (mean±SD age, 60±12 years; 73% male). The median IMR and CFR were 25 (interquartile range, 15-48) and 1.6 (interquartile range, 1.1-2.1), respectively. An IMR>40 was a multivariable associate of myocardial hemorrhage (odds ratio, 2.10; 95% confidence interval, 1.03-4.27; P=0.042). An IMR>40 was closely associated with microvascular obstruction. Symptom-to-reperfusion time, TIMI (Thrombolysis in Myocardial Infarction) blush grade, and no (≤30%) ST-segment resolution were not associated with these pathologies. An IMR>40 was a multivariable associate of the changes in left ventricular ejection fraction (coefficient, -2.12; 95% confidence interval, -4.02 to -0.23; P=0.028) and left ventricular end-diastolic volume (coefficient, 7.85; 95% confidence interval, 0.41-15.29; P=0.039) at 6 months independently of infarct size. An IMR>40 (odds ratio, 4.36; 95% confidence interval, 2.10-9.06; P<0.001) was a multivariable associate of all-cause death or heart failure. Compared with an IMR>40, the combination of IMR>40 and CFR≤2.0 did not have incremental prognostic value. CONCLUSIONS An IMR>40 is a multivariable associate of left ventricular and clinical outcomes after ST-segment-elevation myocardial infarction independently of the infarction size. Compared with standard clinical measures of the efficacy of myocardial reperfusion, including the ischemic time, ST-segment elevation, angiographic blush grade, and CFR, IMR has superior clinical value for risk stratification and may be considered a reference test for failed myocardial reperfusion. CLINICAL TRIAL REGISTRATION URL: https//www.clinicaltrials.gov. Unique identifier: NCT02072850.
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Affiliation(s)
- David Carrick
- From BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., I.M., A.R., K.G.O., C.B.), and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, UK; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H.., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Caroline Haig
- From BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., I.M., A.R., K.G.O., C.B.), and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, UK; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H.., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Nadeem Ahmed
- From BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., I.M., A.R., K.G.O., C.B.), and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, UK; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H.., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Jaclyn Carberry
- From BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., I.M., A.R., K.G.O., C.B.), and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, UK; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H.., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Vannesa Teng Yue May
- From BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., I.M., A.R., K.G.O., C.B.), and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, UK; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H.., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Margaret McEntegart
- From BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., I.M., A.R., K.G.O., C.B.), and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, UK; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H.., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Mark C Petrie
- From BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., I.M., A.R., K.G.O., C.B.), and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, UK; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H.., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Hany Eteiba
- From BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., I.M., A.R., K.G.O., C.B.), and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, UK; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H.., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Mitchell Lindsay
- From BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., I.M., A.R., K.G.O., C.B.), and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, UK; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H.., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Stuart Hood
- From BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., I.M., A.R., K.G.O., C.B.), and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, UK; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H.., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Stuart Watkins
- From BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., I.M., A.R., K.G.O., C.B.), and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, UK; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H.., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Andrew Davie
- From BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., I.M., A.R., K.G.O., C.B.), and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, UK; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H.., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Ahmed Mahrous
- From BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., I.M., A.R., K.G.O., C.B.), and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, UK; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H.., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Ify Mordi
- From BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., I.M., A.R., K.G.O., C.B.), and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, UK; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H.., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Ian Ford
- From BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., I.M., A.R., K.G.O., C.B.), and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, UK; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H.., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Aleksandra Radjenovic
- From BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., I.M., A.R., K.G.O., C.B.), and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, UK; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H.., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Keith G Oldroyd
- From BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., I.M., A.R., K.G.O., C.B.), and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, UK; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H.., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Colin Berry
- From BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., I.M., A.R., K.G.O., C.B.), and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, UK; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK (D.C., N.A., J.C., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H.., S.W., A.D., A.M., I.M., K.G.O., C.B.).
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17
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Carrick D, Haig C, Carberry J, May VTY, McCartney P, Welsh P, Ahmed N, McEntegart M, Petrie MC, Eteiba H, Lindsay M, Hood S, Watkins S, Mahrous A, Rauhalammi SM, Mordi I, Ford I, Radjenovic A, Sattar N, Oldroyd KG, Berry C. Microvascular resistance of the culprit coronary artery in acute ST-elevation myocardial infarction. JCI Insight 2016; 1:e85768. [PMID: 27699259 PMCID: PMC5033815 DOI: 10.1172/jci.insight.85768] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND. Failed myocardial reperfusion is common and prognostically important after acute ST-elevation myocardial infarction (STEMI). The purpose of this study was to investigate coronary flow reserve (CFR), a measure of vasodilator capacity, and the index of microvascular resistance (IMR; mmHg × s) in the culprit artery of STEMI survivors. METHODS. IMR (n = 288) and CFR (n = 283; mean age [SD], 60 [12] years) were measured acutely using guide wire–based thermodilution. Cardiac MRI disclosed left ventricular pathology, function, and volumes at 2 days (n = 281) and 6 months after STEMI (n = 264). All-cause death or first heart failure hospitalization was independently adjudicated (median follow-up 845 days). RESULTS. Myocardial hemorrhage and microvascular obstruction occurred in 89 (42%) and 114 (54%) patients with evaluable T2*-MRI maps. IMR and CFR were associated with microvascular pathology (none vs. microvascular obstruction only vs. microvascular obstruction and myocardial hemorrhage) (median [interquartile range], IMR: 17 [12.0–33.0] vs. 17 [13.0–39.0] vs. 37 [21.0–63.0], P < 0.001; CFR: 1.7 [1.4–2.5] vs. 1.5 [1.1–1.8] vs. 1.4 [1.0–1.8], P < 0.001), whereas thrombolysis in myocardial infarction blush grade was not. IMR was a multivariable associate of changes in left ventricular end-diastolic volume (regression coefficient [95% CI] 0.13 [0.01, 0.24]; P = 0.036), whereas CFR was not (P = 0.160). IMR (5 units) was a multivariable associate of all-cause death or heart failure hospitalization (n = 30 events; hazard ratio [95% CI], 1.09 [1.04, 1.14]; P < 0.001), whereas CFR (P = 0.124) and thrombolysis in myocardial infarction blush grade (P = 0.613) were not. IMR had similar prognostic value for these outcomes as <50% ST-segment resolution on the ECG. CONCLUSIONS. IMR is more closely associated with microvascular pathology, left ventricular remodeling, and health outcomes than the angiogram or CFR. TRIAL REGISTRATION. NCT02072850. FUNDING. A British Heart Foundation Project Grant (PG/11/2/28474), the National Health Service, the Chief Scientist Office, a Scottish Funding Council Senior Fellowship, a British Heart Foundation Intermediate Fellowship (FS/12/62/29889), and a nonfinancial research agreement with Siemens Healthcare. The index of microvascular resistance correlates with microvascular pathology and is a diagnostic test of myocardial reperfusion in patients with acute ST-elevation myocardial infarction.
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Affiliation(s)
- David Carrick
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Caroline Haig
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - Jaclyn Carberry
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Vannesa Teng Yue May
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Peter McCartney
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Paul Welsh
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Nadeem Ahmed
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Mark C Petrie
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Ahmed Mahrous
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Samuli Mo Rauhalammi
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Ify Mordi
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - Aleksandra Radjenovic
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Naveed Sattar
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Colin Berry
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
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