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Nakamura R, Shiono Y, Honda K, Kunimoto H, Wada T, Fujimoto T, Ikuchi M, Ideguchi Y, Taruya A, Takahata M, Ozaki Y, Agematsu K, Tanaka A, Nishimura Y. Risk factors for unsuccessful restoration of coronary flow reserve after coronary bypass surgery. Int J Cardiol 2024; 414:132419. [PMID: 39098607 DOI: 10.1016/j.ijcard.2024.132419] [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: 05/14/2024] [Accepted: 08/01/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVES Coronary flow reserve (CFR) is a strong predictor of cardiovascular events and prognosis in patients with coronary artery disease. This study aimed to evaluate preoperative factors associated with the unsuccessful restoration of CFR after coronary artery bypass grafting (CABG). METHODS Included in this study were the 65 patients who presented with functionally significant left anterior descending artery (LAD) lesions confirmed by both fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR), and who underwent successful CABG at our hospital within the study period. After CABG, graft patency was confirmed by coronary computed tomography angiography, and CFR in the LAD artery was measured by echocardiography. We defined postoperative CFR <2.5 as impaired CFR, and CFR ≥2.5 as preserved CFR. RESULTS Of the 65 patients, 14 patients (22%) showed impaired CFR, while 51 patients had preserved CFR. Patients with impaired CFR had significantly higher HbA1c (6.7% vs. 6.0%, P < 0.01), greater use of insulin (43% vs. 4%, P < 0.01), longer lesion length (33 mm vs. 25 mm, P = 0.044), and lower iFR (0.69 vs 0.81, P = 0.01) than those with preserved CFR, although both groups had comparable FFR (0.65 vs 0.64, P = 0.46). In receiver operating characteristic curve analysis, iFR had a significantly larger area under the curve than FFR in terms of the prediction of impaired CFR (0.74 vs 0.42, P = 0.01). CONCLUSIONS Poorly-controlled preoperative diabetes, greater reliance on insulin, longer lesion length and lower iFR were associated with postoperative impaired CFR, suggesting the involvement of microvascular dysfunction.
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Affiliation(s)
- Ryo Nakamura
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Yasutsugu Shiono
- Department of Cardiology, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Kentaro Honda
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan.
| | - Hideki Kunimoto
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Teruaki Wada
- Department of Cardiology, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Takahiro Fujimoto
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Mizuho Ikuchi
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Yuya Ideguchi
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Akira Taruya
- Department of Cardiology, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Masahiro Takahata
- Department of Cardiology, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Yuichi Ozaki
- Department of Cardiology, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Kota Agematsu
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Atsushi Tanaka
- Department of Cardiology, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Yoshiharu Nishimura
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
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Honda K, Yuzaki M, Kaneko M, Funahashi R, Kunimoto H, Fujimoto T, Nakanishi Y, Agematsu K, Nagashima M, Nishimura Y. Functional assessment of improvement of myocardial ischemia using coronary flow velocity reserve after coronary artery bypass surgery in hemodialysis. J Card Surg 2019; 34:663-669. [DOI: 10.1111/jocs.14098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Kentaro Honda
- Department of Thoracic and Cardiovascular SurgeryWakayama Medical University Wakayama Japan
| | - Mitsuru Yuzaki
- Department of Thoracic and Cardiovascular SurgeryWakayama Medical University Wakayama Japan
| | - Masahiro Kaneko
- Department of Thoracic and Cardiovascular SurgeryWakayama Medical University Wakayama Japan
| | - Ryosuke Funahashi
- Department of Thoracic and Cardiovascular SurgeryWakayama Medical University Wakayama Japan
| | - Hideki Kunimoto
- Department of Thoracic and Cardiovascular SurgeryWakayama Medical University Wakayama Japan
| | - Takahiro Fujimoto
- Department of Thoracic and Cardiovascular SurgeryWakayama Medical University Wakayama Japan
| | - Yasuka Nakanishi
- Department of Thoracic and Cardiovascular SurgeryWakayama Medical University Wakayama Japan
| | - Kota Agematsu
- Department of Thoracic and Cardiovascular SurgeryWakayama Medical University Wakayama Japan
| | - Mitsugi Nagashima
- Department of Thoracic and Cardiovascular SurgeryWakayama Medical University Wakayama Japan
| | - Yoshiharu Nishimura
- Department of Thoracic and Cardiovascular SurgeryWakayama Medical University Wakayama Japan
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Abdelsattar Z, Crestanello JA. Big Hearts, Little Reserve: Coronary Flow Velocity Reserve After Bypass Grafting in Patients With Left Ventricular Hypertrophy. Semin Thorac Cardiovasc Surg 2019; 31:174. [PMID: 30735708 DOI: 10.1053/j.semtcvs.2019.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 02/01/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Zaid Abdelsattar
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Juan A Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
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