TY - JOUR
T1 - Microvascular resistance reserve
T2 - diagnostic and prognostic performance in the ILIAS registry
AU - Boerhout, Coen K. M.
AU - Lee, Joo Myung
AU - de Waard, Guus A.
AU - Mejia-Renteria, Hernan
AU - Lee, Seung Hun
AU - Jung, Ji-Hyun
AU - Hoshino, Masahiro
AU - Echavarria-Pinto, Mauro
AU - Meuwissen, Martijn
AU - Matsuo, Hitoshi
AU - Madera-Cambero, Maribel
AU - Eftekhari, Ashkan
AU - Effat, Mohamed A.
AU - Murai, Tadashi
AU - Marques, Koen
AU - Doh, Joon-Hyung
AU - Christiansen, Evald H.
AU - Banerjee, Rupak
AU - Nam, Chang-Wook
AU - Niccoli, Giampaolo
AU - Nakayama, Masafumi
AU - Tanaka, Nobuhiro
AU - Shin, Eun-Seok
AU - Appelman, Yolande
AU - Beijk, Marcel A. M.
AU - van Royen, Niels
AU - Knaapen, Paul
AU - Escaned, Javier
AU - Kakuta, Tsunekazu
AU - Koo, Bon Kwon
AU - Piek, Jan J.
AU - van de Hoef, Tim P.
N1 - Funding Information: T.v.d.H. has received speaker fees and institutional research grants from Abbott and Philips. J.M.L. has received research grants from Abbott and Philips. M.E.P. has received speaker fees from Abbott and Philips. B.K.K. has received institutional research grants from Abbott Vascular and Philips Volcano. J.J.P. has received support as consultant for Philips/Volcano, and has received institutional research grants from Philips. The other authors report no relationship with industry related to this work. Publisher Copyright: © 2023 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2023/8/7
Y1 - 2023/8/7
N2 - AIMS: The microvascular resistance reserve (MRR) was introduced as a means to characterize the vasodilator reserve capacity of the coronary microcirculation while accounting for the influence of concomitant epicardial disease and the impact of administration of potent vasodilators on aortic pressure. This study aimed to evaluate the diagnostic and prognostic performance of MRR. METHODS AND RESULTS: A total of 1481 patients with stable symptoms and a clinical indication for coronary angiography were included from the global ILIAS Registry. MRR was derived as a function of the coronary flow reserve (CFR) divided by the fractional flow reserve (FFR) and corrected for driving pressure. The median MRR was 2.97 [Q1-Q3: 2.32-3.86] and the overall relationship between MRR and CFR was good [correlation coefficient (Rs) = 0.88, P < 0.005]. The difference between CFR and MRR increased with decreasing FFR [coefficient of determination (R2) = 0.34; Coef.-2.88, 95% confidence interval (CI): -3.05--2.73; P < 0.005]. MRR was independently associated with major adverse cardiac events (MACE) at 5-year follow-up [hazard ratio (HR) 0.78; 95% CI 0.63-0.95; P = 0.024] and with target vessel failure (TVF) at 5-year follow-up (HR 0.83; 95% CI 0.76-0.97; P = 0.047). The optimal cut-off value of MRR was 3.0. Based on this cut-off value, only abnormal MRR was significantly associated with MACE and TVF at 5-year follow-up in vessels with functionally significant epicardial disease (FFR <0.75). CONCLUSION: MRR seems a robust indicator of the microvascular vasodilator reserve capacity. Moreover, in line with its theoretical background, this study suggests a diagnostic advantage of MRR over other indices of vasodilatory capacity in patients with hemodynamically significant epicardial coronary artery disease.
AB - AIMS: The microvascular resistance reserve (MRR) was introduced as a means to characterize the vasodilator reserve capacity of the coronary microcirculation while accounting for the influence of concomitant epicardial disease and the impact of administration of potent vasodilators on aortic pressure. This study aimed to evaluate the diagnostic and prognostic performance of MRR. METHODS AND RESULTS: A total of 1481 patients with stable symptoms and a clinical indication for coronary angiography were included from the global ILIAS Registry. MRR was derived as a function of the coronary flow reserve (CFR) divided by the fractional flow reserve (FFR) and corrected for driving pressure. The median MRR was 2.97 [Q1-Q3: 2.32-3.86] and the overall relationship between MRR and CFR was good [correlation coefficient (Rs) = 0.88, P < 0.005]. The difference between CFR and MRR increased with decreasing FFR [coefficient of determination (R2) = 0.34; Coef.-2.88, 95% confidence interval (CI): -3.05--2.73; P < 0.005]. MRR was independently associated with major adverse cardiac events (MACE) at 5-year follow-up [hazard ratio (HR) 0.78; 95% CI 0.63-0.95; P = 0.024] and with target vessel failure (TVF) at 5-year follow-up (HR 0.83; 95% CI 0.76-0.97; P = 0.047). The optimal cut-off value of MRR was 3.0. Based on this cut-off value, only abnormal MRR was significantly associated with MACE and TVF at 5-year follow-up in vessels with functionally significant epicardial disease (FFR <0.75). CONCLUSION: MRR seems a robust indicator of the microvascular vasodilator reserve capacity. Moreover, in line with its theoretical background, this study suggests a diagnostic advantage of MRR over other indices of vasodilatory capacity in patients with hemodynamically significant epicardial coronary artery disease.
KW - Coroanry artery disease
KW - Coronary microvascular dysfunction
KW - Coronary physiology
KW - Microvascular resistance reserve
UR - http://www.scopus.com/inward/record.url?scp=85167476667&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/eurheartj/ehad378
DO - https://doi.org/10.1093/eurheartj/ehad378
M3 - Article
C2 - 37350567
SN - 0195-668X
VL - 44
SP - 2862
EP - 2869
JO - European Heart journal
JF - European Heart journal
IS - 30
ER -