TY - JOUR
T1 - Prognostic value of structural and functional coronary microvascular dysfunction in patients with non-obstructive coronary artery disease; from the multicentre international ILIAS registry
AU - Boerhout, Coen K. M.
AU - de Waard, Guus A.
AU - Lee, Joo Myung
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 - Appelman, Yolande
AU - Doh, Joon-Hyung
AU - Christiansen, Evald H. j
AU - Banerjee, Rupak
AU - Nam, Chang-Wook
AU - Niccoli, Giampaolo
AU - Nakayama, Masafumi
AU - Tanaka, Nobuhiro
AU - Shin, Eun-Seok
AU - Beijk, Marcel A. M.
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. van de Hoef has received consulting fees, speaker fees and institutional research grants from Abbott and Philips. J.M. Lee received research grants from Abbott and Philips. M. Echavarria-Pinto has received speaker fees from Abbott and Philips. B-K. Koo has received institutional research grants from Abbott Vascular and Philips/Volcano. J.J. Piek has received support as a consultant for Philips/Volcano, and has received institutional research grants from Philips. H. Matsuo received lecture fees from Philips, Abbott Medical, Boston Scientific Japan and Zeon Medical. J. Escaned received speaker fees and was advisory board member for Abbott and Philips. The other authors have no relationship with industry related to this work. Publisher Copyright: © Europa Digital & Publishing 2022. All rights reserved.
PY - 2022/10/1
Y1 - 2022/10/1
N2 - Background: Coronary microvascular dysfunction (CMD) is an important contributor to angina syndromes. Recently, two distinct endotypes were identified using combined assessment of coronary flow reserve (CFR) and minimal microvascular resistance (MR), termed structural and functional CMD. Aims: We aimed to assess the relevance of the combined assessment of CFR and MR in patients with angina and no obstructive coronary arteries. Methods: Patients with chronic coronary syndromes (CCS) and non-obstructive coronary artery disease (fractional flow reserve [FFR] ≥0.80) were selected (N=1,102). Functional CMD was defined as abnormal CFR in combination with normal MR and structural CMD as abnormal CFR with abnormal MR. Clinical endpoints were the incidence of major adverse cardiac events (MACE) and target vessel failure (TVF) at 5-year follow-up. Results: Abnormal CFR was associated with an increased risk of MACE and TVF at 5-year follow-up. Microvascular resistance parameters were not associated with MACE or TVF at 5-year follow-up. The risk of MACE and TVF at 5-year follow-up was similarly increased for patients with structural or functional CMD compared with patients with normal microvascular function. There were no differences between both endotypes (p=0.88 for MACE, and p=0.55 for TVF). Conclusions: Coronary microvascular dysfunction, identified by an impaired CFR, was unequivocally associated with increased MACE and TVF rates over a 5-year follow-up period. In contrast, impaired MR was not associated with 5-year adverse clinical events. Moreover, there was no significant difference in the risk of MACE and TVF between a low CFR accompanied by pathologically increased MR (structural CMD) or not (functional CMD).
AB - Background: Coronary microvascular dysfunction (CMD) is an important contributor to angina syndromes. Recently, two distinct endotypes were identified using combined assessment of coronary flow reserve (CFR) and minimal microvascular resistance (MR), termed structural and functional CMD. Aims: We aimed to assess the relevance of the combined assessment of CFR and MR in patients with angina and no obstructive coronary arteries. Methods: Patients with chronic coronary syndromes (CCS) and non-obstructive coronary artery disease (fractional flow reserve [FFR] ≥0.80) were selected (N=1,102). Functional CMD was defined as abnormal CFR in combination with normal MR and structural CMD as abnormal CFR with abnormal MR. Clinical endpoints were the incidence of major adverse cardiac events (MACE) and target vessel failure (TVF) at 5-year follow-up. Results: Abnormal CFR was associated with an increased risk of MACE and TVF at 5-year follow-up. Microvascular resistance parameters were not associated with MACE or TVF at 5-year follow-up. The risk of MACE and TVF at 5-year follow-up was similarly increased for patients with structural or functional CMD compared with patients with normal microvascular function. There were no differences between both endotypes (p=0.88 for MACE, and p=0.55 for TVF). Conclusions: Coronary microvascular dysfunction, identified by an impaired CFR, was unequivocally associated with increased MACE and TVF rates over a 5-year follow-up period. In contrast, impaired MR was not associated with 5-year adverse clinical events. Moreover, there was no significant difference in the risk of MACE and TVF between a low CFR accompanied by pathologically increased MR (structural CMD) or not (functional CMD).
KW - coronary flow reserve
KW - coronary microvascular dysfunction
KW - hyperaemic microvascular resistance
KW - index of microvascular resistance
KW - prognosis
UR - http://www.scopus.com/inward/record.url?scp=85140417493&partnerID=8YFLogxK
U2 - https://doi.org/10.4244/EIJ-D-22-00043
DO - https://doi.org/10.4244/EIJ-D-22-00043
M3 - Article
C2 - 35694826
SN - 1774-024X
VL - 18
SP - 719
EP - 728
JO - Eurointervention
JF - Eurointervention
IS - 9
ER -