Microvascular resistance reserve: impact on health status and myocardial perfusion after revascularization in chronic coronary syndrome.

IF 37.6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal Pub Date : 2025-02-03 DOI:10.1093/eurheartj/ehae604

Laust Dupont Rasmussen, Jelmer Westra, Salma Raghad Karim, Jonathan Nørtoft Dahl, Jacob Hartmann Søby, June Anita Ejlersen, Lars Christian Gormsen, Ashkan Eftekhari, Evald Høj Christiansen, Morten Bøttcher, Simon Winther

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Abstract

Background and aims: The microvascular resistance reserve (MRR) is a novel invasive index of the microcirculation, which is independent of epicardial stenoses, and has both diagnostic and prognostic implications. This study investigates whether MRR is associated with health status outcomes by revascularization in patients with moderate coronary stenoses.

Methods: Consecutive patients with stable chest pain and moderate (30%-90% diameter) stenoses on invasive coronary angiography (n = 222) underwent invasive physiology assessment. Revascularization was performed according to guideline recommendations. At baseline and follow-up, health status and myocardial perfusion were assessed by the Seattle Angina Questionnaire (SAQ) and positron emission tomography. The primary endpoint was freedom from angina at follow-up with secondary endpoints including changes in health status by SAQ domains and myocardial perfusion by MRR and revascularization status. Low MRR was defined as ≤3.0.

Results: Freedom from angina occurred in 38/173 patients. In multivariate analyses, MRR was associated with freedom from angina at follow-up (odds ratio 0.860, 95% confidence interval 0.740-0.987). By MRR and revascularization groups, patients with normal MRR who did not undergo revascularization, and patients with abnormal MRR who underwent revascularization, had improved health status of angina frequency [mean difference SAQ angina frequency score 8.5 (3.07-13.11) and 13.5 (2.82-23.16), respectively]. For both groups, health status of physical limitation [mean difference in SAQ physical limitation score 9.7 (4.79-11.93) and 8.7 (0.53-13.88), respectively] and general health status [mean difference in SAQ summary score 9.3 (5.18-12.50) and 10.8 (2.51-17.28), respectively] also improved. Only patients with abnormal MRR who underwent revascularization had improved myocardial perfusion.

Conclusions: In patients with moderate coronary stenoses, MRR seems to predict the symptomatic and perfusion benefit of revascularization.

Clinical trial identifiers: NCT03481712 and NCT04707859.

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微血管阻力储备：对慢性冠状动脉综合征患者血管再通后的健康状况和心肌灌注的影响。

背景和目的：微血管阻力储备（MRR）是一种新型的微循环侵入性指标，与心外膜狭窄无关，MRR具有诊断和预后意义。本研究探讨了中度冠状动脉狭窄患者接受血管再通治疗后，MRR 是否与健康状况结果相关：方法：连续接受有创冠状动脉造影检查的胸痛稳定和中度（直径 30-90%）狭窄患者（222 人）接受有创生理学评估。根据指南建议进行了血管重建。在基线和随访期间，通过西雅图心绞痛问卷（SAQ）和正电子发射断层扫描评估健康状况和心肌灌注。主要终点是随访时不再发生心绞痛，次要终点包括根据SAQ域评估的健康状况变化，以及根据MRR和血管再通状况评估的心肌灌注变化。低MRR定义为≤3.0：38/173例患者摆脱了心绞痛。在多变量分析中，MRR 与随访时不再发生心绞痛有关（几率比 0.860，95% 置信区间 0.740-0.987）。按 MRR 和血管再通分组，MRR 正常但未进行血管再通的患者和 MRR 异常但进行了血管再通的患者，其心绞痛频率的健康状况均有所改善（SAQ 心绞痛频率评分的平均差异分别为 8.5 [3.07-13.11] 和 13.5 [2.82-23.16]）。两组患者的身体限制健康状况（SAQ 身体限制评分的平均差异分别为 9.7 [4.79-11.93] 和 8.7 [0.53-13.88]）和一般健康状况（SAQ 总评分的平均差异分别为 9.3 [5.18-12.50] 和 10.8 [2.51-17.28]）也有所改善。只有接受血管重建的 MRR 异常患者的心肌灌注情况有所改善：结论：在中度冠状动脉狭窄患者中，MRR似乎可以预测血管再通治疗对症状和灌注的益处。

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来源期刊

European Heart Journal 医学-心血管系统

CiteScore

39.30

自引率

6.90%

发文量

3942

审稿时长

1 months

期刊介绍： The European Heart Journal is a renowned international journal that focuses on cardiovascular medicine. It is published weekly and is the official journal of the European Society of Cardiology. This peer-reviewed journal is committed to publishing high-quality clinical and scientific material pertaining to all aspects of cardiovascular medicine. It covers a diverse range of topics including research findings, technical evaluations, and reviews. Moreover, the journal serves as a platform for the exchange of information and discussions on various aspects of cardiovascular medicine, including educational matters. In addition to original papers on cardiovascular medicine and surgery, the European Heart Journal also presents reviews, clinical perspectives, ESC Guidelines, and editorial articles that highlight recent advancements in cardiology. Additionally, the journal actively encourages readers to share their thoughts and opinions through correspondence.