OBJECTIVES AND BACKGROUND: Increased microvascular resistance may impair hyperemic coronary flow by limiting the maximal and constant vasodilation, resulting in increased fractional flow reserve (FFR) due to the underestimation of the translesional pressure gradient. We examined whether microvascular resistance affects FFR after successful percutaneous coronary intervention (PCI). METHODS AND RESULTS: We measured FFR and the index of microcirculatory resistance (IMR) in 104 coronary arteries of 98 patients after successful elective stenting. FFR values were compared according to the quartiles of the IMR values. Coronary flow was assessed using the hyperemic mean transit time (Tmn ). The IMR values for the interquartile ranges of 8.5-11.3, 13.9-16.3, 20.9-24.5, and 34.2-61.6 were 10.2, 15.1, 22.8, and 38.2, respectively. Both FFR and Tmn values differed significantly across the IMR quartiles (P < 0.001). The angiographic and intravascular ultrasound findings and post-PCI cardiac troponin levels showed no significant difference across the IMR quartiles. Multivariate logistic regression analysis revealed that the left anterior descending artery lesion location (odds ratio [OR] 0.17, 95% confidence interval [CI] 0.06-0.49, P = 0.001), IMR (OR 1.05, 95% CI 1.01-1.09, P = 0.012), and minimal cross-sectional lumen area (OR 1.49, 95% CI 1.03-2.17, P = 0.036) were independent predictors of increased FFR. CONCLUSIONS: Increased microvascular resistance may reduce coronary flow and increase FFR after successful elective PCI.
OBJECTIVES AND BACKGROUND: Increased microvascular resistance may impair hyperemic coronary flow by limiting the maximal and constant vasodilation, resulting in increased fractional flow reserve (FFR) due to the underestimation of the translesional pressure gradient. We examined whether microvascular resistance affects FFR after successful percutaneous coronary intervention (PCI). METHODS AND RESULTS: We measured FFR and the index of microcirculatory resistance (IMR) in 104 coronary arteries of 98 patients after successful elective stenting. FFR values were compared according to the quartiles of the IMR values. Coronary flow was assessed using the hyperemic mean transit time (Tmn ). The IMR values for the interquartile ranges of 8.5-11.3, 13.9-16.3, 20.9-24.5, and 34.2-61.6 were 10.2, 15.1, 22.8, and 38.2, respectively. Both FFR and Tmn values differed significantly across the IMR quartiles (P < 0.001). The angiographic and intravascular ultrasound findings and post-PCI cardiac troponin levels showed no significant difference across the IMR quartiles. Multivariate logistic regression analysis revealed that the left anterior descending artery lesion location (odds ratio [OR] 0.17, 95% confidence interval [CI] 0.06-0.49, P = 0.001), IMR (OR 1.05, 95% CI 1.01-1.09, P = 0.012), and minimal cross-sectional lumen area (OR 1.49, 95% CI 1.03-2.17, P = 0.036) were independent predictors of increased FFR. CONCLUSIONS: Increased microvascular resistance may reduce coronary flow and increase FFR after successful elective PCI.
Authors: Martin Sejr-Hansen; Jelmer Westra; Simon Winther; Shengxian Tu; Louise Nissen; Lars Gormsen; Steffen E Petersen; June Ejlersen; Christin Isaksen; Hans Erik Bøtker; Morten Bøttcher; Evald H Christiansen; Niels Ramsing Holm Journal: Int J Cardiovasc Imaging Date: 2019-11-19 Impact factor: 2.357
Authors: Hyun Sung Joh; Doosup Shin; Joo Myung Lee; Seung Hun Lee; David Hong; Ki Hong Choi; Doyeon Hwang; Coen K M Boerhout; Guus A de Waard; Ji-Hyun Jung; Hernan Mejia-Renteria; Masahiro Hoshino; Mauro Echavarria-Pinto; Martijn Meuwissen; Hitoshi Matsuo; Maribel Madera-Cambero; Ashkan Eftekhari; Mohamed A Effat; Tadashi Murai; Koen Marques; Joon-Hyung Doh; Evald H Christiansen; Rupak Banerjee; Hyun Kuk Kim; Chang-Wook Nam; Giampaolo Niccoli; Masafumi Nakayama; Nobuhiro Tanaka; Eun-Seok Shin; Steven A J Chamuleau; Niels van Royen; Paul Knaapen; Bon Kwon Koo; Tsunekazu Kakuta; Javier Escaned; Jan J Piek; Tim P van de Hoef Journal: J Am Heart Assoc Date: 2022-07-25 Impact factor: 6.106
Authors: Damien Collison; Matthaios Didagelos; Muhammad Aetesam-Ur-Rahman; Samuel Copt; Robert McDade; Peter McCartney; Thomas J Ford; John McClure; Mitchell Lindsay; Aadil Shaukat; Paul Rocchiccioli; Richard Brogan; Stuart Watkins; Margaret McEntegart; Richard Good; Keith Robertson; Patrick O'Boyle; Andrew Davie; Adnan Khan; Stuart Hood; Hany Eteiba; Colin Berry; Keith G Oldroyd Journal: Eur Heart J Date: 2021-12-01 Impact factor: 29.983