Roberto Scarsini1, Mayooran Shanmuganathan2, Giovanni Luigi De Maria3, Alessandra Borlotti4, Rafail A Kotronias5, Matthew K Burrage6, Dimitrios Terentes-Printzios3, Jeremy Langrish3, Andrew Lucking3, Gregor Fahrni3, Florim Cuculi3, Flavio Ribichini7, Robin Choudhury8, Rajesh Kharbanda5, Vanessa M Ferreira2, Keith M Channon5, Adrian P Banning9. 1. Oxford Heart Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom; Division of Cardiology, Department of Medicine, University of Verona, Verona Italy. 2. Oxford Heart Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom; Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford United Kingdom. 3. Oxford Heart Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom. 4. Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom. 5. Oxford Heart Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom; Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United Kingdom. 6. Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford United Kingdom. 7. Division of Cardiology, Department of Medicine, University of Verona, Verona Italy. 8. Oxford Heart Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom; Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom. 9. Oxford Heart Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom; Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United Kingdom. Electronic address: Adrian.Banning@ouh.nhs.uk.
Abstract
OBJECTIVES: This study sought to evaluate the long-term prognostic implications of coronary microvascular dysfunction (CMD) when assessed with both cardiovascular magnetic resonance (CMR) and index of microcirculatory resistance (IMR) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). BACKGROUND: Post-ischemic CMD can be assessed using the pressure-wire based IMR and/or by the presence of microvascular obstruction (MVO) on CMR. METHODS: A total of 198 patients with STEMI underwent IMR and MVO assessment. Patients were classified as follows: Group 1, no significant CMD (low IMR [≤40 U] and no MVO); Group 2, CMD with either high IMR (>40 U) or MVO; Group 3, CMD with both IMR >40 U and MVO. The primary endpoint was the composite of all-cause mortality, diagnosis of new heart failure, cardiac arrest, sustained ventricular tachycardia/fibrillation, and cardioverter defibrillator implantation. RESULTS: CMD with both high IMR and MVO was present in 23.7% of the cases (Group 3) and CMD with either high IMR or MVO was observed in 40.9% of cases (Group 2). At a median follow-up of 40.1 months, the primary endpoint occurred in 34 (17%) cases. At 1 year of follow-up, Group 3 (hazard ratio [HR]: 12.6; 95% confidence interval [CI]: 1.6 to 100.6; p = 0.017) but not Group 2 (HR: 7.2; 95% CI: 0.9 to 57.9; p = 0.062) had worse clinical outcomes compared with those with no significant CMD in Group 1. However, in the long-term, patients in Group 2 (HR: 4.2; 95% CI: 1.4 to 12.5; p = 0.009) and those in Group 3 (HR: 5.2; 95% CI: 1.7 to 16.2; p = 0.004) showed similar adverse outcomes, mainly driven by the occurrence of heart failure. CONCLUSIONS: Post-ischemic CMD predicts a more than 4-fold increase in long-term risk of adverse outcomes, mainly driven by the occurrence of heart failure. Defining CMD by either invasive IMR >40 U or by CMR-assessed MVO showed similar risk of adverse outcomes.
OBJECTIVES: This study sought to evaluate the long-term prognostic implications of coronary microvascular dysfunction (CMD) when assessed with both cardiovascular magnetic resonance (CMR) and index of microcirculatory resistance (IMR) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). BACKGROUND: Post-ischemic CMD can be assessed using the pressure-wire based IMR and/or by the presence of microvascular obstruction (MVO) on CMR. METHODS: A total of 198 patients with STEMI underwent IMR and MVO assessment. Patients were classified as follows: Group 1, no significant CMD (low IMR [≤40 U] and no MVO); Group 2, CMD with either high IMR (>40 U) or MVO; Group 3, CMD with both IMR >40 U and MVO. The primary endpoint was the composite of all-cause mortality, diagnosis of new heart failure, cardiac arrest, sustained ventricular tachycardia/fibrillation, and cardioverter defibrillator implantation. RESULTS:CMD with both high IMR and MVO was present in 23.7% of the cases (Group 3) and CMD with either high IMR or MVO was observed in 40.9% of cases (Group 2). At a median follow-up of 40.1 months, the primary endpoint occurred in 34 (17%) cases. At 1 year of follow-up, Group 3 (hazard ratio [HR]: 12.6; 95% confidence interval [CI]: 1.6 to 100.6; p = 0.017) but not Group 2 (HR: 7.2; 95% CI: 0.9 to 57.9; p = 0.062) had worse clinical outcomes compared with those with no significant CMD in Group 1. However, in the long-term, patients in Group 2 (HR: 4.2; 95% CI: 1.4 to 12.5; p = 0.009) and those in Group 3 (HR: 5.2; 95% CI: 1.7 to 16.2; p = 0.004) showed similar adverse outcomes, mainly driven by the occurrence of heart failure. CONCLUSIONS: Post-ischemic CMD predicts a more than 4-fold increase in long-term risk of adverse outcomes, mainly driven by the occurrence of heart failure. Defining CMD by either invasive IMR >40 U or by CMR-assessed MVO showed similar risk of adverse outcomes.
Authors: Roberto Scarsini; Mayooran Shanmuganathan; Rafail A Kotronias; Dimitrios Terentes-Printzios; Alessandra Borlotti; Jeremy P Langrish; Andrew J Lucking; Flavio Ribichini; Vanessa M Ferreira; Keith M Channon; Hector M Garcia-Garcia; Adrian P Banning; Giovanni Luigi De Maria Journal: Int J Cardiovasc Imaging Date: 2021-05-05 Impact factor: 2.357
Authors: Rafail A Kotronias; Kirsty Fielding; Charlotte Greenhalgh; Regent Lee; Mohammad Alkhalil; Federico Marin; Maria Emfietzoglou; Adrian P Banning; Claire Vallance; Keith M Channon; Giovanni Luigi De Maria Journal: Front Cardiovasc Med Date: 2022-09-20