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Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
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Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction

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Microvascular dysfunction in chronic total coronary occlusions

G S Werner1, M Ferrari, B M Richartz

  • 1Clinic for Internal Medicine III, Friedrich-Schiller-University Jena, Erlanger Allee 101, Jena, Germany. gerald.werner@med.uni-jena.de

Circulation
|September 6, 2001
PubMed

Insights

Microvascular dysfunction affects over half of patients with chronic total coronary occlusions (TCOs), particularly those with diabetes or hypertension. Combining coronary flow velocity reserve (CFVR) and fractional flow reserve (FFR) is crucial for accurate assessment after TCO angioplasty.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Coronary Artery Disease

Background:

  • Microvascular dysfunction is characterized by reduced coronary flow reserve without epicardial stenosis.
  • This study investigated the prevalence and impact of microvascular dysfunction in chronic total coronary occlusions (TCOs).

Purpose of the Study:

  • To determine the prevalence of microvascular dysfunction in TCOs.
  • To assess the relationship between microvascular dysfunction and regional myocardial function.
  • To evaluate the utility of coronary flow velocity reserve (CFVR) and fractional flow reserve (FFR) in TCOs.

Main Methods:

  • Recanalization and stenting of TCOs in 42 patients.
  • Coronary flow velocity reserve (CFVR) measured by intracoronary Doppler.
  • Fractional flow reserve (FFR) recorded in a subset of 27 patients.
  • CFVR reassessed after 24 hours in 21 patients.

Main Results:

  • 55% of patients exhibited reduced CFVR (<2.0).
  • In a subgroup, 52% showed reduced CFVR with a non-significant FFR (>=0.75), indicating microvascular dysfunction.
  • Microvascular dysfunction was more prevalent in patients with diabetes and/or hypertension.
  • CFVR and FFR were poorly correlated (r=0.03).

Conclusions:

  • Microvascular dysfunction is common in TCOs (55%), irrespective of regional myocardial function.
  • Diabetes and hypertension are associated with increased microvascular dysfunction.
  • Neither CFVR nor FFR alone is sufficient for assessing angioplasty outcomes in TCOs; combined assessment is recommended.
Abstract

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