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Clinical role of post-angioplasty hyperemic microvascular resistances in chronic ischemic left ventricular

Riccardo Gorla1, Edoardo Verna, Simone Scotti

  • 1aDepartment of Cardiology bDepartment of Nuclear Medicine, Ospedale di Circolo and Fondazione Macchi, University of Insubria, Varese, Italy.

Journal of Cardiovascular Medicine (Hagerstown, Md.)
|November 30, 2016
PubMed

Insights

Increased hyperemic microvascular resistances (HMRs) after percutaneous coronary intervention (PCI) indicate poor functional recovery in patients with chronic ischemic left ventricular dysfunction (CILVD). This finding aids in predicting outcomes post-PCI.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Physiology

Background:

  • Chronic ischemic left ventricular dysfunction (CILVD) significantly impacts cardiac function.
  • Percutaneous coronary intervention (PCI) aims to restore myocardial perfusion.
  • Assessing microvascular function post-PCI is crucial for predicting recovery.

Purpose of the Study:

  • To evaluate the relationship between hyperemic microvascular resistances (HMRs) and myocardial functional recovery after PCI in CILVD patients.
  • To determine if post-PCI HMRs can predict the improvement in left ventricular ejection fraction (LVEF) and contractility.

Main Methods:

  • Retrospective study of 48 CILVD patients undergoing PCI.
  • HMRs assessed pre- and post-PCI using a dual-sensor intracoronary pressure-flow wire.
  • Myocardial perfusion (summed rest score, SRS-T) and contractility (wall motion index, WMSI-T, LVEF) evaluated by SPECT and echocardiography.

Main Results:

  • Patients were grouped by post-PCI HMRs (>2 vs. <2 mmHg/cm/s).
  • Significant improvements in LVEF, WMSI-T, and SRS-T were observed only in the group with lower post-PCI HMRs.
  • Post-PCI HMRs >1.95 mmHg/cm/s predicted the absence of LVEF and WMSI-T improvement with high accuracy.

Conclusions:

  • Elevated post-PCI HMRs are associated with a lack of functional improvement in the revascularized myocardium of CILVD patients.
  • HMRs serve as a valuable predictor for functional recovery after PCI in this population.
Abstract

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