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Prognostic impact and clinical outcomes of coronary flow reserve and hyperaemic microvascular resistance
Takumi Toya1, Michel T Corban, Ji Young Park
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
Insights
Coronary flow reserve (CFR) and hyperaemic microvascular resistance (HMR) as continuous variables predict major adverse cardiovascular events (MACE) in patients with non-obstructive coronary artery disease. These findings offer new insights into cardiovascular risk assessment.
Area of Science:
- Cardiology
- Vascular Biology
- Diagnostic Imaging
Background:
- Traditional assessment of coronary microvascular function often dichotomizes key indices.
- This approach may limit the prognostic accuracy of these important cardiovascular markers.
Purpose of the Study:
- To evaluate coronary flow reserve (CFR) and hyperaemic microvascular resistance (HMR) as continuous variables for predicting major adverse cardiovascular events (MACE).
- To assess MACE, including death, myocardial infarction, revascularisation, and stroke, in patients with ischaemia and non-obstructive coronary artery disease.
Main Methods:
- A cohort of 610 patients with ischaemia and non-obstructive coronary artery disease was followed for a median of 8.0 years.
- Coronary flow reserve (CFR) and hyperaemic microvascular resistance (HMR) were analyzed as continuous parameters.
Main Results:
- Both CFR and HMR as continua significantly predicted MACE.
- An increase in CFR was associated with a reduced risk of MACE (OR 0.70), while increased HMR predicted higher MACE risk (OR 1.63).
- HMR provided additional prognostic value to CFR in predicting MACE, even after adjustment for age and sex.
Conclusions:
- Coronary flow reserve (CFR) and hyperaemic microvascular resistance (HMR), when analyzed as continuous variables, are significant predictors of future MACE.
- These continuous indices offer valuable prognostic information for patients with ischaemia and non-obstructive coronary artery disease.
Background:
Most studies dichotomise indices of coronary microvascular function to assess their prognostic values.
Aims:
We aimed to investigate whether coronary flow reserve (CFR) and hyperaemic microvascular resistance (HMR) as continua predict major adverse cardiovascular events (MACE), comprising all-cause death, myocardial infarction, revascularisation, and stroke in patients with ischaemia and non-obstructive coronary artery disease.
Methods:
A total of 610 patients were included and followed up over a median of 8.0 years (199 individual MACE in 174 patients).
Results:
Both CFR and HMR as continua predicted MACE with an odds ratio (OR) of 0.70 (per 1-unit increase, 95% confidence interval [CI]: 0.53, 0.92; p=0.01) and 1.63 (per 1 mmHg/cm/s, 95% CI: 1.20, 2.21; p=0.002), respectively. This relationship remained significant after adjustment for age and sex with an adjusted OR of 0.66 (per 1 unit increase, 95% CI: 0.49, 0.89; p=0.01) and 1.42 (per 1 mmHg/cm/s, 95% CI: 1.03, 1.94; p=0.03). HMR added prognostic value to CFR in predicting MACE (net reclassification index 0.17, 95% CI: 0.02, 0.31; p=0.03; integrated discrimination improvement 0.01, 95% CI: 0.0001, 0.02; p=0.046).
Conclusions:
Both CFR and HMR as continuous variables predict future risk of MACE.
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