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Effect of percutaneous coronary intervention on global hemodynamics and the prevalence of residual microvascular
Toru Misawa1, Yoshihisa Kanaji1, Tomoyo Sugiyama1
1Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
Insights
Percutaneous coronary intervention (PCI) increased coronary sinus flow (CSF) but not global coronary flow reserve (g-CFR). A quarter of patients had residual coronary microvascular dysfunction (CMD) after PCI, highlighting the need for improved assessment strategies.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) management often involves percutaneous coronary intervention (PCI) to restore epicardial blood flow.
- Assessing microvascular function post-PCI remains crucial for optimizing patient outcomes.
- Coronary sinus flow (CSF) and global coronary flow reserve (g-CFR) are key hemodynamic parameters.
Purpose of the Study:
- To evaluate changes in hyperemic CSF and g-CFR following PCI.
- To identify predictors for improving these microvascular parameters.
- To determine the prevalence of residual coronary microvascular dysfunction (CMD) after PCI.
Main Methods:
- Prospective, single-center study of 118 stable CAD patients undergoing PCI.
- Phase-contrast cine-cardiac magnetic resonance (PC-CMR) used for pre- and post-PCI assessment of hyperemic CSF and g-CFR.
- Residual CMD defined by impaired post-PCI HCSF and g-CFR.
Main Results:
- Hyperemic CSF significantly increased post-PCI, but 32.2% of patients experienced a decrease.
- No significant change in g-CFR was observed despite improved fractional flow reserve (FFR).
- Residual CMD was present in 25.4% of patients, linked to pre-PCI renal dysfunction and lower baseline CSF.
Conclusions:
- FFR-guided PCI improved HCSF but not g-CFR.
- A significant proportion of patients exhibit residual CMD post-PCI.
- PC-CMR-derived data aids in identifying patients with residual CMD or those potentially benefiting from enhanced coronary perfusion.
Objectives:
We aimed to examine the changes in hyperemic coronary sinus flow (CSF) and global coronary flow reserve (g-CFR) after percutaneous coronary intervention (PCI) and investigate the predictors to improve these metrics and the prevalence of residual coronary microvascular dysfunction (CMD).
Methods:
This prospective, single-center study included 118 patients with stable coronary artery disease undergoing PCI for a single proximal lesion. Phase-contrast cine-cardiac magnetic resonance (PC-CMR) was used to assess hyperemic CSF (HCSF) and g-CFR, before and after PCI. Residual CMD was defined as concordantly impaired post-PCI HCSF (<2.3 ml/min/g) and g-CFR (<2.0).
Results:
HCSF significantly increased, although 38 (32.2%) patients showed a decrease. There was no significant change in g-CFR despite fractional flow reserve (FFR) improvement in all target territories. Concordantly increased HCSF and g-CFR were effectively discriminated by adding PC-CMR-derived information to pre-PCI FFR. Residual CMD was observed in 30 (25.4%) patients and was associated with pre-PCI renal dysfunction and lower pre-PCI rest and hyperemic CSF, but not with pre-PCI regional physiological indices.
Conclusions:
FFR-guided PCI was associated with increased HCSF, but not with increased g-CFR. After uncomplicated PCI, one-quarter of patients showed residual CMD. Our approach may help identify patients who may benefit from increased coronary perfusion or show residual CMD.
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