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Prevalence of coronary microcirculatory dysfunction in patients with chronic coronary syndromes and moderate coronary
Łukasz Niewiara1,2, Paweł Kleczyński1,2, Bartłomiej Guzik1,2
1Department of Interventional Cardiology, Jagiellonian University Medical College, Institute of Cardiology, John Paul II Hospital, Kraków, Poland.
Insights
Coronary microcirculatory dysfunction (CMD) is highly prevalent in patients with chronic coronary syndromes (CCS) and moderate coronary stenosis. Early functional testing is advised due to high prevalence and lack of specific predictors.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Coronary microcirculatory dysfunction (CMD) is increasingly recognized in chronic coronary syndromes (CCS).
- Limited data exists on CMD prevalence according to current guidelines.
- CMD impacts diagnosis and patient outcomes in CCS.
Purpose of the Study:
- To determine the prevalence of CMD in CCS patients with moderate coronary angiography lesions.
- Utilized the thermodilution method for CMD assessment.
Main Methods:
- Prospective registry of 101 CCS patients with moderate coronary stenosis.
- Excluded patients with significant epicardial stenosis.
- Assessed fractional flow reserve, coronary flow reserve, and index of microcirculatory resistance (IMR).
Main Results:
- CMD was diagnosed in 45% of patients.
- CMD prevalence differed significantly between groups with and without significant ischemia (55% vs. 24%; P=0.03).
- CMD group showed lower coronary flow reserve (1.6 vs. 2.6; P<0.001) and higher IMR (29 vs. 15; P<0.001).
- Higher resting full-cycle ratio and diastolic dysfunction predicted CMD.
Conclusions:
- CMD is highly prevalent in CCS patients with moderate coronary stenosis, irrespective of stenosis severity.
- CMD may contribute to persistent angina post-revascularization in 34% of eligible patients.
- Widespread functional testing is recommended due to high CMD prevalence and absent specific predictors.
Background:
Coronary microcirculatory dysfunction (CMD) is an emerging topic in the contemporary treatment of patients with chronic coronary syndromes (CCS), with influence both on diagnosis and patient outcome. Data on CMD prevalence according to current guidelines is scarce.
Aims:
We aimed to assess prevalence of CMD in patients with CCS and moderate lesions in coronary angiography using thermodilution method.
Methods:
The study was a prospective registry including patients undergoing coronary angiography for CCS who was diagnosed with moderate coronary stenosis. Patients with significant epicardial stenosis were excluded. All patients underwent fractional flow reserve, coronary flow reserve and index of microcirculatory resistance (IMR) assessment.
Results:
We enrolled a total of 101 patients. CMD was diagnosed in 45% of cases, with a particular difference between groups without any significant lesions and with at least one vessel causing significant ischemia (55% vs. 24%; P = 0.03). In the CMD group, there were lower coronary flow reserve and higher IMR median values compared with no CMD group (1.6 vs. 2.6; P <0.001and 29 vs. 15; P <0.001 respectively). In logistic regression models, higher resting full-cycle ratio values (P = 0.006) and the presence of diastolic dysfunction (P = 0.03) were independent predictors of CMD presence.
Conclusions:
In patients with CCS and moderate coronary stenosis CMD is highly prevalent, independent of the level of diameter stenosis. The presence of CMD in 34% of patients qualified for revascularization may influence persistent angina after revascularization. As there are no specific predictors of CMD, more common functional testing in these patients should be advised.
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