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Published on: January 28, 2020
Prognostic Value of Coronary Angiography-Derived Index of Microvascular Resistance in Patients With Hypertrophic
Yuxuan Zhang1,2,3,4, Rui Ji1,2,3,4, Shuxin Lei1,2,3,4
1Department of Cardiology of The Second Affiliated Hospital School of Medicine, Zhejiang University Hangzhou China.
Insights
Assessing coronary microcirculation with angiography-derived index of microvascular resistance (angio-IMR) helps predict major adverse cardiovascular events in hypertrophic cardiomyopathy (HCM) patients.
Area of Science:
- Cardiology
- Cardiovascular Research
- Medical Imaging
Background:
- Coronary microcirculation assessment is vital for hypertrophic cardiomyopathy (HCM) progression but often insufficient clinically.
- Microvascular dysfunction plays a significant role in HCM pathophysiology and patient outcomes.
Purpose of the Study:
- To investigate the predictive value of angiography-derived index of microvascular resistance (angio-IMR) for clinical outcomes in HCM patients.
- To determine if elevated angio-IMR is an independent predictor of major adverse cardiovascular events (MACE) in this population.
Main Methods:
- Retrospective analysis of angio-IMR in 422 HCM patients across two centers.
- Coronary angiography-derived index of microvascular resistance (angio-IMR) was measured for the left anterior descending artery (LAD).
- Major adverse cardiovascular events (MACE) were tracked, including cardiovascular death, heart failure readmission, arrhythmias, septal reduction therapy, and stroke.
Main Results:
- A total of 63 patients (14.93%) experienced MACE during a mean follow-up of 43 months.
- Patients with LAD angio-IMR > 25 had a significantly higher incidence of MACE (25.4% vs. 13.3%, p=0.035).
- Elevated LAD angio-IMR was confirmed as an independent predictor of MACE after adjusting for risk factors (HR 1.779, p=0.031).
Conclusions:
- Elevated LAD angio-IMR is a robust and independent indicator of adverse prognosis in HCM patients.
- Evaluating LAD angio-IMR during coronary angiography is crucial for risk stratification in HCM.
- This assessment can guide clinical management and improve patient outcomes in hypertrophic cardiomyopathy.
Abstract:
Assessing coronary microcirculation is crucial in the progression of hypertrophic cardiomyopathy (HCM), but it's often inadequate in clinical practice. This study investigates the role of coronary microcirculation, assessed via angiography-derived index of microvascular resistance (angio-IMR), in predicting clinical outcomes in HCM patients. We retrospectively measured angio-IMR in 422 HCM patients across two sites. The primary endpoint was major advance cardiovascular event (MACE), including cardiovascular death, heart failure readmission, life-threatening ventricular arrhythmias, septal reduction therapy or new-onset stroke. Over a mean follow-up of 43 ± 23 months, 63 patients (14.93%) experienced MACE. The mean angio-IMR value for the left anterior descending artery (LAD) was 22 ± 8. Using maximally selected log-rank statistic, 123 patients were stratified into the high LAD angio-IMR group, indicating microvascular dysfunction. Patients with LAD angio-IMR > 25 exhibited a higher incidence of MACE than those with LAD angio-IMR ≤ 25 (25.4% vs. 13.3%, p = 0.035). After adjusting for risk factors, elevated LAD angio-IMR remained an independent predictor of MACE (HR 1.779, 95% CI, 1.053-3.007, p = 0.031). Subgroup analysis showed consistent results. Our findings underscore that elevated LAD angio-IMR is a robust, independent indicator of adverse prognosis in HCM patients, highlighting the importance of evaluating LAD angio-IMR during coronary angiography for these patients.
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