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Prognostic Significance of Endogenous-Type Coronary Microvascular Dysfunction in the Left Anterior Descending Artery

Takahiro Watanabe1, Yoshihisa Kanaji1, Eisuke Usui1

  • 1Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|September 17, 2025
PubMed

Insights

Endogenous coronary microvascular dysfunction (CMD) after percutaneous coronary intervention (PCI) is a significant predictor of major adverse cardiac events (MACE). Identifying this subtype using stress echocardiography can improve risk stratification for high-risk patients.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Diagnostic Imaging

Background:

  • Coronary microvascular dysfunction (CMD) presents as endogenous or classical types.
  • Understanding the prognostic implications of these CMD endotypes is crucial for patient management.

Purpose of the Study:

  • To investigate the prognostic significance of endogenous and classical CMD endotypes.
  • To assess the predictive value of CMD phenotyping after elective percutaneous coronary intervention (PCI) in patients with chronic coronary syndrome.

Main Methods:

  • Retrospective analysis of 205 patients undergoing elective PCI in the left anterior descending artery (LAD).
  • Coronary flow assessed post-PCI using stress transthoracic Doppler echocardiography to measure diastolic peak flow velocity (DPV) and coronary flow velocity reserve (CFVR).
  • CMD defined as CFVR ≤ 2.0, classified as endogenous (DPV > 33 cm/s) or classical (DPV ≤ 33 cm/s).

Main Results:

  • Over 2.3 years, 14.6% of patients experienced major adverse cardiac events (MACE).
  • Endogenous-type CMD was associated with a significantly higher incidence of MACE compared to classical CMD or no CMD (p < 0.001).
  • Endogenous-type CMD independently predicted MACE (HR: 3.28, p = 0.002).

Conclusions:

  • Endogenous-type CMD in the LAD territory post-PCI independently predicts MACE.
  • Noninvasive phenotyping of CMD using stress echocardiography aids risk stratification.
  • Personalized management strategies can be guided by CMD endotype identification in high-risk patients.
Abstract

Keywords:
coronary microvascular dysfunctionpercutaneous coronary interventionphysiologystress‐transthoracic Doppler echocardiography

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