Domenico Galante, Andrea Viceré, Ciro Pollio Benvenuto, Vincenzo Viccaro, Chiara Giuliana, Simona Todisco, Gennaro Capalbo, Rocco Montone, Enrico Romagnoli, Cristina Aurigemma, Carlo Trani, Francesco Burzotta, Filippo Crea, Antonio Maria Leone
{"title":"心绞痛和非阻塞性冠状动脉的功能评估：从微血管阻力储备到冠状动脉微血管功能障碍亚型。","authors":"Domenico Galante, Andrea Viceré, Ciro Pollio Benvenuto, Vincenzo Viccaro, Chiara Giuliana, Simona Todisco, Gennaro Capalbo, Rocco Montone, Enrico Romagnoli, Cristina Aurigemma, Carlo Trani, Francesco Burzotta, Filippo Crea, Antonio Maria Leone","doi":"10.2459/JCM.0000000000001689","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>Coronary microvascular dysfunction (CMD) is a heterogeneous condition defined by reduced coronary flow reserve (CFR). The new index 'microvascular resistance reserve' (MRR) has been developed, but its role is unclear. We investigate the relationships between functional indices in ANOCA (angina and non-obstructive coronary arteries) patients and evaluate the hemodynamic features of different CMD subtypes.</p><p><strong>Methods: </strong>We enrolled consecutive ANOCA patients assessed by using the bolus thermodilution technique. CFR, index of microcirculatory resistance (IMR) and MRR were estimated and correlated with each other. Patients were divided into two groups based on CMD presence (CFR < 2.5). Subsequently, high-hyperaemic-resistance (HHR) and low-hyperaemic-resistance (LHR) CMD subtypes were defined according to IMR values (cut-off 25). Microvascular flow and resistance were estimated both at rest and during hyperaemia with Tmnrest/IMRrest and Tmnhyp/IMR, respectively. All functional indices were compared between groups.</p><p><strong>Results: </strong>In total, 108 patients were enrolled: 66 patients in the normal group (CFR ≥ 2.5), 20 in the HHR-CMD group (CFR < 2.5 and IMR ≥ 25) and 22 in the LHR-CMD group (CFR < 2.5 and IMR < 25). MRR strongly correlated (r = 0.968, P < 0.01) with CFR, showing a good discriminatory power (area under the curve = 0.97) and accuracy (85%) for detecting CMD. LHR-CMD patients showed reduced microvascular resistance (IMRrest 34.3 ± 15.1, P < 0.01) and increased resting flow (Tmnrest 0.37 ± 0.17, P < 0.01), while HHR-CMD patients had impaired hyperaemic flow (Tmnhyp 0.45 ± 0.24 P < 0.01). MRR was reduced in CMD patients (P < 0.01), with no differences between CMD subtypes (P = 0.66).</p><p><strong>Conclusions: </strong>In ANOCA patients, MRR and CFR are strongly correlated and could be considered as functionally interchangeable tools. IMR is crucial for differentiating CMD endotypes.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"26 2","pages":"72-80"},"PeriodicalIF":2.9000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Functional assessment in angina and non-obstructive coronary arteries: from microvascular resistance reserve to subtypes of coronary microvascular dysfunction.\",\"authors\":\"Domenico Galante, Andrea Viceré, Ciro Pollio Benvenuto, Vincenzo Viccaro, Chiara Giuliana, Simona Todisco, Gennaro Capalbo, Rocco Montone, Enrico Romagnoli, Cristina Aurigemma, Carlo Trani, Francesco Burzotta, Filippo Crea, Antonio Maria Leone\",\"doi\":\"10.2459/JCM.0000000000001689\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>Coronary microvascular dysfunction (CMD) is a heterogeneous condition defined by reduced coronary flow reserve (CFR). The new index 'microvascular resistance reserve' (MRR) has been developed, but its role is unclear. We investigate the relationships between functional indices in ANOCA (angina and non-obstructive coronary arteries) patients and evaluate the hemodynamic features of different CMD subtypes.</p><p><strong>Methods: </strong>We enrolled consecutive ANOCA patients assessed by using the bolus thermodilution technique. CFR, index of microcirculatory resistance (IMR) and MRR were estimated and correlated with each other. Patients were divided into two groups based on CMD presence (CFR < 2.5). Subsequently, high-hyperaemic-resistance (HHR) and low-hyperaemic-resistance (LHR) CMD subtypes were defined according to IMR values (cut-off 25). Microvascular flow and resistance were estimated both at rest and during hyperaemia with Tmnrest/IMRrest and Tmnhyp/IMR, respectively. All functional indices were compared between groups.</p><p><strong>Results: </strong>In total, 108 patients were enrolled: 66 patients in the normal group (CFR ≥ 2.5), 20 in the HHR-CMD group (CFR < 2.5 and IMR ≥ 25) and 22 in the LHR-CMD group (CFR < 2.5 and IMR < 25). MRR strongly correlated (r = 0.968, P < 0.01) with CFR, showing a good discriminatory power (area under the curve = 0.97) and accuracy (85%) for detecting CMD. LHR-CMD patients showed reduced microvascular resistance (IMRrest 34.3 ± 15.1, P < 0.01) and increased resting flow (Tmnrest 0.37 ± 0.17, P < 0.01), while HHR-CMD patients had impaired hyperaemic flow (Tmnhyp 0.45 ± 0.24 P < 0.01). MRR was reduced in CMD patients (P < 0.01), with no differences between CMD subtypes (P = 0.66).</p><p><strong>Conclusions: </strong>In ANOCA patients, MRR and CFR are strongly correlated and could be considered as functionally interchangeable tools. IMR is crucial for differentiating CMD endotypes.</p>\",\"PeriodicalId\":15228,\"journal\":{\"name\":\"Journal of Cardiovascular Medicine\",\"volume\":\"26 2\",\"pages\":\"72-80\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2025-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Cardiovascular Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2459/JCM.0000000000001689\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/17 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cardiovascular Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2459/JCM.0000000000001689","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/17 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Functional assessment in angina and non-obstructive coronary arteries: from microvascular resistance reserve to subtypes of coronary microvascular dysfunction.
Aims: Coronary microvascular dysfunction (CMD) is a heterogeneous condition defined by reduced coronary flow reserve (CFR). The new index 'microvascular resistance reserve' (MRR) has been developed, but its role is unclear. We investigate the relationships between functional indices in ANOCA (angina and non-obstructive coronary arteries) patients and evaluate the hemodynamic features of different CMD subtypes.
Methods: We enrolled consecutive ANOCA patients assessed by using the bolus thermodilution technique. CFR, index of microcirculatory resistance (IMR) and MRR were estimated and correlated with each other. Patients were divided into two groups based on CMD presence (CFR < 2.5). Subsequently, high-hyperaemic-resistance (HHR) and low-hyperaemic-resistance (LHR) CMD subtypes were defined according to IMR values (cut-off 25). Microvascular flow and resistance were estimated both at rest and during hyperaemia with Tmnrest/IMRrest and Tmnhyp/IMR, respectively. All functional indices were compared between groups.
Results: In total, 108 patients were enrolled: 66 patients in the normal group (CFR ≥ 2.5), 20 in the HHR-CMD group (CFR < 2.5 and IMR ≥ 25) and 22 in the LHR-CMD group (CFR < 2.5 and IMR < 25). MRR strongly correlated (r = 0.968, P < 0.01) with CFR, showing a good discriminatory power (area under the curve = 0.97) and accuracy (85%) for detecting CMD. LHR-CMD patients showed reduced microvascular resistance (IMRrest 34.3 ± 15.1, P < 0.01) and increased resting flow (Tmnrest 0.37 ± 0.17, P < 0.01), while HHR-CMD patients had impaired hyperaemic flow (Tmnhyp 0.45 ± 0.24 P < 0.01). MRR was reduced in CMD patients (P < 0.01), with no differences between CMD subtypes (P = 0.66).
Conclusions: In ANOCA patients, MRR and CFR are strongly correlated and could be considered as functionally interchangeable tools. IMR is crucial for differentiating CMD endotypes.
期刊介绍：
Journal of Cardiovascular Medicine is a monthly publication of the Italian Federation of Cardiology. It publishes original research articles, epidemiological studies, new methodological clinical approaches, case reports, design and goals of clinical trials, review articles, points of view, editorials and Images in cardiovascular medicine.
Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.
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