Blood haemoglobin, renal insufficiency, fractional flow reserve and plasma NT-proBNP is associated with index of microcirculatory resistance in chronic coronary syndrome

Östlund-Papadogeorgos, Nikolaos; Ekenbäck, Christina; Jokhaji, Fadi; Mir-Akbari, Habib; Witt, Nils; Jernberg, Tomas; Wallén, Håkan; Linder, Rikard; Törnerud, Mattias; Samad, Bassem A.; Persson, Jonas

doi:10.1016/j.ijcard.2020.05.037

Cited by 5 publications

(4 citation statements)

References 37 publications

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“…Third, the INOCA controls were numerically, but not statistically, younger than the TTS patients in our study, which could have influenced the differences in CMD between groups. CMD has however not been associated with age in previous studies 15,25 . Fourth, intravascular and cardiac imaging was not performed in the INOCA control group.…”

Section: Discussionmentioning

confidence: 82%

“…Because invasive assessment of coronary microvascular function is not feasible for ethical reasons in healthy subjects, age-and gender-matched controls were selected from an observational study of coronary microvascular function in consecutive patients with chronic coronary syndrome conducted at our institution as previously described. 14,15 The controls had symptoms and/or non-invasive testing suggestive of ischemia, and no coronary stenoses on elective coronary angiogram, thus representative of INOCA. Furthermore, they had no history of previous percutaneous coronary intervention or myocardial infarction.…”

Section: Study Groupsmentioning

confidence: 99%

“…CMD has however not been associated with age in previous studies. 15,25 Fourth, intravascular and cardiac imaging was not performed in the INOCA control group. Finally, our study cannot provide causative evidence of CMD as the underlying pathophysiological mechanism of TTS.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Coronary microvascular dysfunction in Takotsubo syndrome and associations with left ventricular function

et al. 2023

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Aims Coronary microvascular dysfunction (CMD) has been proposed as an important pathophysiological mechanism in Takotsubo syndrome (TTS). Our aims were (i) to evaluate and compare levels of CMD in patients with TTS and patients with ischaemia and no obstructive coronary arteries (INOCA) and (ii) to investigate associations between CMD and clinical parameters, left ventricular function, and coronary atherosclerosis in TTS. Methods and results We conducted a prospective study of 27 female TTS patients and an equally sized, age‐ and gender‐matched, cohort of INOCA patients. Coronary microvascular function was quantified invasively using the index of microcirculatory resistance (IMR), coronary flow reserve (CFR), and resistive reserve ratio (RRR). CMD was defined as IMR ≥ 25 and/or CFR ≤ 2. In the TTS patients, left ventricular function was assessed with echocardiography and cardiovascular magnetic resonance (CMR) imaging, and coronary atherosclerosis was visualized with intravascular ultrasound with near‐infrared spectroscopy (IVUS‐NIRS). The incidence of CMD was higher in the TTS patients than in the INOCA cohort (78% vs. 44%, P = 0.01), with higher IMR (30 vs. 14, P = 0.002), lower CFR (1.8 vs. 2.8, P = 0.009), and lower RRR (2.1 vs. 3.5, P = 0.003). In apical compared with midventricular TTS, IMR was numerically higher (50 vs. 28, P = 0.20), whereas CFR and RRR were lower (1.5 vs. 2.5, P = 0.003 and 1.6 vs. 2.7, P = 0.01, respectively). Global longitudinal strain and global circumferential strain, assessed with CMR imaging, were more impaired in apical than in midventricular TTS (−11 vs. −14, P < 0.001 and −12 vs. −15, P = 0.049, respectively). In the TTS patients, CFR and RRR correlated with echocardiography‐derived (R2 = 0.15, P = 0.002 and R2 = 0.18, P = 0.007, respectively) and CMR‐derived (R2 = 0.09, P = 0.025 and R2 = 0.10, P = 0.038, respectively) ejection fraction. CFR and RRR correlated inversely with CMR‐derived end‐diastolic volume index, end‐systolic volume index, and left ventricular mass index. IMR, CFR, and RRR were not associated with measures of coronary atherosclerosis derived by IVUS‐NIRS. Conclusions Coronary microvascular dysfunction is common in patients with TTS and more frequent than in patients with INOCA. CMD in TTS is more severe in the apical compared with the midventricular phenotype of the syndrome, is associated with left ventricular function, but is unrelated to coronary atherosclerosis. Our results support the notion of CMD as a key mediator in TTS.

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Section: Discussionmentioning

confidence: 82%

Section: Study Groupsmentioning

confidence: 99%

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Coronary microvascular dysfunction in Takotsubo syndrome and associations with left ventricular function

et al. 2023

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“…This increased blood flow causes a greater loss of translesional pressure, (especially in diastole) and leads to more positive iFR. 26 In a study done by Östlund‐Papadogeorgos et al, 27 lower intramyocardial resistance was found in patients with lower hemoglobin levels, and a higher occurence of the FFRn/RFRp discrepancy in patients with lower hemoglobin level was found in studies published by Kato et al 28 and Muroya et al 26 …”

Section: Discussionmentioning

confidence: 91%

Fractional Flow Reserve Versus Instantaneous Wave‐Free Ratio in Assessment of Lesion Hemodynamic Significance and Explanation of their Discrepancies. International, Multicenter and Prospective Trial: The FiGARO Study

Kovárník

Matsuo

Král

et al. 2022

JAHA

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Background The FiGARO (FFR versus iFR in Assessment of Hemodynamic Lesion Significance, and an Explanation of Their Discrepancies) trial is a prospective registry searching for predictors of fractional flow reserve/instantaneous wave‐free ratio (FFR/iFR) discrepancy. Methods and Results FFR/iFR were analyzed using a Verrata wire, and coronary flow reserve was analyzed using a Combomap machine (both Philips‐Volcano). The risk polymorphisms for endothelial nitric oxide synthase and for heme oxygenase‐1 were analyzed. In total, 1884 FFR/iFR measurements from 1564 patients were included. The FFR/iFR discrepancy occurred in 393 measurements (20.9%): FFRp (positive)/iFRn (negative) type (264 lesions, 14.0%) and FFRn/iFRp (129 lesions, 6.8%) type. Coronary flow reserve was measured in 343 lesions, correlating better with iFR (R=0.56, P <0.0001) than FFR (R=0.36, P <0.0001). The coronary flow reserve value in FFRp/iFRn lesions (2.24±0.7) was significantly higher compared with both FFRp/iFRp (1.39±0.36), and FFRn/iFRn lesions (1.8±0.64, P <0.0001). Multivariable logistic regression analysis confirmed (1) sex, age, and lesion location in the right coronary artery as predictors for FFRp/iFRn discrepancy; and (2) hemoglobin level, smoking, and renal insufficiency as predictors for FFRn/iFRp discrepancy. The FFRn/iFRp type of discrepancy was significantly more frequent in patients with both risk types of polymorphisms (endothelial nitric oxide synthase r +heme oxygenase‐1 r ): 8 patients (24.2%) compared with FFRp/iFRn type of discrepancy: 2 patients (5.9%), P =0.03. Conclusions Predictors for FFRp/iFRn discrepancy were sex, age, and location in the right coronary artery. Predictors for FFRn/iFRp were hemoglobin level, smoking, and renal insufficiency. The risk type of polymorphism in endothelial nitric oxide synthase and heme oxygenase‐1 genes was more frequently found in patients with FFRn/iFRp type of discrepancy. Registration URL: https://clinicaltrials.gov ; Unique identifier: NCT03033810.

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Microvascular Dysfunction as a Systemic Disease: A Review of the Evidence

Feuer

Handberg

Mehrad

et al. 2022

The American Journal of Medicine

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Blood haemoglobin, renal insufficiency, fractional flow reserve and plasma NT-proBNP is associated with index of microcirculatory resistance in chronic coronary syndrome

Cited by 5 publications

References 37 publications

Coronary microvascular dysfunction in Takotsubo syndrome and associations with left ventricular function

Coronary microvascular dysfunction in Takotsubo syndrome and associations with left ventricular function

Fractional Flow Reserve Versus Instantaneous Wave‐Free Ratio in Assessment of Lesion Hemodynamic Significance and Explanation of their Discrepancies. International, Multicenter and Prospective Trial: The FiGARO Study

Microvascular Dysfunction as a Systemic Disease: A Review of the Evidence

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