Comprehensive physiological evaluation of epicardial and microvascular coronary domains using vascular conductance and zero flow pressure

Hoeven, Nina W. van der; Waard, Guus A. de; Quirós, Alicia; Hoyos, Alfonso de; Broyd, Christopher; Nijjer, Sukhjinder; Hoef, Tim P. van de; Petraco, Ricardo; Driessen, Roel; Mejía‐Rentería, Hernán; Kikuta, Yuetsu; Pinto, Mauro Echavarría; Ven, Peter M. van de; Meuwissen, Martijn; Knaapen, Paul; Piek, Jan J.; Davies, Justin E.; Royen, Niels van; Escaned, Javier

doi:10.4244/eij-d-18-00021

Cited by 5 publications

(3 citation statements)

References 29 publications

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“…HMR was calculated as the ratio between hyperemic Pd to hyperemic APV and expressed as mmHg.cm -1 .s -1 [16]. DMVC, which has also been described as Instantaneous Hyperaemic Diastolic Velocity Pressure Slope, was defined as the slope (beta coefficient) of the relationship between hyperemic Pd and AVP flow in mid to end diastole and was represented by a regression line (y= a + bx), expressed in cm.s -1 .mmHg -1 [17].…”

Section: Study Populationmentioning

confidence: 99%

Age-related structural remodelling of the coronary microcirculation

Faria,

Lombardi,

van der Hoeven

et al. 2024

Preprint

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Background: While it is broadly accepted that ageing is associated with impairment of coronary microvascular function, little is known on the underlying mechanisms. Diastolic microcirculatory conductance (DMVC) and the backward expansion wave (BEW) derived from wave intensity analysis (WIA) are two physiological indices derived from post-analysis of coronary pressure and flow that have been previously validated against endomyocardial biopsy micromorphometry, thus serving as metrics of structural microcirculatory remodelling applicable to in vivo assessment of the human coronary microcirculation. We investigated age-related changes in coronary microvascular structure in patients with stable angina without epicardial coronary stenoses. Methods: This is an analysis of the IDEAL registry, including a total of 165 vessels without coronary stenosis interrogated with combined pressure/Doppler guidewires in non-diabetic patients. We calculated DMVCs and BEWs using dedicated software, and we compared them between patient groups according to age tertiles. We also calculated the prevalence of CMD, defined by reduced Coronary Flow Reserve (CFR <2.5), and calculated the prevalence of low BEW and low DMVC (values below the 25th percentile) in each group. Results: The three study groups were defined as having 37-53; 54-66 and 67-77 years of age, respectively. Oldest (3rd tertile) patients show lower hyperemic flow velocity (46.7±14.4 vs 45.1±12.4 vs 38.4±11.5 cm.s-1, p=0.019), lower DMVC (1.90±0.71 vs 1.44±0.56 vs 1.37±0.67 cm.s-1.mmHg-1, p<0.001) and lower BEW intensity (5.9 [2.9-8.4] vs 4.8 [2.9-6.8] vs 4.4 [3.4-6.3] x106 W.m-2.s-1, p=0.094). Older age was also found to be an independent predictor of lower cumulative BEW intensity (B -0.10, 95% CI: -0.17 to -0.09, p=0.021) and lower DMVC (B -0.25 95% CI: -0.45 to -0.09, p=0.027). In patients with CMD as determined by CFR <2.5, the prevalence of BEW intensity and DMVC below the 25th percentile increased with age (25.0%, vs 52.0% vs 72.7%, for the 1st, 2nd and 3rd age tertiles, respectively, p=0.010). Conclusions: Ageing is independently associated with structural microcirculatory remodelling that is reflected in BEW intensity and DMVC measurements and increased prevalence of structural CMD. These results are important in understanding non-obstructive mechanisms of myocardial ischemia in the elderly.

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Section: Study Populationmentioning

confidence: 99%

Age-related structural remodelling of the coronary microcirculation

Faria,

Lombardi,

van der Hoeven

et al. 2024

Preprint

Self Cite

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“…Although in general, a myocardial flow reserve below two is considered abnormal whereas beyond 2.5 is deemed normal, with an ambiguous transition zone between 2.0 and 2.5 (6). These values were confirmed by a recent multicenter study presenting an optimal threshold of 2.30 mL•min -1 •g -1 for hyperemic MBF and 2.50 mL•min -1 •g -1 for myocardial flow reserve when compared with invasive fractional flow reserve (FFR) measurements (40). It can be questioned, however, whether single thresholds are reasonable.…”

Section: Clinical Value Of Myocardial Blood Flow Imagingmentioning

confidence: 75%

“…Another interesting finding from recent studies is that hyperemic MBF quantification outperforms CFR to diagnose obstructive CAD, highlighting the potential of stress only protocols (40,53,54). The largest of these studies, involving 330 patients, reported a sensitivity, specificity, and accuracy of 89, 84, and 86% against 86, 72, and 78% for hyperemic MBF and CFR, respectively (40) (Figure 4).…”

Section: O Pet (B) and Invasive Coronary Angiography (C) Images Of A ...mentioning

confidence: 99%

Advanced detection of coronary artery disease with multimodality imaging

Driessen¹

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Because coronary artery disease (CAD) remains a leading cause of global morbidity and mortality, a careful diagnostic workup of patients with suspected CAD continues to be of utmost importance. Invasive coronary angiography (ICA) is currently the reference standard for diagnosing obstructive CAD, especially in conjunction with invasive functional tests. However, because of the potential risks and costs related to ICA, current guidelines advocate to use non-invasive imaging as an initial test in patients with suspected CAD. Although, or perhaps partially because of, an ever increasing array of diagnostic tools are available for contemporary cardiologists, the diagnostic workup remains challenging. Therefore, this thesis investigates the diagnostic value of multiple established and novel imaging modalities when compared with invasive reference measurements. Furthermore, additional non-invasive imaging features are tested for a potential incremental diagnostic and prognostic value. Finally, this thesis explores the complex relationship between coronary stenosis, plaque morphology and flow in a non-invasive as well as invasive fashion.

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Age‐related structural remodelling of the coronary circulation

Faria,

Lombardi,

van der Hoeven

et al. 2024

Cathet Cardio Intervent

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BackgroundWhile it is broadly accepted that ageing is associated with impairment of coronary microvascular function, little is known about the underlying mechanisms.AimsWe investigated age‐related changes in coronary microvascular structure in patients with stable angina without epicardial coronary stenoses.MethodsIn an analysis of the IDEAL registry, a total of 165 vessels without coronary stenosis were interrogated with combined pressure/Doppler guidewires. We calculated diastolic microvascular conductance (DMVC) and backward expansion wave (BEW), and compared them between age tertiles. We calculated the prevalence of CMD, defined by reduced coronary flow reserve (CFR), and the prevalence of low BEW and low DMVC in each group.ResultsThe three study groups were defined as having 37–53, 54–66, and 67–77 years of age, respectively. Oldest (3rd tertile) patients showed lower hyperemic flow velocity (46.7 ± 14.4 vs. 45.1 ± 12.4 vs. 38.4 ± 11.5 cm s−1, p = 0.019), lower DMVC (1.90 ± 0.71 vs. 1.44 ± 0.56 vs. 1.37 ± 0.67 cm s−1 mmHg−1, p < 0.001) and lower BEW intensity (5.9 [2.9–8.4] vs. 4.8 [2.9–6.8] vs. 4.4 [3.4–6.3] × 106 W m−2 s−1, p = 0.094). Older age was independently associated with lower BEW intensity (B: −0.10, 95% confidence interval [CI]: −0.17 to −0.09, p = 0.021) and DMVC (B: −0.25 95% CI: −0.45 to −0.09, p = 0.027). In patients with CFR < 2.5, the prevalence of BEW intensity and DMVC below the 25th percentile increased with age (25.0% vs. 52.0% vs. 72.7%, p = 0.010).ConclusionsAgeing is independently associated with structural microcirculatory remodeling that is reflected in BEW intensity and DMVC measurements, and with an increased prevalence of structural CMD. These results are important to understand non‐obstructive mechanisms of myocardial ischemia in the elderly.

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Comprehensive physiological evaluation of epicardial and microvascular coronary domains using vascular conductance and zero flow pressure

Cited by 5 publications

References 29 publications

Age-related structural remodelling of the coronary microcirculation

Age-related structural remodelling of the coronary microcirculation

Advanced detection of coronary artery disease with multimodality imaging

Age‐related structural remodelling of the coronary circulation

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