Prognostic impact and clinical outcomes of coronary flow reserve and hyperaemic microvascular resistance

Toya, Takumi; Corban, Michel; Park, Ji Young; Ahmad, Ali; Ӧzcan, Ilke; Sebaali, Faten; Sara, Jaskanwal D.; Gulati, Rajiv; Lerman, Lilach O.; Lerman, Amir

doi:10.4244/eij-d-20-00853

Cited by 18 publications

(10 citation statements)

References 42 publications

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“… 42 demonstrated that HMR, a Doppler-based measure of microvascular function, had greater prognostic association with MACE per 1 unit change (HR: 1.55, 95% CI: 1.18–2.04) than CFR (HR: 0.36, 95% CI: 0.12–1.09). These findings have been reinforced by Toya et al ., 93 who demonstrated a comparable risk of MACE associated with unit changes in CFR and HMR. Consequently, further studies are required to clarify the prognostic association of HMR with mortality and MACE.…”

Section: Discussionmentioning

confidence: 97%

Coronary flow reserve and cardiovascular outcomes: a systematic review and meta-analysis

Kelshiker

Seligman

Howard

et al. 2021

European Heart Journal

185

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Aims This meta-analysis aims to quantify the association of reduced coronary flow with all-cause mortality and major adverse cardiovascular events (MACE) across a broad range of patient groups and pathologies. Methods and results We systematically identified all studies between 1 January 2000 and 1 August 2020, where coronary flow was measured and clinical outcomes were reported. The endpoints were all-cause mortality and MACE. Estimates of effect were calculated from published hazard ratios (HRs) using a random-effects model. Seventy-nine studies with a total of 59 740 subjects were included. Abnormal coronary flow reserve (CFR) was associated with a higher incidence of all-cause mortality [HR: 3.78, 95% confidence interval (CI): 2.39–5.97] and a higher incidence of MACE (HR 3.42, 95% CI: 2.92–3.99). Each 0.1 unit reduction in CFR was associated with a proportional increase in mortality (per 0.1 CFR unit HR: 1.16, 95% CI: 1.04–1.29) and MACE (per 0.1 CFR unit HR: 1.08, 95% CI: 1.04–1.11). In patients with isolated coronary microvascular dysfunction, an abnormal CFR was associated with a higher incidence of mortality (HR: 5.44, 95% CI: 3.78–7.83) and MACE (HR: 3.56, 95% CI: 2.14–5.90). Abnormal CFR was also associated with a higher incidence of MACE in patients with acute coronary syndromes (HR: 3.76, 95% CI: 2.35–6.00), heart failure (HR: 6.38, 95% CI: 1.95–20.90), heart transplant (HR: 3.32, 95% CI: 2.34–4.71), and diabetes mellitus (HR: 7.47, 95% CI: 3.37–16.55). Conclusion Reduced coronary flow is strongly associated with increased risk of all-cause mortality and MACE across a wide range of pathological processes. This finding supports recent recommendations that coronary flow should be measured more routinely in clinical practice, to target aggressive vascular risk modification for individuals at higher risk.

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Section: Discussionmentioning

confidence: 97%

Coronary flow reserve and cardiovascular outcomes: a systematic review and meta-analysis

Kelshiker

Seligman

Howard

et al. 2021

European Heart Journal

185

View full text Add to dashboard Cite

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“…De Waard et al 42 demonstrated that HMR, a Doppler-based measure of microvascular function, had greater prognostic association with MACE per 1 unit change (HR: 1.55, 95% CI: 1.18-2.04) than CFR (HR: 0.36, 95% CI: 0.12-1.09). These findings have been reinforced by Toya et al, 93 who demonstrated a comparable risk of MACE associated with unit changes in CFR and HMR. Consequently, further studies are required to clarify the prognostic association of HMR with mortality and MACE.…”

Section: Prognostic Impact Of the Imrmentioning

confidence: 66%

Coronary Flow Reserve and Cardiovascular Outcomes: A Systematic Review and Meta-Analysis

Kelshiker

Seligman

Howard

et al. 2022

Journal of the American College of Cardiology

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“…The Mayo Clinic protocol of CRT has been described previously in detail. 10,[17][18][19][20][21][22][23] Patients discontinued vasodilatory medications (calcium channel blockers, beta-blockers, and long-acting nitrates) at least 24 hours before the study. They were only allowed to take sublingual nitroglycerin tablets or spray for angina up to 6 hours before the catheterization procedure.…”

Section: Coronary Reactivity Testing Protocolmentioning

confidence: 99%

Coronary Reactivity Assessment Is Associated With Lower Health Care–Associated Costs in Patients Presenting With Angina and Nonobstructive Coronary Artery Disease

Ahmad

Corban

Moriarty

et al. 2023

Circ: Cardiovascular Interventions

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BACKGROUND: The financial burden linked to the diagnosis and treatment of patients with chest pain on the health care system is considerable. Angina and nonobstructive coronary artery disease (ANOCA) is common, associated with adverse cardiovascular events, and may lead to repeat testing or hospitalizations. Diagnostic certainty can be achieved in patients with ANOCA using coronary reactivity testing (CRT); however, its financial effect on the patient has not been studied. Our goal was to assess the effect of CRT on health care–related cost in patients with ANOCA. METHODS: Patients with ANOCA who underwent diagnostic coronary angiography (CAG) and CRT (CRT group) were matched to controls who had similar presentation but only underwent a CAG without CRT (CAG group). Standardized inflation-adjusted costs were collected and compared between the 2 groups on an annual basis for 2 years post the index date (CRT or CAG). RESULTS: Two hundred seven CRT and 207 CAG patients were included in the study with an average age of 52.3±11.5 years and 76% females. The total cost was significantly higher in the CAG group as compared with the CRT group ($37 804 [$26 933–$48 674] versus $13 679 [$9447–$17 910]; P <0.001). When costs are itemized and divided based on the Berenson-Eggers Type of Service categorization, the largest cost difference occurred in imaging (any type, including CAG; P <0.001), procedures (eg, percutaneous coronary intervention/coronary artery bypass grafting/thrombectomy) ( P =0.001), and test (eg, blood tests, EKG; P <0.001). CONCLUSIONS: In this retrospective observational study, assessment of CRT in patients with ANOCA was associated with significantly reduced annual total costs and health care utilization. Therefore, the study may support the integration of CRT into clinical practice.

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Prognostic impact and clinical outcomes of coronary flow reserve and hyperaemic microvascular resistance

Cited by 18 publications

References 42 publications

Coronary flow reserve and cardiovascular outcomes: a systematic review and meta-analysis

Coronary flow reserve and cardiovascular outcomes: a systematic review and meta-analysis

Coronary Flow Reserve and Cardiovascular Outcomes: A Systematic Review and Meta-Analysis

Coronary Reactivity Assessment Is Associated With Lower Health Care–Associated Costs in Patients Presenting With Angina and Nonobstructive Coronary Artery Disease

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