Prognostic value of coronary microvascular dysfunction assessed by coronary angiography-derived index of microcirculatory resistance in diabetic patients with chronic coronary syndrome

Zhang, Wen; Singh, Shekhar; Liu, Lu; Yin, Guoqing; Xu, Siling; Lv, Xian; Shi, Tingting; Feng, Cailin; Jiang, Rong; Mohammed, Ayman A; Mareai, Redhwan M.; Abdu, Fuad A; Mohammed, Abdul-Quddus

doi:10.1186/s12933-022-01653-y

Cited by 20 publications

(13 citation statements)

References 57 publications

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“…Coronary microvascular dysfunction (CMD) may result in reduced coronary flow and vasodilatory capacity, increasing the chance of generating falsely negative FFR values [ 26 ]. Another study by Zhang et al [ 27 ] investigated micro-vascular function in diabetic patients with chronic coronary syndromes, using a novel coronary angiography-derived index of microcirculatory resistance (ca-IMR). This study showed a significantly higher incidence of CMD among diabetic patients, and also showed that CMD is an independent predictor of MACE among diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of deferred revascularisation following negative fractional flow reserve in diabetic and non-diabetic patients: a meta-analysis

Ekmejian

Sritharan

Selvakumar

et al. 2023

Cardiovasc Diabetol

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Background Fractional Flow Reserve (FFR) is a widely applied invasive physiological assessment, endorsed by major guidelines to aid in the decision to perform or defer revascularisation. While a threshold of > 0.8 has been applied universally, clinical outcomes may be affected by numerous factors, including the presence of diabetes. This meta-analysis aims to investigate the outcomes of diabetic versus non-diabetic patients in whom revascularisation was deferred based on negative FFR. Methods We performed a meta-analysis investigating the outcomes of diabetic and non-diabetic patients in whom revascularisation was deferred based on negative FFR. A search was performed on MEDLINE, PubMed and EMBASE, and peer-reviewed studies that reported MACE for diabetic and non-diabetic patients with deferred revascularisation based on FFR > 0.8 were included. The primary end point was MACE. Results The meta-analysis included 7 studies in which 4275 patients had revascularisation deferred based on FFR > 0.8 (1250 diabetic). Follow up occurred over a mean of 3.2 years. Diabetes was associated with a higher odds of MACE (OR = 1.66, 95% CI 1.35–2.04, p = < 0.001), unplanned revascularisation (OR = 1.48, 95% CI 1.06–2.06, p = 0.02), all-cause mortality (OR = 1.74, 95% CI 1.20–2.52, p = 0.004) and cardiovascular mortality (OR = 2.08, 95% CI 1.07–4.05, p = 0.03). Conclusions For patients with stable coronary syndromes and deferred revascularisation based on FFR > 0.8, the presence of diabetes portends an increased long-term risk of MACE compared to non-diabetic patients. Trail registration URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42022367312.

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Section: Discussionmentioning

confidence: 99%

Outcomes of deferred revascularisation following negative fractional flow reserve in diabetic and non-diabetic patients: a meta-analysis

Ekmejian

Sritharan

Selvakumar

et al. 2023

Cardiovasc Diabetol

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“…Neng et al found that CMD diagnosed by caIMR was a strong predictor for cardiac death and heart failure in CAD patients [ 6 ]. We recently found that CMD measured by caIMR was common and was a reliable predictor of clinical outcomes in diabetic patients with CCS [ 31 ]. Based on this, CMD is clearly associated with poor prognosis, and the identification of predictive factors associated with CMD may be necessary for prompt risk stratification.…”

Section: Discussionmentioning

confidence: 99%

Association between the triglyceride-glucose index and the presence and prognosis of coronary microvascular dysfunction in patients with chronic coronary syndrome

Zhang

Liu

et al. 2023

Cardiovasc Diabetol

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Background Coronary microvascular dysfunction (CMD) is a strong determinant of prognosis in patients with chronic coronary syndrome (CCS). The triglyceride-glucose index (TyG index), an alternative method to evaluate insulin resistance, is positively correlated with the incidence and adverse outcomes of cardiovascular diseases. However, the relationship between the TyG index and the presence and prognosis of CMD in CCS patients has not been investigated. Therefore, we aimed to evaluate the association between the TyG index and the presence and clinical outcomes of CMD among CCS patients. Methods CCS patients who underwent coronary angiography between June 2015 to June 2019 were included. The TyG index was calculated as Ln[fasting triglycerides (mg/dL) × fasting blood glucose (mg/dL)/2]. Coronary angiography‑derived index of microvascular resistance (caIMR) was used to measure microvascular function, and CMD was defined as caIMR ≥ 25U. Patients with CMD were divided into three groups (T1, T2, and T3 groups) according to TyG tertiles. The primary endpoint was major adverse cardiac event (MACE). Results Of 430 CCS patients, 221 patients had CMD. CMD patients had significantly higher TyG index than those without CMD. Sixty-three MACE was recorded during the follow-up duration among CMD patients, and the incidence rate of MACE was higher in the T3 group compared to T1/T2 groups (39.2% vs. 20.5% vs. 25.7%; P = 0.035). Multivariable logistic regression analysis showed that the TyG index was an independent predictor of CMD (OR, 1.436; 95% CI, 1.014–2.034; P = 0.042). Compared to the T1 group, the T3 group strongly correlated with the risk of MACE in CMD patients even after adjusting for additional confounding risk factors (HR, 2.132; 95%CI, 1.066–4.261; P = 0.032). Conclusion TyG index is significantly associated with the risk of CMD, and it is an independent predictor of MACE among CMD patients with CCS. This study suggests that the TyG index has important clinical significance for the early prevention and risk stratification of CMD.

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“…Because the total number of CMD in the nonobstructive group was relatively small, the prognostic effect of CMD in the nonobstructive was inconclusive; thus, further studies with a larger sample are needed to verify our findings. CMD is common among diabetic 44 and prediabetic patients 45 . Diabetes is associated with an increased risk of adverse outcomes in patients with nonobstructive and obstructive acute MI 46,47 .…”

Section: Discussionmentioning

confidence: 99%

Effect of nonobstructive coronary stenosis on coronary microvascular dysfunction and long‐term outcomes in patients with INOCA

Mohammed

Zhang

Abdu

et al. 2022

Clinical Cardiology

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Background Ischemic pain with no‐obstructive coronary artery (INOCA) is clinically significant and defined by nonobstructive coronary stenosis <50%. Coronary microvascular dysfunction (CMD) is a relevant cause associated with adverse outcomes. Objectives Investigated the effect of no‐stenosis (0% stenosis) and non‐obstructive (0% < stenosis < 50%) on the prognostic impact of CMD in INOCA. Method A retrospective study assessed the coronary microvascular function in 151 INOCA patients who underwent invasive angiography by the coronary angiography‐derived index of microcirculation‐resistance (caIMR). CZT‐SPECT was performed to evaluate myocardial perfusion imaging (MPI) abnormalities. Chi‐square test/Fisher exact test, Student t‐test, Kaplan–Meier curve, and Uni‐multivariable Cox proportional models were used for analysis. Clinical outcomes were major adverse cardiovascular events (MACE) during a median follow‐up of 35 months. Result No‐stenosis was present in 71 (47%) INOCA patients, and 80 (53%) were with nonobstructive. CMD (caIMR ≥ 25) was more prevalent in patients with no‐stenosis than nonobstructive (76.1% vs. 48.8%, p = .001), along with abnormal MPI (39.4% vs. 22.5%, p = .024). The MACE rates were not different between no‐stenosis and nonobstructive stenosis. CMD showed an increased risk of MACE for all INOCA. No‐stenosis with CMD had the worst prognosis. Cox regression analysis identified CMD and abnormal MPI as predictors of MACE in all INOCA and patients with no‐stenosis. However, no‐stenosis and nonobstructive stenosis were not predictors of MACE in INOCA. Conclusion CMD was more frequently present in INOCA with no‐stenosis. However, there was no difference in long‐term clinical outcomes between no‐stenosis and nonobstructive stenosis. CMD could independently predict poor outcomes in INOCA, particularly in patients with no‐stenosis.

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Prognostic value of coronary microvascular dysfunction assessed by coronary angiography-derived index of microcirculatory resistance in diabetic patients with chronic coronary syndrome

Cited by 20 publications

References 57 publications

Outcomes of deferred revascularisation following negative fractional flow reserve in diabetic and non-diabetic patients: a meta-analysis

Outcomes of deferred revascularisation following negative fractional flow reserve in diabetic and non-diabetic patients: a meta-analysis

Association between the triglyceride-glucose index and the presence and prognosis of coronary microvascular dysfunction in patients with chronic coronary syndrome

Effect of nonobstructive coronary stenosis on coronary microvascular dysfunction and long‐term outcomes in patients with INOCA

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