Reference values for intracoronary Doppler flow velocity-derived hyperaemic microvascular resistance index

Feenstra, Rutger G T; Seitz, Andreas; Boerhout, Coen K.M.; Winter, Robbert J. de; Ong, Peter; Beijk, Marcel A.M.; Piek, Jan J.; Sechtem, Udo; Hoef, Tim P. van de

doi:10.1016/j.ijcard.2022.09.054

Cited by 17 publications

(7 citation statements)

References 15 publications

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“…There was no correlation between the CFR values and the left ventricular ejection fraction, or the cardiac index assessed by transthoracic echocardiography ( p > 0.05; Spearman correlation) as to explain the observed low CFR values. Using the described cut-off of 2.5 mmHg/cm/s for pathological HMR ( 19 , 20 ), and the pattern of structural/functional CMD identified in the general population ( 16 ), we divided the vessels of patients with AF and non-obstructive epicardial disease as presenting structural CMD (HMR ≥ 2.5 mmHg/cm/s; 7 coronary arteries and 6 patients) or functional CMD (HMR < 2.5 mmHg/cm/s; 8 coronary arteries and 7 patients) ( Tables 3 , 4 ). The subgroup of vessels with structural CMD demonstrated significantly higher BMR values compared to the vessels with functional CMD (4.34 ± 0.67 mmHg/cm/s vs. 2.71 ± 1.43 mmHg/cm/s; p = 0.0289) ( Table 4 ).…”

Section: Resultsmentioning

confidence: 99%

“…The microvascular coronary status is reflected in terms of coronary indices by HMR and BMR. Recent studies have identified that HMR values above 2.5 mmHg/cm/s are suggestive of increased microvascular resistance ( 19 , 20 ) defining structural CMD, whereas functional CMD is characterized by HMR < 2.5 mmHg/cm/s in presence of diminished CFR ( 16 , 40 ). Interestingly, we identified amongst the population with AF and non-obstructive epicardial coronary disease, 47% (7/15) vessels showing HMR ≥ 2.5 mmHg/cm/s, which contrasts to approximately 21% reported in the general population ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

“…Patients with AF and non-obstructive epicardial coronary disease (FFR > 0.8; 15 vessels from 13 patients) were divided in two subgroups based on the presence of increased microvascular resistance [HMR ≥ 2.5 mmHg/cm/s ( 19 , 20 )]. We compared patient and vessel characteristics between the two subgroups (HMR < 2.5 mmHg/cm/s vs. HMR ≥ 2.5 mmHg/cm/s), including differences in pressure- and flow-based indices.…”

Section: Methodsmentioning

confidence: 99%

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Particularities of coronary physiology in patients with atrial fibrillation: insights from combined pressure and flow indices measurements

Pintea Bentea,

Berdaoui,

Samyn

et al. 2023

Front. Cardiovasc. Med.

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BackgroundSymptoms suggestive of myocardial ischemia are frequently encountered in patients with atrial fibrillation (AF) even in the absence of obstructive coronary artery disease. Nevertheless, an in-depth characterisation of coronary physiology in patients with AF is currently lacking.ObjectivesWe aim to provide an insight into the characteristics of coronary physiology in AF, by performing simultaneous invasive measurements of coronary flow- and pressure- indices in a real-life population of patients with AF and indication of coronary angiography.MethodsThis is a prospective open label study including patients with permanent or persistent AF and indication of coronary angiography showing intermediate coronary stenosis requiring routine physiological assessment (n = 18 vessels from 14 patients). We measured FFR (fractional flow reserve), and Doppler-derived coronary flow indices, including CFR (coronary flow reserve) and HMR (hyperaemic microvascular resistance).ResultsFrom the analysed vessels, 18/18 vessels (100%) presented a pathological CFR (<2.5), indicative of coronary microvascular dysfunction (CMD), and 3/18 (17%) demonstrated obstructive epicardial coronary disease (FFR ≤ 0.8). A large proportion of vessels (15/18; 83%) showed discordant FFR/CFR with preserved FFR and low CFR. 47% of the coronary arteries in patients with AF and non-obstructive epicardial coronary disease presented structural CMD (HMR ≥ 2.5 mmHg/cm/s), and were associated with high BMR and an impaired response to adenosine. Conversely, vessels from patients with AF and non-obstructive epicardial coronary disease with functional CMD (HMR < 2.5 mmHg/cm/s) showed higher bAPV. The permanent AF subpopulation presented increased values of HMR and BMR compared to persistent AF, while structural CMD was more often associated with persistent symptoms at 3 months, taking into account the limited sample size of our study.ConclusionOur findings highlight a systematically impaired CFR in patients with AF even in the absence of obstructive epicardial coronary disease, indicative of CMD. In addition, patients with AF presented more prevalent structural CMD (HMR ≥ 2.5 mmHg/cm/s), characterized by reduced hyperaemic responses to adenosine, possibly interfering with the FFR assessment.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Particularities of coronary physiology in patients with atrial fibrillation: insights from combined pressure and flow indices measurements

Pintea Bentea,

Berdaoui,

Samyn

et al. 2023

Front. Cardiovasc. Med.

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“…With regards to microvascular function, normal is defined as bolus thermodilution CFR ≥ 2.0 and IMR < 25 or Doppler CFR ≥ 2.0 and HMR ≤ 1.9. [11] While these cut-offs are according to the recent consensus document, we note that a CFR and HMR of 2.0-2.5 can be considered a grey zone that could reflect disease as shown by recent data [22,31].…”

Section: Endotype Definitionsmentioning

confidence: 86%

Design and rationale of the NetherLands registry of invasive Coronary vasomotor Function Testing (NL-CFT)

Crooijmans

Jansen

Konst

et al. 2023

International Journal of Cardiology

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“…Feenstra et al enrolled a cohort of 41 patients presenting with angina, non-obstructive coronary artery disease (<50% luminal obstruction on angiography), FFR > 0.80, and CFR > 2.5 undergoing vasomotor function test. They aimed to establish a reference range for Doppler flow velocity-derived index HMR, and they documented that values equal to or higher than 2.5 mmHg/cm/s can identify increased microvascular resistance and, therefore, microvascular dysfunction, regardless of patients’ clinical features [ 43 ].…”

Section: Clinical Evidence In Non-acute Scenariosmentioning

confidence: 99%

Invasive Assessment of Coronary Microcirculation: A State-of-the-Art Review

Ciaramella,

Di Serafino,

Mitrano

et al. 2023

Diagnostics

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A significant proportion of patients presenting with signs and symptoms of myocardial ischemia have no “significant” epicardial disease; thereby, the assessment of coronary microcirculation gained an important role in improving diagnosis and guiding therapy. In fact, coronary microvascular dysfunction (CMD) could be found in a large proportion of these patients, supporting both symptoms and signs of myocardial ischemia. However, CMD represents a diagnostic challenge for two main reasons: (1) the small dimension of the coronary microvasculature prevents direct angiographic visualization, and (2) despite the availability of specific diagnostic tools, they remain invasive and underused in the current clinical practice. For these reasons, CMD remains underdiagnosed, and most of the patients remain with no specific treatment and quality-of-life-limiting symptoms. Of note, recent evidence suggests that a “full physiology” approach for the assessment of the whole coronary vasculature may offer a significant benefit in terms of symptom improvement among patients presenting with ischemia and non-obstructive coronary artery disease. We analyze the pathophysiology of coronary microvascular dysfunction, providing the readers with a guide for the invasive assessment of coronary microcirculation, together with the available evidence supporting its use in clinical practice.

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Reference values for intracoronary Doppler flow velocity-derived hyperaemic microvascular resistance index

Cited by 17 publications

References 15 publications

Particularities of coronary physiology in patients with atrial fibrillation: insights from combined pressure and flow indices measurements

Particularities of coronary physiology in patients with atrial fibrillation: insights from combined pressure and flow indices measurements

Design and rationale of the NetherLands registry of invasive Coronary vasomotor Function Testing (NL-CFT)

Invasive Assessment of Coronary Microcirculation: A State-of-the-Art Review

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