Coronary angiography-derived index for assessing microcirculatory resistance in patients with non-obstructed vessels: The FLASH IMR study

Huang, Dong; Gong, Yanjun; Fan, Yongzhen; Zheng, Bo; Lu, Zhibing; Li, Jianping; Huo, Yunlong; Escaned, Javier; Huo, Yong; Ge, Junbo

doi:10.1016/j.ahj.2023.03.016

Cited by 11 publications

(6 citation statements)

References 32 publications

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“…With the advancement in angiography technology, caIMR is proposed as a novel pressure‐wire–free tool to assess CMD. This innovation effectively addresses several clinical challenges encountered in wire‐based IMR measurements, such as the necessity of vasodilator usage, repeated saline injections, prolonged measurement duration, and heig,htened surgical risks [ 11 , 19 , 20 , 21 , 22 , 23 ]. In a comparative study with wire‐based IMR as the diagnostic standard, a strong correlation between IMR and caIMR was observed [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…This innovation effectively addresses several clinical challenges encountered in wire‐based IMR measurements, such as the necessity of vasodilator usage, repeated saline injections, prolonged measurement duration, and heig,htened surgical risks [ 11 , 19 , 20 , 21 , 22 , 23 ]. In a comparative study with wire‐based IMR as the diagnostic standard, a strong correlation between IMR and caIMR was observed [ 8 ]. Further investigations have also demonstrated that caIMR has a high diagnostic sensitivity, specificity, and accuracy in CMD patients [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

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Prognostic Value of Coronary Microvascular Dysfunction Assessed by Coronary Angiography–Derived Index of Microcirculatory Resistance in Patients With ST‐Segment Elevation Myocardial Infarction

Chao,

Jun‐Qing,

Hong

et al. 2024

Clinical Cardiology

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BackgroundCaIMR is proposed as a novel angiographic index designed to assess microcirculation without the need for pressure wires or hyperemic agents. We aimed to investigate the impact of caIMR on predicting clinical outcomes in STEMI patients.MethodsOne hundred and forty patients with STEMI who received PCI in Putuo Hospital of Shanghai from October 2021 to September 2022 were categorized into CMD and non–CMD groups according to the caIMR value. The baseline information, patient‐related examinations, and the occurrence of MACE at the 12‐month follow‐up were collected to investigate risk factors in patients with STEMI.ResultsWe divided 140 patients with STEMI enrolled into two groups according to caIMR results, including 61 patients diagnosed with CMD and 79 patients diagnosed with non–CMD. A total of 21 MACE occurred during the 1 year of follow‐up. Compared with non–CMD group, patients with CMD showed a significantly higher risk of MACE. A multivariate Cox regression model was conducted for the patients, and it was found thatcaIMR was a significant predictor of prognosis in STEMI patients (HR: 8.921). Patients with CMD were divided into culprit vascular CMD and non‐culprit vascular CMD, and the result found that culprit vascular CMD was associated with the incidence of MACE (OR: 4.75) and heart failure (OR: 7.50).ConclusionCaIMR is a strong predictor of clinical outcomes and can provide an objective risk stratification for patients with STEMI. There is a strong correlation among leukocyte index, the use of furosemide, Killips classification, and clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Coronary Microvascular Dysfunction Assessed by Coronary Angiography–Derived Index of Microcirculatory Resistance in Patients With ST‐Segment Elevation Myocardial Infarction

Chao,

Jun‐Qing,

Hong

et al. 2024

Clinical Cardiology

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“…Widespread implementation of wire-based CFR and IMR in clinical practice is hampered by the requirement for a specific intracoronary wire and the time- and cost-consuming nature of the techniques. More recently, with the technical development, coronary angiography-derived indices, such as angiography-derived index of microcirculatory resistance (IMRangio) [51], nonhyperemic angiography-derived index of microcirculatory resistance (NH-IMRangio) [42], caIMR [13], and angiographic microvascular resistance (AMR) [52], have emerged as potential alternatives to pressure-derived indices and have been proved to show good diagnostic accuracy in assessing CMD. In addition, these indices are advantageous as they do not require the use of pressure wire, hyperemic agents, or thermodilution methods, enabling the assessment of coronary microvascular function more efficiently, conveniently, and cost-effectively.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, systematic review and meta-analysis have revealed elevated rates of all-cause or cardiac mortality and MACE in the isolated CMD population [10, 11]. However, these studies did not incorporate emerging technologies, such as the wire-free angiography‐based index known as the coronary angiography-derived index of microcirculatory resistance (caIMR) [12, 13]. Due to a lack of data, the prognostic utility of coronary flow indices has not been systematically quantified across a wide broad range of measurement modalities in the isolated CMD population.…”

Section: Introductionmentioning

confidence: 99%

Impact of Isolated Coronary Microvascular Disease Diagnosed Using Various Measurement Modalities on Prognosis: An Updated Systematic Review and Meta-Analysis

Luo,

Liu,

Liu

et al. 2023

Cardiology

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Introduction: The main aim of this study was to investigate the impact of isolated coronary microvascular disease (CMD) as diagnosed via various modalities on prognosis. Methods: A systematic literature review of PubMed, Embase, and Cochrane Library databases was conducted to identify relevant studies published up to March 2023. Included studies were required to measure coronary microvascular function and report outcomes in patients without obstructive coronary artery disease (CAD) or any other cardiac pathological characteristics. The primary endpoint was all-cause mortality, and the secondary endpoint was a major adverse cardiac event (MACE). Pooled effects were calculated using random effects models. Results: A total of 27 studies comprising 18,204 subjects were included in the meta-analysis. Indices of coronary microvascular function measurement included coronary angiography-derived index of microcirculatory resistance (caIMR), hyperemic microcirculatory resistance (HMR), coronary flow reserve (CFR), and so on. Patients with isolated CMD exhibited a significantly higher risk of mortality (OR: 2.97, 95% CI, 1.91–4.60, p < 0.0001; HR: 3.38, 95% CI, 1.77–6.47, p = 0.0002) and MACE (OR: 5.82, 95% CI, 3.65–9.29, p < 0.00001; HR: 4.01, 95% CI, 2.59–6.20, p < 0.00001) compared to those without CMD. Subgroup analysis by measurement modality demonstrated consistent and robust pooled effect estimates in various subgroups. Conclusion: CMD is significantly associated with an elevated risk of mortality and MACE in patients without obstructive CAD or any other identifiable cardiac pathologies. The utilization of various measurement techniques may have potential advantages in the management of isolated CMD.

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“…Ultimately, 22 studies met the inclusion criterion and were included in the systematic review. Among them, twelve studies (12)(13)(14)(15)(25)(26)(27)(28)(29)(30)(31)(32) were included in the meta-analysis of diagnostic test, and twelve in prognostic test (7,30,31,(33)(34)(35)(36)(37)(38)(39)(40)(41). The study selection process is illustrated in Figure 1.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Diagnostic and prognostic value of angiography-derived index of microvascular resistance: a systematic review and meta-analysis

Wang,

Li,

Feng

et al. 2024

Front. Cardiovasc. Med.

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BackgroundThe angiography-derived index of microvascular resistance (A-IMR) is a novel tool for diagnosing coronary microvascular dysfunction (CMD) addressing limitation of unavailability. However, the clinical value of A-IMR remains controversial.MethodsA systematic review and meta-analysis was conducted. PubMed, EMBASE, Cochrane Library and Web of Science were searched for relevant studies. Studies that reported estimates of A-IMR's diagnostic accuracy (with thermodilution-based IMR as the reference test) and/or predictions of adverse cardiovascular events were selected. Pooled sensitivity, specificity, area under the summary receiver operating characteristic curve (sROC) were calculated to measure diagnostic performance; pooled hazard/risk ratio (HR/RR) and 95% confidence interval (95% CI) of major adverse cardiovascular events (MACE) or other independent adverse events were calculated to measure prognostic effect. This study was registered with PROSPERO (CRD42023451884).ResultsA total of 12 diagnostic studies pooling 1,642 vessels and 12 prognostic studies pooling 2,790 individuals were included. A-IMR yielded an area under sROC of 0.93 (95% CI: 0.91, 0.95), a pooled sensitivity of 0.85 (95% CI: 0.79, 0.89) and a pooled specificity of 0.89 (95% CI: 0.83, 0.93) for the diagnosis of CMD. CMD diagnosed using A-IMR was associated with higher risks of MACE (HR, 2.73, 95% CI: 2.16, 3.45), CV death (RR, 2.39, 95% CI: 1.49, 3.82) and heart failure hospitalization (HR, 2.30, 95% CI: 1.53, 3.45).ConclusionA-IMR demonstrated high diagnostic accuracy for CMD and showed a strong prognostic capability in predicting the risk of adverse CV outcomes.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023451884, PROSPERO (CRD42023451884).

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Coronary angiography-derived index for assessing microcirculatory resistance in patients with non-obstructed vessels: The FLASH IMR study

Cited by 11 publications

References 32 publications

Prognostic Value of Coronary Microvascular Dysfunction Assessed by Coronary Angiography–Derived Index of Microcirculatory Resistance in Patients With ST‐Segment Elevation Myocardial Infarction

Prognostic Value of Coronary Microvascular Dysfunction Assessed by Coronary Angiography–Derived Index of Microcirculatory Resistance in Patients With ST‐Segment Elevation Myocardial Infarction

Impact of Isolated Coronary Microvascular Disease Diagnosed Using Various Measurement Modalities on Prognosis: An Updated Systematic Review and Meta-Analysis

Diagnostic and prognostic value of angiography-derived index of microvascular resistance: a systematic review and meta-analysis

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