Coronary Flow Reserve and Microcirculatory Resistance in Patients With Intermediate Coronary Stenosis

Lee, Joo Myung; Jung, Ji Hyun; Hwang, Doyeon; Park, Jonghanne; Yang, Fan; Na, Sang Hoon; Doh, Joon Hyung; Nam, Chang Wook; Shin, Eun Seok; Koo, Bon Kwon

doi:10.1016/j.jacc.2015.12.053

Cited by 259 publications

(174 citation statements)

References 34 publications

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“…Mehta et al reported that lower FFR values among acute coronary syndrome patients with coronary lesions deferred revascularization based on FFR are associated with a significantly higher rate of adverse cardiac events 23. The principle of CFR has been vigorously applied to a number of diagnostic tests, although its sensitivity toward resting hemodynamic relevance has been considered an important limitation in its use to consider myocardial flow impairment, despite reported evidence of powerful efficacy to stratify the risk of adverse cardiac events 7, 16, 24, 25. Our results indicated that CFR decrease after successful PCI was not uncommon, and CFR decrease was associated with pre‐PCI physiological indices including high CFR, high FFR, low IMR, and no significant coronary flow increase after successful PCI.…”

Section: Discussionmentioning

confidence: 99%

“…Coronary artery disease exists diffusely in addition to a local isolated stenosis, so that localized mechanical intervention may fail to alter long‐term disease outcome. Information on coronary physiology and myocardial blood flow in patients with coronary heart disease has been rigorously debated recently as to whether it informs treatment decisions 6, 8, 12, 14, 24, 25. Despite incorporation into contemporary guidelines, these techniques are still poorly understood, and their interpretation to guide revascularization decisions is often inconsistent (eg, FFR/CFR discordant).…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and Clinical Significance of Discordant Changes in Fractional and Coronary Flow Reserve After Elective Percutaneous Coronary Intervention

Matsuda

Murai

Kanaji

et al. 2016

JAHA

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BackgroundFractional flow reserve (FFR) and coronary flow reserve (CFR) are well‐validated physiological indices; however, changes in FFR and CFR after percutaneous coronary intervention (PCI) remain elusive. We sought to evaluate these changes and to investigate whether physiological indices predict cardiac event‐free survival after PCI.Methods and ResultsPhysiological assessment of 220 stenoses from 220 patients was performed before and after PCI. The changes in FFR and CFR were studied, and factors associated with CFR change were investigated. Follow‐up data were collected to determine the predictor of cardiac events. CFR increase was found in 158 (71.8%) territories, and 62 (28.2%) presented a decrease, whereas FFR increased in all 220 (100%) territories. Pre‐ and post‐PCI percentage diameter stenoses were 57.7±11.2% and 7.48±4.79%, respectively. Post‐PCI CFR increase was associated with pre‐PCI indices including low FFR, low CFR and high microvascular resistance, and post‐PCI hyperemic coronary flow increase. Post‐PCI CFR decrease was not associated with significant post‐PCI hyperemic coronary flow increase. At a median follow‐up of 24.3 months, adverse event–free survival was significantly worse in patients with lower pre‐PCI CFR (log‐rank test λ2=7.26; P=0.007). Cox proportional hazards analysis showed that lower pre‐PCI CFR (hazard ratio 0.73; 95% CI 0.55–0.97; P=0.028) was an independent predictor of adverse cardiovascular events after PCI.Conclusions CFR decrease after PCI was not uncommon, and discordant change in FFR and CFR was associated with high pre‐PCI CFR, low pre‐PCI microvascular resistance, and no significant post‐PCI hyperemic coronary flow increase. Pre‐PCI CFR, not post‐PCI physiological indices, may help identify patients who require adjunctive management strategy after successful PCI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prevalence and Clinical Significance of Discordant Changes in Fractional and Coronary Flow Reserve After Elective Percutaneous Coronary Intervention

Matsuda

Murai

Kanaji

et al. 2016

JAHA

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“…Additionally, the microvascular resistance index also provides data on microvascular function, being measured by through the distal coronary pressure multiplied by the mean transit time of 3 mL of saline bolus during adenosine-induced hyperemia, with the normal value being < 20, whereas the altered value is > 30. [11][12][13] In the total sample, the FFR was negative in 53.57% of the patients who had a positive MPS, a result that can be explained by the presence of microvascular disease, which was confirmed by the abovementioned methods.…”

Section: -13mentioning

confidence: 80%

Comparison between Myocardial Ischemia Evaluation by Fractional Flow Reserve and Myocardial Perfusion Scintigraphy

Issa

Pittella

Leandro

et al. 2018

International Journal of Cardiovascular Sciences

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Background: Moderate coronary artery lesions can be, or not, responsible for myocardial ischemia. The functional analysis of these lesions can be performed by invasive and noninvasive methods. Objective:To compare the functional analysis of moderate coronary lesions by fractional flow reserve and myocardial perfusion scintigraphy.Methods: 47 patients with stable coronary artery disease and at least one moderate coronary artery obstruction were prospectively studied. They were submitted to fractional flow reserve and myocardial perfusion scintigraphy with a median interval of 24.5 days between January 2013 and December 2015. There was no change in clinical status or revascularization procedure between the exams. The population variables were described as medians and interquartile range. Fractional flow reserve was performed in one left main coronary artery; 37 left descending coronary arteries; 12 circumflex arteries and 4 right coronary arteries. Fractional flow reserve < 0.8 was considered positive. The comparative analysis between the results of the tests was performed by two-tailed Fisher's test and a p-value ≤ 0.05 was considered significant.Results: Fractional flow reserve < 0.8 was found in the left main coronary artery (100%); 13 in the left descending coronary artery (35.14%); 6 in circumflex artery (50%) and 2 in the right coronary artery (50%). Among the patients with positive fractional flow reserve, 83% had myocardial ischemia demonstrated by the myocardial perfusion scintigraphy (p = 0.058). When analyzing specifically the left descending coronary artery, 83% of the patients with negative fractional flow reserve showed no ischemia at the myocardial perfusion scintigraphy, but 69% of the patients with positive fractional flow reserve showed no ischemia at the myocardial perfusion scintigraphy (p = 0.413). Conclusion:Disagreements can occur between the results of the functional analysis of moderate coronary lesions by invasive and noninvasive tests. (Int J Cardiovasc Sci. 2018;31(4)333-338)

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“…Blood supply via microvessels in the heart is a critical determinant of the outcome of myocardial infarction (10,11). Disruption of coordinated cardiomyocytes growth and blood supply can eventually lead to the transition from cardiac hypertrophy to heart failure (12,13).…”

Section: Discussionmentioning

confidence: 99%

Case report: improvement of cardiac remodeling with shock wave therapy of a patient with ischemic cardiomyopathy

Bai¹,

Wang²,

Deng³

et al. 2017

J. Thorac. Dis.

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Percutaneous coronary intervention (PCI) and coronary-artery bypass grafting (CABG) are two major preferred reperfusion strategies to restore the ischemic-related artery patency, but PCI and CABG do not necessarily guarantee the recovery of post-procedure left ventricular (LV) dysfunction and release of symptoms. Moreover, there is no definitive effective way to enhance microcirculations. Theoretically, shock wave therapy (SWT) is an option. We report here a case of patient who received SWT. The patient's medical history was characterized by chest pain for 20 years, having received CABG 13 years ago. The follow-up angiography showed all blood vessels are stiff and rigid therefore no chance for a second CABG. After cardiac SWT treatment for 1 year, the patient's symptoms of chest pain and chronic heart failure significantly improved, the odds of cardiac muscle survival increased, the cardiac remodeling was also improved. What's more, left ventricular ejection fraction (LVEF) was improved from 34% to 51% and 43% in half year and 1 year after SWT which is indicated by single-photon emission computed tomography (SPECT), respectively. To our knowledge, this is the first report of 2-cycle cardiac SWT treatments over 1 year with a complete follow-up, indicating that SWT can not only improve the symptoms of chronic heart failure, but also improve LVEF and cardiac remodeling caused by ischemic cardiomyopathy.Keywords: Cardiac shock wave therapy (CSWT); chronic heart failure; microcirculation; angiogenesis; cardiac remodeling Submitted Sep 05, 2017. Accepted for publication Oct 23, 2017Oct 23, . doi: 10.21037/jtd.2017 View this article at: http://dx.doi.org/10.21037/jtd.2017.11.108 E1105 Journal of Thoracic Disease, Vol 9, No 12 December 2017 © Journal of Thoracic Disease. All rights reserved.J Thorac Dis 2017;9(12):E1104-E1109 jtd.amegroups.com ventricular remodeling over long term. In addition, few study has reported the efficacy and safety of SWT on heart failure.Therefore, we report the effect of SWT on a patient who was diagnosed as heart failure and had no valid drug therapy, with a long-term follow-up for 1.5 years and review the pertinent literature. Case presentationA 59-year-old man with a 10-year history of diabetes and frequently exhibited chest pain for 20 years was admitted to our hospital. The patient had received CABG in 2002, the bypass grafts were: left internal mammary artery (LIMA)-left coronary artery (LCA), aorta (AO)-saphenous vein graft (SVG)-the first diagonal (D1)-obtuse marginal (OM), AO-SVG-right coronary artery (RCA). Follow-up angiography showed all blood vessels are stiff and rigid, among which the largest degree of the stenosis for AO-SVG-D1-OM and AO-SVG-RCA were both 90%, and unfortunately this patient cannot undergo a second CABG according to the current guidelines. He suffered from chest pain and exertional dyspnea after a 200-m walk and was hospitalized more than 3 times due to dyspnea and other manifestations of chronic heart failure per year. His angiography in 2015 show...

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Coronary Flow Reserve and Microcirculatory Resistance in Patients With Intermediate Coronary Stenosis

Abstract: CFR and IMR improved the risk stratification of patients with high FFR. Low CFR with high IMR was associated with poor prognosis. (Clinical, Physiological and Prognostic Implication of Microvascular Status; NCT02186093).

Cited by 259 publications

References 34 publications

Prevalence and Clinical Significance of Discordant Changes in Fractional and Coronary Flow Reserve After Elective Percutaneous Coronary Intervention

Prevalence and Clinical Significance of Discordant Changes in Fractional and Coronary Flow Reserve After Elective Percutaneous Coronary Intervention

Comparison between Myocardial Ischemia Evaluation by Fractional Flow Reserve and Myocardial Perfusion Scintigraphy

Case report: improvement of cardiac remodeling with shock wave therapy of a patient with ischemic cardiomyopathy

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