Epicardial Stenosis Severity Does Not Affect Minimal Microcirculatory Resistance

Aarnoudse, Wilbert; Fearon, William F.; Manoharan, Ganesh; Geven, Maartje; Vosse, F.N. van de; Rutten, Marcel; Bruyne, Bernard De; Pijls, Nico H.J.

doi:10.1161/01.cir.0000143893.18451.0e

Cited by 221 publications

(187 citation statements)

References 21 publications

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“…[1][2][3] We have found that it correlates well with an accepted experimental technique for determining microvascular resistance 1 and that it is more reproducible than CFR. 14 The ability to assess easily and accurately both the epicardial artery and the microvasculature simultaneously by measuring FFR and IMR with a single wire is a potential advantage over the standard methods of using IVUS and a Doppler velocity wire.…”

Section: Author Manuscriptmentioning

confidence: 61%

“…[1][2][3] The purpose of this study is to Correspondence Address: William F. Fearon, M.D., Center for Research in Cardiovascular Interventions, 300 Pasteur Drive, Room H3554, Stanford University Medical Center, Stanford, wfearon@stanford.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication.…”

Section: Introductionmentioning

confidence: 99%

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Changes in Coronary Anatomy and Physiology After Heart Transplantation

Hirohata

Nakamura

Waseda

et al. 2007

The American Journal of Cardiology

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Cardiac allograft vasculopathy (CAV) is a progressive process involving both the epicardial and microvascular coronary systems. Timing of the development of abnormalities in these 2 compartments and correlation between changes in physiology and anatomy are undefined. Invasive evaluation of coronary artery anatomy and physiology with intravascular ultrasound (IVUS), fractional flow reserve (FFR), coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR) was performed in the left anterior descending coronary artery during 151 angiographic evaluations of asymptomatic heart transplant (HT) recipients between 0 and >5 years after HT. There was no angiographic evidence of significant CAV, but during the first year after HT, FFR decreased significantly (0.89±0.06 vs. 0.85±0.07, p=0.001) and IVUS-derived % plaque volume increased significantly (15.6±7.7 to 22.5±12.3%, p=0.0002) resulting in a significant inverse correlation between epicardial physiology and anatomy (r=-0.58, p<0.0001). IMR was lower in these patients, compared to those ≥ 2 years after HT (24.1±14.3 vs. 29.4±18.8 units, p=0.05), suggesting later spread of CAV to the microvasculature. As IMR increased, FFR increased (0.86±0.06 to 0.90±0.06, p=0.0035 comparing recipients with IMR ≤20 to those with IMR ≥40), despite no difference in % plaque volume (21.0±11.2 vs. 20.5±10.5%, p=NS). In conclusion, early after HT, both anatomic and physiologic evidence of epicardial CAV were found. Later after HT, the physiologic effect of epicardial CAV may be less, due to increased microvascular dysfunction.It is now possible to independently assess epicardial coronary artery physiology by measuring myocardial fractional flow reserve (FFR) and microvascular physiology by measuring the index of microcirculatory resistance (IMR) relatively easily and simultaneously with a single coronary guidewire. [1][2][3] The purpose of this study is to Correspondence Address: William F. Fearon, M.D., Center for Research in Cardiovascular Interventions, 300 Pasteur Drive, Room H3554, Stanford University Medical Center, Stanford, wfearon@stanford.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author Manuscript investigate changes over time in epicardial coronary artery anatomy and physiology after heart transplantation, as determined by intravascular (ultrasound) IVUS and FFR. By also measuring IMR, we hope to better understand the timing of the development of cardiac allograft vasculopathy (CAV) in the microvasculature and its relationship to...

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Section: Author Manuscriptmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Changes in Coronary Anatomy and Physiology After Heart Transplantation

Hirohata

Nakamura

Waseda

et al. 2007

The American Journal of Cardiology

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“…4,5 It has been demonstrated that IMR correlates very well with true microvascular resistance and can distinguish between normal and abnormal microcirculatory function without being influenced by the presence of epicardial arterial stenosis. 6 In addition, Fearon demonstrated that, compared to other traditional methods for assessing the microvasculature, IMR appears to be a better predictor of microvascular damage and recovery of left ven-ITO N et al tricular function after ST-segment elevation MI (STEMI). 7 Although microvascular injury following PCI can be evaluated with IMR, no method of treatment has been established.…”

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confidence: 99%

High Index of Microcirculatory Resistance Level After Successful Primary Percutaneous Coronary Intervention Can Be Improved by Intracoronary Administration of Nicorandil

Ito

Nanto

Doi

et al. 2010

Circ J

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“…1) An increased microcirculatory resistance indicates the presence of coronary microvascular dysfunction (CMVD), a term introduced to describe abnormalities in the regulation of microvascular blood flow. CMVD has been found to play an important role in determining ischemic threshold 2) and to be independent of epicardial stenosis severity. 3) Smoking is known to be associated with the development of epicardial atherosclerosis and impairment of coronary endothelial function.…”

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Impact of Smoking on Coronary Microcirculatory Resistance in Patients With Coronary Artery Disease

et al. 2015

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SummaryThe aim of this study was to investigate the relationship between coronary microvascular function and smoking using the 3 parameters fractional flow reserve (FFR), coronary flow reserve (CFR thermo ), and index of microcirculatory resistance (IMR) in patients with coronary artery disease (CAD). A total of 97 CAD patients with 148 intermediate stenotic lesions were divided into two groups: current and former smokers (Smokers: n = 54), and those who had never smoked (Non-smokers: n = 43). Coronary physiology measurements were made following coronary angiography at rest and during hyperemia induced with intravenous adenosine triphosphate. If a patient had several intermediate lesions, the lesion producing the largest IMR value and minimum FFR myo and CFR thermo value was selected. Averaged over all patients, the FFR myo , CFR thermo , and IMR values were 0.86 ± 0.10, 2.66 ± 1.50, and 20.8 ± 10.7, respectively. There was no significant correlation between FFR myo and IMR. There were no significant differences between smokers and non-smokers in FFR myo value ( perfusion is dependent on both epicardial and microvascular resistance. 1) An increased microcirculatory resistance indicates the presence of coronary microvascular dysfunction (CMVD), a term introduced to describe abnormalities in the regulation of microvascular blood flow. CMVD has been found to play an important role in determining ischemic threshold 2) and to be independent of epicardial stenosis severity.3) Smoking is known to be associated with the development of epicardial atherosclerosis and impairment of coronary endothelial function. [4][5][6] However, the effects of smoking on coronary microvascular function are unknown.Recently, a parameter called the index of microcirculatory resistance (IMR) was proposed for evaluating coronary microvascular function. The advantage of this parameter is that it could be calculated from values obtained using a coronary temperature and pressure sensing guidewire. 7) IMR has been found to be a reproducible index and to be independent of epicardial stenosis severity.7-10) The aim of this study was to investigate the relationship between microvascular function and smoking in patients with CAD by comparing 3 coronary physiology parameters, fractional flow reserve (FFR), coronary flow reserve (CFR), and IMR, between patients with and without a smoking history. MethodsStudy population: A total of 97 patients with CAD who had 148 discrete intermediate grade stenotic lesions (40-70% diameter stenosis on visual assessment) and visited the Department of Cardiovascular Medicine, Kashiwa Municipal Hospital (Chiba, Japan) from August 2010 to August 2013 were retrospectively enrolled. To examine the relationship between coronary physiology and smoking, patients were divided into two groups based on smoking status; current and former smokers (smokers), and those who had never smoked (non-smokers). The exclusion criteria were 1) history of coronary artery bypass surgery; 2) history of myocardial infarction (MI); 3) recent MI,...

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Epicardial Stenosis Severity Does Not Affect Minimal Microcirculatory Resistance

Cited by 221 publications

References 21 publications

Changes in Coronary Anatomy and Physiology After Heart Transplantation

Changes in Coronary Anatomy and Physiology After Heart Transplantation

High Index of Microcirculatory Resistance Level After Successful Primary Percutaneous Coronary Intervention Can Be Improved by Intracoronary Administration of Nicorandil

Impact of Smoking on Coronary Microcirculatory Resistance in Patients With Coronary Artery Disease

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