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

Abstract

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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