Invasive Evaluation of the Microvasculature in Acute Myocardial Infarction: Coronary Flow Reserve versus the Index of Microcirculatory Resistance

Clarke, John‐Ross D.; Kennedy, Randol; Lau, Freddy Duarte; Lancaster, Gilead; Zarich, Stuart

doi:10.3390/jcm9010086

Cited by 11 publications

(14 citation statements)

References 80 publications

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“…Author details 1 Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China. 2 Department of Cardiology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China.…”

Section: Availability Of Data and Materialsmentioning

confidence: 99%

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Index of microcirculatory resistance predicts long term cardiac systolic function in patients with STEMI undergoing primary PCI

et al. 2021

BMC Cardiovasc Disord

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Background To evaluate the predictive value of the index of microcirculatory resistance (IMR) for long-term cardiac systolic function after primary percutaneous coronary intervention (pPCI) in patients with acute anterior wall ST-segment elevation myocardial infarction (STEMI). Methods A total of 53 acute anterior wall STEMI patients were included and followed up within 1-year. IMR was measured to evaluate the immediate intraoperative reperfusion. IMR > 40 U was defined as the high IMR group and ≤ 40 U was defined as the low IMR group. Left ventricular ejection fraction (LVEF) was measured by echocardiography at 24 h, 1 month, 3 months, and 1 year after PCI to analyze the correlation between IMR and cardiac systolic function. Heart failure was estimated according to classification within one year. Results The ratio of TMPG (TIMI myocardial perfusion grade) 3 (85.7% vs. 52%, p = 0.015) and STR (ST-segment resolution) > 70% (82.1% vs. 48%, p = 0.019) were significantly higher in the low IMR group. The LVEF in the low IMR group was significantly higher than that in the high IMR group at 3 months (43.06 ± 2.63% vs. 40.20 ± 2.67%, p < 0.001) and 1 year (44.16 ± 2.40% vs. 40.13 ± 3.48%, p < 0.001). IMR was negatively correlated with LVEF at 3 months (r = − 0.1014, p = 0.0040) and 1 year (r = − 0.1754, p < 0.0001). Conclusions The IMR showed significant negative correlation with the LVEF value after primary PCI. The high IMR is a strong predictor of heart failure within 1 year after anterior myocardial infarction.

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Section: Availability Of Data and Materialsmentioning

confidence: 99%

“…Acute ST-segment elevation myocardial infarction (STEMI) is one of the most common causes of death in both the developed and developing world [1]. Immediate coronary revascularization by pPCI within 90 min is the gold standard reperfusion therapy for patients with acute STEMI [2].…”

Section: Introductionmentioning

confidence: 99%

Index of microcirculatory resistance predicts long term cardiac systolic function in patients with STEMI undergoing primary PCI

et al. 2021

BMC Cardiovasc Disord

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“…The more dedicated microvascular measurement instruments of coronary flow reserve (CFR) and the index of the microcirculatory resistance (IMR) are not as readily available and have not yet made their way into universal practice. Our group has previously discussed a role for more routine use of these more dedicated tools (CFR and IMR) in another review [96]. Non-invasive modalities like coronary-computed tomography angiography (CCTA) have emerged as alternatives to invasive coronary angiography (ICA) for the assessment of coronary stenosis/luminal narrowing [97].…”

Section: Coronary Physiology Assessment In the Catheterization Laboramentioning

confidence: 99%

Determining the Significance of Coronary Plaque Lesions: Physiological Stenosis Severity and Plaque Characteristics

Clarke

Lau

Zarich

2020

JCM

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The evaluation of coronary lesions has evolved in recent years. Physiologic-guided revascularization (particularly with pressure-derived fractional flow reserve (FFR)) has led to superior outcomes compared to traditional angiographic assessment. A greater importance, therefore, has been placed on the functional significance of an epicardial lesion. Despite the improvements in the limitations of angiography, insights into the relationship between hemodynamic significance and plaque morphology at the lesion level has shown that determining the implications of epicardial lesions is rather complex. Investigators have sought greater understanding by correlating ischemia quantified by FFR with plaque characteristics determined on invasive and non-invasive modalities. We review the background of the use of these diagnostic tools in coronary artery disease and discuss the implications of analyzing physiological stenosis severity and plaque characteristics concurrently.

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“…However, CABG surgery could be associated with several other cardiac complications, including arrhythmias or hemodynamic instability. Therefore, the possibility of intraoperative and postoperative myocardial blood flow assessment is of major clinical importance, especially in vascular surgery [3]. Several studies have indicated that laser Doppler flowmetry (LDF) is able to detect the real-time fluctuations in myocardial perfusion under different circumstances [4].…”

Section: Introductionmentioning

confidence: 99%

Invasive Assessment of the Myocardial Microcirculation during Beating Heart Coronary Artery Bypass Grafting

Hellmann

Piotrowski

Kaszubowski³

et al. 2020

JCM

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Coronary artery bypass grafting may be associated with several cardiac complications, including ischemia, acute myocardial infarction, arrhythmias, or hemodynamic instability. Accumulating evidence suggests that well-developed coronary collateral circulation may protect against adverse effects, including myocardial ischemia. Assessment of myocardial microvascular perfusion is, therefore, of great clinical interest in beating heart surgery. In this paper, myocardial microvascular perfusion is continuously assessed on the beating heart using laser Doppler flowmetry in consecutive patients who underwent coronary artery bypass grafting procedures. No significant (p = 0.110) differences were found between the averaged perfusion signal (n = 42) at the baseline, during artery occlusion, or after reperfusion (732.4 ± 148.0 vs. 711.4 ± 144.1 vs. 737.0 ± 141.2, respectively). In contrast, significantly different (p < 0.001) mean perfusion signals (n = 12) were found (805.4 ± 200.1 vs. 577.2 ± 212.8 vs. 649.3 ± 220.8) in a subset of patients who presented with hemodynamic instability and myocardial ischemia. Additionally, a strong positive correlation between the plasma levels of high-sensitivity troponin I and perfusion decrease level after artery occlusion was found (r = 0.854, p < 0.001). This study argues that myocardial microvascular perfusion remains constant during coronary artery bypass grafting on the beating heart in advanced coronary artery disease. This phenomenon is most likely due to an extensive coronary collateral circulation.

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Invasive Evaluation of the Microvasculature in Acute Myocardial Infarction: Coronary Flow Reserve versus the Index of Microcirculatory Resistance

Cited by 11 publications

References 80 publications

Index of microcirculatory resistance predicts long term cardiac systolic function in patients with STEMI undergoing primary PCI

Index of microcirculatory resistance predicts long term cardiac systolic function in patients with STEMI undergoing primary PCI

Determining the Significance of Coronary Plaque Lesions: Physiological Stenosis Severity and Plaque Characteristics

Invasive Assessment of the Myocardial Microcirculation during Beating Heart Coronary Artery Bypass Grafting

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