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

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Author(s)
Joo Myung LeeJi-Hyun JungDoyeon HwangJonghanne ParkYongzhen FanSang-Hoon NaJoon-Hyung DohChang-Wook NamEun-Seok ShinBon-Kwon Koo
Keimyung Author(s)
Nam, Chang Wook
Department
Dept. of Internal Medicine (내과학)
Journal Title
Journal of the American College of Cardiology
Issued Date
2016
Volume
67
Issue
10
Keyword
Coronary artery diseaseCoronary flow reserveFractional flow reserveIndex of microcirculatory resistanceMicrovascular function
Abstract
BACKGROUND The prognostic impact of microvascular status in patients with high fractional flow reserve (FFR) is
not clear.
OBJECTIVES The goal of this study was to investigate the implications of coronary flow reserve (CFR) and the index of
microcirculatory resistance (IMR) in patients who underwent FFR measurement.
METHODS Patients with high FFR (>0.80) were grouped according to CFR (#2) and IMR ($23 U) levels: group A,
high CFR with low IMR; group B, high CFR with high IMR; group C, low CFR with low IMR; and group D, low CFR with high
IMR. Patient-oriented composite outcome (POCO) of any death, myocardial infarction, and revascularization was
assessed. The median follow-up was 658 days (interquartile range: 503.8 to 1,139.3 days).
RESULTS A total of 313 patients (663 vessels) were assessed with FFR, CFR, and IMR. Correlation (r ¼ 0.201;
p < 0.001) and categorical agreement (kappa value ¼ 0.178; p < 0.001) between FFR and CFR were modest. Low CFR
was associated with higher POCO than high CFR (p ¼ 0.034). There were no significant differences in clinical and
angiographic characteristics among groups. Patients with high IMR with low CFR had the highest POCO (p ¼ 0.002).
Overt microvascular disease (p ¼ 0.008), multivessel disease (p ¼ 0.033), and diabetes mellitus (p ¼ 0.033) were
independent predictors of POCO. Inclusion of a physiological index significantly improved the discriminant function
of a predictive model (relative integrated discrimination improvement 0.467 [p ¼ 0.037]; category-free net reclassification
index 0.648 [p ¼ 0.007]).
CONCLUSIONS 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.
Keimyung Author(s)(Kor)
남창욱
Publisher
School of Medicine
Citation
Joo Myung Lee et al. (2016). Coronary Flow Reserve and Microcirculatory Resistance in Patients With Intermediate Coronary Stenosis. Journal of the American College of Cardiology, 67(10), 1158–1169. doi: 10.1016/j.jacc.2015.12.053
Type
Article
ISSN
0735-1097
DOI
10.1016/j.jacc.2015.12.053
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/33173
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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