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Characteristic findings of microvascular dysfunction on coronary computed tomography angiography in patients with intermediate coronary stenosis

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Author(s)
Masahiro HoshinoSeokhun YangTomoyo SugiyamaJinlong ZhangYoshihisa KanajiRikuta HamayaMasao YamaguchiMasahiro HadaTomoki HorieKai NogamiHiroki UenoToru MisawaTaishi YonetsuDoyeon HwangJoo Myung LeeEun-Seok ShinJoon-Hyung DohChang-Wook NamBon-Kwon KooTetsuo SasanoTsunekazu Kakuta
Keimyung Author(s)
Nam, Chang Wook
Department
Dept. of Internal Medicine (내과학)
Journal Title
Eur Radiol
Issued Date
2021
Volume
31
Issue
12
Keyword
Coronary artery diseaseComputed tomography angiographyMicrocirculationMyocardial fractional flow reserveAdipose tissue
Abstract
Objectives:
We aimed to assess the prevalence of coexistence of coronary microvascular dysfunction (CMD) in patients with intermediate epicardial stenosis and to explore coronary computed tomography angiography (CCTA)–derived lesion-, vessel-, and cardiac fat–related characteristic findings associated with CMD.

Methods:
A retrospective cross-sectional single-center study included a total of 177 patients with intermediate stenosis in the left anterior descending artery (LAD) who underwent CCTA and invasive physiological measurements. The 320-slice CCTA analysis included qualitative and quantitative assessments of plaque, vessel, epicardial fat volume (ECFV) and epicardial fat attenuation (ECFA), and pericoronary fat attenuation (FAI). CMD was defined by the index of microcirculatory resistance (IMR) ≥ 25.

Results:
In the entire cohort, median fractional flow reserve (FFR) and median IMR values were 0.77 (0.69–0.84) and 19.0 (13.7–27.7), respectively. The prevalence of CMD was 32.8 % (58/177) in the total cohort. The coexistence of CMD and functionally significant stenosis was 34.3 % (37/108), whereas CMD in nonsignificant intermediate stenosis was 30.4 % (21/69). CMD was significantly associated with greater lumen volume (p = 0.031), greater fibrofatty and necrotic component (FFNC) volume (p = 0.030), and greater ECFV (p = 0.030), but not with FAI (p = 0.832) and ECFA (p = 0.445). On multivariable logistic regression analysis, vessel volume, vessel lumen volume, lesion remodeling index, ECFV, and lesion FFNC volume were independent predictors of CMD.

Conclusions:
The prevalence of CMD was about one-third in patients with intermediate stenosis in LAD regardless of the presence or absence of functional stenosis significance. The integrated CCTA assessment may help in the identification of CMD.
Keimyung Author(s)(Kor)
남창욱
Publisher
School of Medicine (의과대학)
Citation
Masahiro Hoshino et al. (2021). Characteristic findings of microvascular dysfunction on coronary computed tomography angiography in patients with intermediate coronary stenosis. Eur Radiol, 31(12), 9198–9210. doi: 10.1007/s00330-021-07909-7
Type
Article
ISSN
1432-1084
Source
https://link.springer.com/article/10.1007%2Fs00330-021-07909-7
DOI
10.1007/s00330-021-07909-7
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43793
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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