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Prognostic value of structural and functional coronary microvascular dysfunction in patients with non-obstructive coronary artery disease; from the multicentre international ILIAS registry

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Author(s)
Coen K.M. BoerhoutGuus A. de WaardJoo Myung LeeHernan Mejia-RenteriaSeung Hun LeeJi-Hyun JungMasahiro HoshinoMauro Echavarria-PintoMartijn MeuwissenHitoshi MatsuoMaribel Madera-CamberoAshkan EftekhariMohamed A. EffatTadashi MuraiKoen MarquesYolande AppelmanJoon-Hyung DohEvald Høj ChristiansenRupak BanerjeeChang-Wook NamGiampaolo NiccoliMasafumi NakayamaNobuhiro TanakaEun-Seok ShinMarcel A.M. BeijkPaul KnaapenJavier EscanedTsunekazu KakutaBon-Kwon KooJan J. PiekTim P. van de Hoef
Keimyung Author(s)
Nam, Chang Wook
Department
Dept. of Internal Medicine (내과학)
Journal Title
EuroIntervention
Issued Date
2022
Volume
18
Issue
9
Keyword
coronary flow reservecoronary microvascular dysfunctionhyperaemic microvascular resistanceindex of microvascular resistanceprognosis
Abstract
Background:
Coronary microvascular dysfunction (CMD) is an important contributor to angina syndromes. Recently, two distinct endotypes were identified using combined assessment of coronary flow reserve (CFR) and minimal microvascular resistance (MR), termed structural and functional CMD.

Aims:
We aimed to assess the relevance of the combined assessment of CFR and MR in patients with angina and no obstructive coronary arteries.

Methods:
Patients with chronic coronary syndromes (CCS) and non-obstructive coronary artery disease (fractional flow reserve [FFR] ≥0.80) were selected (N=1,102). Functional CMD was defined as abnormal CFR in combination with normal MR and structural CMD as abnormal CFR with abnormal MR. Clinical endpoints were the incidence of major adverse cardiac events (MACE) and target vessel failure (TVF) at 5-year follow-up.

Results:
Abnormal CFR was associated with an increased risk of MACE and TVF at 5-year follow-up. Microvascular resistance parameters were not associated with MACE or TVF at 5-year follow-up. The risk of MACE and TVF at 5-year follow-up was similarly increased for patients with structural or functional CMD compared with patients with normal microvascular function. There were no differences between both endotypes (p=0.88 for MACE, and p=0.55 for TVF).

Conclusions:
Coronary microvascular dysfunction, identified by an impaired CFR, was unequivocally associated with increased MACE and TVF rates over a 5-year follow-up period. In contrast, impaired MR was not associated with 5-year adverse clinical events. Moreover, there was no significant difference in the risk of MACE and TVF between a low CFR accompanied by pathologically increased MR (structural CMD) or not (functional CMD).
Keimyung Author(s)(Kor)
남창욱
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
1969-6213
Source
https://eurointervention.pcronline.com/article/prognostic-value-of-structural-and-functional-coronary-microvascular-dysfunction-in-patients-with-non-obstructive-coronary-artery-disease-from-the-multicentre-international-ilias-registry
DOI
10.4244/EIJ-D-22-00043
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/44716
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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