Comprehensive Angiography-Derived Functional Assessment of Epicardial and Microvascular Coronary Disease. Correlation With Non-invasive Myocardial Stress Imaging - 31/03/24
Résumé |
Coronary angiography (CA) is poorly correlated with non-invasive myocardial stress imaging (NSI) and myocardial ischemia is often observed in patients with unobstructed coronary arteries. Moreover, the diagnostic performance of combined epicardial and microcirculatory angiography-derived physiological assessment and its correlation with NSI remains unknown. A total of 917 coronary vessels in 319 patients who underwent both CA and NSI were included in this multicenter observational retrospective analysis. Quantitative flow ratio (QFR) and angiography-derived index of microcirculatory resistance (IMRangio) analyses were performed to estimate coronary epicardial and microcirculatory function respectively. NSI demonstrated evidence of myocardial ischemia in 76% of the cases. IMRangio (36 [22 to 50] vs 29 [21 to 41], p <0.001) was significantly higher and QFR (0.92 [0.78 to 0.99] vs 0.97 [0.91 to 0.99], p <0.001) was significantly lower in vessels subtending ischemic territories. Overall, the diagnostic accuracy of QFR was moderate (area under the curve of receiver operating characteristic [AUCROC] 0.632 [95% confidence interval [CI] 0.589 to 0.674], p <0.0001) but it was higher in patients with normal microcirculatory function (AUCROC = 0.726 [95% CI 0.669 to 0.784], p <0.0001, p Value for AUCROC comparison = 0.009). Combined QFR/IMRangio assessment provided incremental diagnostic performance compared with the evaluation of epicardial or microcirculatory districts in isolation (p Value for AUC comparison <0.0001) and it was able to identify the predominant mechanism of myocardial ischemia in 77% of the patients with positive NSI. Our study suggests the value of a combined angiography-derived assessment of epicardial and microvascular function for the definition of the predominant mechanism of myocardial ischemia in patients with suspected coronary artery disease.
Le texte complet de cet article est disponible en PDF.Graphic abstract |
In a multicenter and international cohort, a combined angiography-derived epicardial and microvascular coronary assessment showed increasing diagnostic value in predicting ischemia defined at noninvasive myocardial stress imaging (stress-echo and SPECT). Implementing microvascular assessment allowed the definition of coronary microvascular dysfunction as the mechanism of ischemia in most patients with documented ischemia and nonobstructive coronary artery disease
QFR = quantitative flow ratio; IMRangio = angiography-derived index of microcirculatory resistance.
Le texte complet de cet article est disponible en PDF.Keywords : coronary physiology assessment, index of microcirculatory resistance, myocardial stress imaging, QFR, stress-echocardiography, SPECT
Plan
| Dr. Della Mora and Dr. Portolan contributed equally to this manuscript and are joint first authors. |
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| Funding: none. |
Vol 217
P. 144-152 - avril 2024 Retour au numéro
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