Angiography-derived index of microcirculatory resistance as a novel, pressure-wire-free tool to assess coronary microcirculation in ST elevation myocardial infarction.
Angiography-derived index of microcirculatory resistance as a novel, pressure-wire-free tool to assess coronary microcirculation in ST elevation myocardial infarction.
- 2020
Immediate assessment of coronary microcirculation during treatment of ST elevation myocardial infarction (STEMI) may facilitate patient stratification for targeted treatment algorithms. Use of pressure-wire to measure the index of microcirculatory resistance (IMR) is possible but has inevitable practical restrictions. We aimed to develop and validate angiography-derived index of microcirculatory resistance (IMRangio) as a novel and pressure-wire-free index to facilitate assessment of the coronary microcirculation. 45 STEMI patients treated with primary percutaneous coronary intervention (pPCI) were enrolled. Immediately before stenting and at completion of pPCI, IMR was measured within the infarct related artery (IRA). At the same time points, 2 angiographic views were acquired during hyperaemia to measure quantitative flow ratio (QFR) from which IMRangio was derived. In a subset of 15 patients both IMR and IMRangio were also measured in the non-IRA. Patients underwent cardiovascular magnetic resonance imaging (CMR) at 48 h for assessment of microvascular obstruction (MVO). IMRangio and IMR were significantly correlated (rho: 0.85, p < 0.001). Both IMR and IMRangio were higher in the IRA rather than in the non-IRA (p = 0.01 and p = 0.006, respectively) and were higher in patients with evidence of clinically significant MVO (> 1.55% of left ventricular mass) (p = 0.03 and p = 0.005, respectively). Post-pPCI IMRangio presented and area under the curve (AUC) of 0.96 (CI95% 0.92-1.00, p < 0.001) for prediction of post-pPCI IMR > 40U and of 0.81 (CI95% 0.65-0.97, p < 0.001) for MVO > 1.55%. IMRangio is a promising tool for the assessment of coronary microcirculation. Assessment of IMR without the use of a pressure-wire may enable more rapid, convenient and cost-effective assessment of coronary microvascular function.
English
1569-5794
10.1007/s10554-020-01831-7 [doi] 10.1007/s10554-020-01831-7 [pii]
*Coronary Angiography
*Coronary Artery Disease/dg [Diagnostic Imaging]
*Coronary Circulation
*Coronary Vessels/dg [Diagnostic Imaging]
*Microcirculation
*ST Elevation Myocardial Infarction/dg [Diagnostic Imaging]
*Vascular Resistance
Aged
Angioplasty, Balloon, Coronary/is [Instrumentation]
Blood Flow Velocity
Cardiac Catheterization/is [Instrumentation]
Cardiac Catheters
Coronary Artery Disease/pp [Physiopathology]
Coronary Artery Disease/th [Therapy]
Coronary Vessels/pp [Physiopathology]
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Radiographic Image Interpretation, Computer-Assisted
Reproducibility of Results
ST Elevation Myocardial Infarction/pp [Physiopathology]
ST Elevation Myocardial Infarction/th [Therapy]
Stents
Transducers, Pressure
MedStar Heart & Vascular Institute
Journal Article
Immediate assessment of coronary microcirculation during treatment of ST elevation myocardial infarction (STEMI) may facilitate patient stratification for targeted treatment algorithms. Use of pressure-wire to measure the index of microcirculatory resistance (IMR) is possible but has inevitable practical restrictions. We aimed to develop and validate angiography-derived index of microcirculatory resistance (IMRangio) as a novel and pressure-wire-free index to facilitate assessment of the coronary microcirculation. 45 STEMI patients treated with primary percutaneous coronary intervention (pPCI) were enrolled. Immediately before stenting and at completion of pPCI, IMR was measured within the infarct related artery (IRA). At the same time points, 2 angiographic views were acquired during hyperaemia to measure quantitative flow ratio (QFR) from which IMRangio was derived. In a subset of 15 patients both IMR and IMRangio were also measured in the non-IRA. Patients underwent cardiovascular magnetic resonance imaging (CMR) at 48 h for assessment of microvascular obstruction (MVO). IMRangio and IMR were significantly correlated (rho: 0.85, p < 0.001). Both IMR and IMRangio were higher in the IRA rather than in the non-IRA (p = 0.01 and p = 0.006, respectively) and were higher in patients with evidence of clinically significant MVO (> 1.55% of left ventricular mass) (p = 0.03 and p = 0.005, respectively). Post-pPCI IMRangio presented and area under the curve (AUC) of 0.96 (CI95% 0.92-1.00, p < 0.001) for prediction of post-pPCI IMR > 40U and of 0.81 (CI95% 0.65-0.97, p < 0.001) for MVO > 1.55%. IMRangio is a promising tool for the assessment of coronary microcirculation. Assessment of IMR without the use of a pressure-wire may enable more rapid, convenient and cost-effective assessment of coronary microvascular function.
English
1569-5794
10.1007/s10554-020-01831-7 [doi] 10.1007/s10554-020-01831-7 [pii]
*Coronary Angiography
*Coronary Artery Disease/dg [Diagnostic Imaging]
*Coronary Circulation
*Coronary Vessels/dg [Diagnostic Imaging]
*Microcirculation
*ST Elevation Myocardial Infarction/dg [Diagnostic Imaging]
*Vascular Resistance
Aged
Angioplasty, Balloon, Coronary/is [Instrumentation]
Blood Flow Velocity
Cardiac Catheterization/is [Instrumentation]
Cardiac Catheters
Coronary Artery Disease/pp [Physiopathology]
Coronary Artery Disease/th [Therapy]
Coronary Vessels/pp [Physiopathology]
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Radiographic Image Interpretation, Computer-Assisted
Reproducibility of Results
ST Elevation Myocardial Infarction/pp [Physiopathology]
ST Elevation Myocardial Infarction/th [Therapy]
Stents
Transducers, Pressure
MedStar Heart & Vascular Institute
Journal Article