Angiography-derived index of microcirculatory resistance as a novel, pressure-wire-free tool to assess coronary microcirculation in ST elevation myocardial infarction.

MedStar author(s):
Citation: The International Journal of Cardiovascular Imaging. 36(8):1395-1406, 2020 Aug.PMID: 32409977Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *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, PressureYear: 2020ISSN:
  • 1569-5794
Name of journal: The international journal of cardiovascular imagingAbstract: 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.All authors: Banning AP, Borlotti A, Channon KM, Choudhury RP, De Maria GL, Ferreira VM, Garcia-Garcia HM, Kharbanda R, Kotronias RA, Langrish JP, Lucking AJ, Oxford Acute Myocardial Infarction (OXAMI) Study Investigators, Scarsini R, Shanmuganathan M, Terentes-Printzios DOriginally published: The International Journal of Cardiovascular Imaging. 2020 May 14Fiscal year: FY2021Fiscal year of original publication: FY2020Digital Object Identifier: Date added to catalog: 2020-07-09
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 32409977 Available 32409977

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

Powered by Koha