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

Coen K.M. Boerhout, Guus A. de Waard, Joo Myung Lee, Hernan Mejia-Renteria, Seung Hun Lee, Ji Hyun Jung, Masahiro Hoshino, Mauro Echavarria-Pinto, Martijn Meuwissen, Hitoshi Matsuo, Maribel Madera-Cambero, Ashkan Eftekhari, Mohamed A. Effat, Tadashi Murai, Koen Marques, Yolande Appelman, Joon Hyung Doh, Evald Høj Christiansen, Rupak Banerjee, Chang Wook NamGiampaolo Niccoli, Masafumi Nakayama, Nobuhiro Tanaka, Eun Seok Shin, Marcel A.M. Beijk, Paul Knaapen, Javier Escaned, Tsunekazu Kakuta, Bon Kwon Koo, Jan J. Piek, Tim P. van de Hoef

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

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).

Original languageEnglish
Pages (from-to)719-728
Number of pages10
JournalEuroIntervention
Volume18
Issue number9
DOIs
StatePublished - Oct 2022

Keywords

  • coronary flow reserve
  • coronary microvascular dysfunction
  • hyperaemic microvascular resistance
  • index of microvascular resistance
  • prognosis

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