Coronary microvascular dysfunction in patients with stable coronary artery disease: The CE-MARC 2 coronary physiology sub-study.
Coronary microvascular dysfunction in patients with stable coronary artery disease: The CE-MARC 2 coronary physiology sub-study.
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DOI：
10.1016/j.ijcard.2018.04.061
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发表时间：
2018-09-01
影响因子：
3.5
通讯作者：
Berry C
中科院分区：
文献类型：
--
作者：
Corcoran D;Young R;Adlam D;McConnachie A;Mangion K;Ripley D;Cairns D;Brown J;Bucciarelli-Ducci C;Baumbach A;Kharbanda R;Oldroyd KG;McCann GP;Greenwood JP;Berry C
In patients with angina undergoing invasive management, no obstructive coronary artery disease (NOCAD) is a common finding, and angina may persist following percutaneous coronary intervention (PCI). Coronary microvascular dysfunction may be relevant. We aimed to assess the proportion of patients presenting with suspected CAD who had coronary microvascular dysfunction. Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2 (CE-MARC 2) was a prospective multicenter randomised controlled trial of functional imaging versus guideline-based management in patients with suspected CAD. Invasive coronary angiography was protocol-directed. Fractional flow reserve (FFR) and parameters of microvascular function (coronary flow reserve (CFR), index of microcirculatory resistance (IMR), resistance reserve ratio (RRR)) were measured in major epicardial coronary arteries with ≥40–≤90% diameter stenosis. An FFR value ≤0.80 indicated the presence of obstructive CAD. 267/1202 (22.2%) patients underwent angiography and 81 (30%) patients had FFR measured. 63 (78%) of these patients had microvascular function assessed in 85 arteries (mean age 58.5 ± 8.2 years; 47 (75%) male). 25/63 (40%) patients had NOCAD, and of these, 17 (68%) had an abnormality ≥1 parameter of microvascular function (abnormal IMR (≥25), abnormal CFR (<2.0), and abnormal RRR (<2.0) occurred in 10 (40%), 12 (48%), and 11 (44%), respectively). 38/63 (60%) patients had obstructive epicardial CAD. Of these patients, 15/38 (39%), 20/38 (53%), and 12/38 (32%) had an abnormal IMR, CFR and RRR, respectively. Coronary microvascular dysfunction is common in patients with angina. Invasive assessment of microvascular function may be informative and relevant for decision-making in patients with both NOCAD and obstructive epicardial CAD. ClinicalTrials.gov Identifier: NCT01664858 In patients with angina undergoing invasive diagnostic management, no obstructive coronary artery disease (NOCAD) is a common finding. In a contemporary, multicenter, prospectively enrolled population of patients presenting with stable angina, 63 patients underwent invasive measurement of microvascular function and 45 (71%) of these had evidence of coronary microvascular dysfunction. Twenty-five (40%) patients had NOCAD and 17 (68%) of these patients had microvascular dysfunction. Our results demonstrate that microvascular dysfunction is highly prevalent in patients with stable angina. In patients with NOCAD, ischaemia due to microvascular dysfunction may provide an explanation for chest pain symptoms. Further work is required to determine whether routine invasive measurement of coronary microvascular function leads to improved diagnosis, targeted therapeutics, and long-term health outcomes.
In patients with angina undergoing invasive management, no obstructive coronary artery disease (NOCAD) is a common finding, and angina may persist following percutaneous coronary intervention (PCI). Coronary microvascular dysfunction may be relevant. We aimed to assess the proportion of patients presenting with suspected CAD who had coronary microvascular dysfunction. Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2 (CE-MARC 2) was a prospective multicenter randomised controlled trial of functional imaging versus guideline-based management in patients with suspected CAD. Invasive coronary angiography was protocol-directed. Fractional flow reserve (FFR) and parameters of microvascular function (coronary flow reserve (CFR), index of microcirculatory resistance (IMR), resistance reserve ratio (RRR)) were measured in major epicardial coronary arteries with ≥40–≤90% diameter stenosis. An FFR value ≤0.80 indicated the presence of obstructive CAD. 267/1202 (22.2%) patients underwent angiography and 81 (30%) patients had FFR measured. 63 (78%) of these patients had microvascular function assessed in 85 arteries (mean age 58.5 ± 8.2 years; 47 (75%) male). 25/63 (40%) patients had NOCAD, and of these, 17 (68%) had an abnormality ≥1 parameter of microvascular function (abnormal IMR (≥25), abnormal CFR (<2.0), and abnormal RRR (<2.0) occurred in 10 (40%), 12 (48%), and 11 (44%), respectively). 38/63 (60%) patients had obstructive epicardial CAD. Of these patients, 15/38 (39%), 20/38 (53%), and 12/38 (32%) had an abnormal IMR, CFR and RRR, respectively. Coronary microvascular dysfunction is common in patients with angina. Invasive assessment of microvascular function may be informative and relevant for decision-making in patients with both NOCAD and obstructive epicardial CAD. ClinicalTrials.gov Identifier: NCT01664858 In patients with angina undergoing invasive diagnostic management, no obstructive coronary artery disease (NOCAD) is a common finding. In a contemporary, multicenter, prospectively enrolled population of patients presenting with stable angina, 63 patients underwent invasive measurement of microvascular function and 45 (71%) of these had evidence of coronary microvascular dysfunction. Twenty-five (40%) patients had NOCAD and 17 (68%) of these patients had microvascular dysfunction. Our results demonstrate that microvascular dysfunction is highly prevalent in patients with stable angina. In patients with NOCAD, ischaemia due to microvascular dysfunction may provide an explanation for chest pain symptoms. Further work is required to determine whether routine invasive measurement of coronary microvascular function leads to improved diagnosis, targeted therapeutics, and long-term health outcomes.
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