Changes in absolute coronary flow and microvascular resistance during exercise in patients with ANOCA.
EuroIntervention
; 20(16): 1008-1017, 2024 Aug 19.
Article
en En
| MEDLINE
| ID: mdl-39155757
ABSTRACT
BACKGROUND:
Whether saline-induced hyperaemia captures exercise-induced coronary flow regulation remains unknown.AIMS:
Through this study, we aimed to describe absolute coronary flow (Q) and microvascular resistance (Rµ) adaptation during exercise in participants with angina with non-obstructive coronary artery disease (ANOCA) and to explore the correlations between saline- and exercise-derived coronary flow reserve (CFR) and microvascular resistance reserve (MRR).METHODS:
Rµ, Q, CFR and MRR were assessed in the left anterior descending artery using continuous thermodilution with saline infusion at 10 mL/min (rest), 20 mL/min (hyperaemia) and finally at a 10 mL/min infusion rate during stress testing with a dedicated supine cycling ergometer. An incremental workload of 30 watts every two minutes was applied. A saline-derived CFR (CFRsaline) cutoff <2.5 was used to identify coronary microvascular dysfunction (CMD).RESULTS:
CFRsaline-defined CMD was observed in 53.3% of the participants (16/30). While cycling, these patients less of an ability to increase Q (7 [interquartile range [IQR] 30.5-103.0] vs 21 [IQR 5.8-45.0] mL/min/30 watts; p=0.01) due to a smaller decrease of Rµ (109 {IQR 32-286} vs 202 [IQR 102-379] Wood units [WU]/30 watts; p<0.01) as compared with the group with normal CFRsaline. In the overall population, CFRsaline and exercise-derived CFR (CFRexercise) were 2.70±0.90 and 2.85±1.54, respectively, with an agreement classification of 83.3%. A good correlation between saline and exercise techniques for both CFR (r=0.73; p<0.0001) and MRR (r=0.76; p<0.0001) was observed. Among participants with normal CFRsaline, 28.7% (4/14) had an impaired CFRexercise <2.5 at the peak of exercise due to a moderate and late decrease of Rµ.CONCLUSIONS:
Saline-induced hyperaemia provided a valid surrogate for exercise physiology independently of the absolute level of CFR and MRR, although exercise provided more granularity to evaluate adaptation among participants with exercise-related CMD.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Resistencia Vascular
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Enfermedad de la Arteria Coronaria
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Ejercicio Físico
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Circulación Coronaria
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Prueba de Esfuerzo
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
EuroIntervention
Asunto de la revista:
ANGIOLOGIA
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CARDIOLOGIA
/
TERAPEUTICA
Año:
2024
Tipo del documento:
Article
País de afiliación:
Francia