Primary versus iatrogenic (post-PCI) coronary microvascular dysfunction: a wire-based multimodal comparison.
Open Heart
; 10(2)2023 Nov 27.
Article
en En
| MEDLINE
| ID: mdl-38011991
ABSTRACT
BACKGROUND:
Although there are studies examining each one separately, there are no data in the literature comparing the magnitudes of the iatrogenic, percutaneous coronary intervention (PCI)-induced, microvascular dysfunction (Type-4 CMD) and coronary microvascular dysfunction (CMD) in the setting of ischaemia in non-obstructed coronary arteries (INOCA) (Type-1 CMD).OBJECTIVES:
We aimed to compare the characteristics of Type-1 and Type-4 CMD subtypes using coronary haemodynamic (resistance and flow-related parameters), thermodynamic (wave energy-related parameters) and hyperemic ECG changes.METHODS:
Coronary flow reserve (CFR) value of <2.5 was defined as CMD in both groups. Wire-based multimodal perfusion markers were comparatively analysed in 35 patients (21 INOCA/CMD and 14 CCS/PCI) enrolled in NCT05471739 study.RESULTS:
Both groups had comparably blunted CFR values per definition (2.03±0.22 vs 2.11±0.37; p 0.518) and similar hyperemic ST shift in intracoronary ECG (0.16±0.09 vs 0.18±0.07 mV; p 0.537). While the Type-1 CMD was characterised with impaired hyperemic blood flow acceleration (46.52+12.83 vs 68.20+28.63 cm/s; p 0.017) and attenuated diastolic microvascular decompression wave magnitudes (p=0.042) with higher hyperemic microvascular resistance (p<0.001), Type-4 CMD had blunted CFR mainly due to higher baseline flow velocity due to post-occlusive reactive hyperemia (33.6±13.7 vs 22.24±5.3 cm/s; p=0.003).CONCLUSIONS:
The perturbations in the microvascular milieu seen in CMD in INOCA setting (Type-1 CMD) seem to be more prominent than that of seen following elective PCI (Type-4 CMD), although resulting reversible ischaemia is equally severe in the downstream myocardium.Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Isquemia Miocárdica
/
Intervención Coronaria Percutánea
Límite:
Humans
Idioma:
En
Revista:
Open Heart
Año:
2023
Tipo del documento:
Article
País de afiliación:
Turquía