학술논문
Angiographic Coronary Slow Flow Is Not a Valid Surrogate for Invasively Diagnosed Coronary Microvascular Dysfunction.
Document Type
Academic Journal
Author
Mayer M; Department of Cardiology, University of Chicago, Chicago, Illinois, USA.; Allan T; Department of Cardiology, University of Chicago, Chicago, Illinois, USA.; Harkin KL; Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA.; Loftspring E; Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA.; Saffari SE; Department of Cardiology, University of Chicago, Chicago, Illinois, USA.; Reynolds HR; Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA.; Paul J; Department of Cardiology, University of Chicago, Chicago, Illinois, USA.; Kalathiya R; Department of Cardiology, University of Chicago, Chicago, Illinois, USA.; Shah AP; Department of Cardiology, University of Chicago, Chicago, Illinois, USA.; Nathan S; Department of Cardiology, University of Chicago, Chicago, Illinois, USA.; McCarthy MC; Division of Cardiology, Southlake Regional Health Centre, Newmarket, Ontario, Canada.; Smilowitz NR; Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA; Cardiology Section, Department of Medicine, VA New York Harbor Healthcare System, New York, New York, USA.; Miner SES; Division of Cardiology, Southlake Regional Health Centre, Newmarket, Ontario, Canada; School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.; Blair J; Department of Cardiology, University of Chicago, Chicago, Illinois, USA; Division of Cardiology, Department of Internal Medicine, University of Washington, Seattle, Washington, USA. Electronic address: jblair1@gmail.com.
Source
Publisher: Elsevier Country of Publication: United States NLM ID: 101467004 Publication Model: Print Cited Medium: Internet ISSN: 1876-7605 (Electronic) Linking ISSN: 19368798 NLM ISO Abbreviation: JACC Cardiovasc Interv Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Ischemia with no obstructive coronary arteries is frequently caused by coronary microvascular dysfunction (CMD). Consensus diagnostic criteria for CMD include baseline angiographic slow flow by corrected TIMI (Thrombolysis In Myocardial Infarction) frame count (cTFC), but correlations between slow flow and CMD measured by invasive coronary function testing (CFT) are uncertain.
Objectives: The aim of this study was to investigate relationships between cTFC and invasive CFT for CMD.
Methods: Adults with ischemia with no obstructive coronary arteries underwent invasive CFT with thermodilution-derived baseline coronary blood flow, coronary flow reserve (CFR), and index of microcirculatory resistance (IMR). CMD was defined as abnormal CFR (<2.5) and/or abnormal IMR (≥25). cTFC was measured from baseline angiography; slow flow was defined as cTFC >25. Correlations between cTFC and baseline coronary flow and between CFR and IMR and associations between slow flow and invasive measures of CMD were evaluated, adjusted for covariates. All patients provided consent.
Results: Among 508 adults, 49% had coronary slow flow. Patients with slow flow were more likely to have abnormal IMR (36% vs 26%; P = 0.019) but less likely to have abnormal CFR (28% vs 42%; P = 0.001), with no difference in CMD (46% vs 51%). cTFC was weakly correlated with baseline coronary blood flow (r = -0.35; 95% CI: -0.42 to -0.27), CFR (r = 0.20; 95% CI: 0.12 to 0.28), and IMR (r = 0.16; 95% CI: 0.07-0.24). In multivariable models, slow flow was associated with lower odds of abnormal CFR (adjusted OR: 0.53; 95% CI: 0.35 to 0.80).
Conclusions: Coronary slow flow was weakly associated with results of invasive CFT and should not be used as a surrogate for the invasive diagnosis of CMD.
Competing Interests: Funding Support and Author Disclosures Dr Reynolds is supported by in-kind donations for research from Abbott Vascular, Philips, SHL Telemedicine, and Siemens. Dr McCarthy has received speaking honoraria and payments as a content expert for educational materials from Abbott Vascular. Dr Smilowitz is supported in part by the National Heart, Lung, and Blood Institute of the National Institutes of Health (award K23HL150315); and has served on an advisory board and as a consultant for Abbott Vascular. Dr Miner has received unrestricted research grants and speaking honoraria from Abbott Vascular. Dr Blair has served on an advisory board, as a consultant, and on the Speakers Bureau for Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Objectives: The aim of this study was to investigate relationships between cTFC and invasive CFT for CMD.
Methods: Adults with ischemia with no obstructive coronary arteries underwent invasive CFT with thermodilution-derived baseline coronary blood flow, coronary flow reserve (CFR), and index of microcirculatory resistance (IMR). CMD was defined as abnormal CFR (<2.5) and/or abnormal IMR (≥25). cTFC was measured from baseline angiography; slow flow was defined as cTFC >25. Correlations between cTFC and baseline coronary flow and between CFR and IMR and associations between slow flow and invasive measures of CMD were evaluated, adjusted for covariates. All patients provided consent.
Results: Among 508 adults, 49% had coronary slow flow. Patients with slow flow were more likely to have abnormal IMR (36% vs 26%; P = 0.019) but less likely to have abnormal CFR (28% vs 42%; P = 0.001), with no difference in CMD (46% vs 51%). cTFC was weakly correlated with baseline coronary blood flow (r = -0.35; 95% CI: -0.42 to -0.27), CFR (r = 0.20; 95% CI: 0.12 to 0.28), and IMR (r = 0.16; 95% CI: 0.07-0.24). In multivariable models, slow flow was associated with lower odds of abnormal CFR (adjusted OR: 0.53; 95% CI: 0.35 to 0.80).
Conclusions: Coronary slow flow was weakly associated with results of invasive CFT and should not be used as a surrogate for the invasive diagnosis of CMD.
Competing Interests: Funding Support and Author Disclosures Dr Reynolds is supported by in-kind donations for research from Abbott Vascular, Philips, SHL Telemedicine, and Siemens. Dr McCarthy has received speaking honoraria and payments as a content expert for educational materials from Abbott Vascular. Dr Smilowitz is supported in part by the National Heart, Lung, and Blood Institute of the National Institutes of Health (award K23HL150315); and has served on an advisory board and as a consultant for Abbott Vascular. Dr Miner has received unrestricted research grants and speaking honoraria from Abbott Vascular. Dr Blair has served on an advisory board, as a consultant, and on the Speakers Bureau for Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)