Prognostic Implications of Microvascular Resistance Reserve in Symptomatic Patients With Intermediate Coronary Stenosis
Authors' conclusion
The presence of CMD defined by MRR was independently associated with the risk for a composite of cardiovascular death, myocardial infarction, repeat revascularization, and admission for heart failure in patients with stable IHD, irrespective of significant epicardial coronary artery stenosis.
Study context
- Population
- Patients undergoing echocardiographic and invasive physiological assessment for suspected stable ischemic heart disease (IHD)172 with fractional flow reserve (FFR) ≤0.80
- Participants
- 547 patients
- Exposure
- Coronary microvascular dysfunction (CMD) vs no CMD, by FFR stratum
- CMDn = 200
- Outcome
- Major adverse cardiovascular events (MACE):
- CV death
- MI
- Repeat revascularization
- HF admission
- Follow-up
- Median 3.3 years (Q1-Q3: 2.0-4.5 years)
Methodological detailsconsecutive patients
- Consecutive patients
Main finding
As reported in the abstract
MACE · median 3.3 years
Estimate (95% CI)P value
MRRper 1-U decrease
HR 1.23(1.12–1.36)
P < 0.001CMDvs No CMDFFR >0.80: 41.0% vs 26.0%
adjusted HR 1.59(1.07–2.35)
P = 0.021CMDvs No CMDFFR ≤0.80: 34.7% vs 14.8%
adjusted HR 2.32(1.12–4.82)
P = 0.024Observational data: associations, not effects.
Further findings
Correlations of microvascular resistance reserve (MRR)
- MRR vs FFR, R = −0.031
- P = 0.469
- MRR vs index of microcirculatory resistance, R = −0.353
- P < 0.001
- MRR vs NT-proBNP, R = −0.296
- P < 0.001
- MRR vs LV filling pressure (E/e'), R = −0.224
- P < 0.001
- MRR vs diastolic dysfunction grade
- P < 0.001
Original publication
Prognostic Implications of Microvascular Resistance Reserve in Symptomatic Patients With Intermediate Coronary Stenosis. JACC Cardiovasc Interv. Published 25 March 2024. doi:10.
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