Comprehensive Angiography-Derived Functional Assessment of Epicardial and Microvascular Coronary Disease. Correlation With Non-invasive Myocardial Stress Imaging
Copyright © 2024 Elsevier Inc. All rights reserved..
Coronary angiography (CA) is poorly correlated with non-invasive myocardial stress imaging (NSI) and myocardial ischemia is often observed in patients with unobstructed coronary arteries. Moreover, the diagnostic performance of combined epicardial and microcirculatory angiography-derived physiological assessment and its correlation with NSI remains unknown. A total of 917 coronary vessels in 319 patients who underwent both CA and NSI were included in this multicenter observational retrospective analysis. Quantitative flow ratio (QFR) and angiography-derived index of microcirculatory resistance (IMRangio) analyses were performed to estimate coronary epicardial and microcirculatory function respectively. NSI demonstrated evidence of myocardial ischemia in 76% of the cases. IMRangio (36 [22 to 50] vs 29 [21 to 41], p <0.001) was significantly higher and QFR (0.92 [0.78 to 0.99] vs 0.97 [0.91 to 0.99], p <0.001) was significantly lower in vessels subtending ischemic territories. Overall, the diagnostic accuracy of QFR was moderate (area under the curve of receiver operating characteristic [AUCROC] 0.632 [95% confidence interval [CI] 0.589 to 0.674], p <0.0001) but it was higher in patients with normal microcirculatory function (AUCROC = 0.726 [95% CI 0.669 to 0.784], p <0.0001, p Value for AUCROC comparison = 0.009). Combined QFR/IMRangio assessment provided incremental diagnostic performance compared with the evaluation of epicardial or microcirculatory districts in isolation (p Value for AUC comparison <0.0001) and it was able to identify the predominant mechanism of myocardial ischemia in 77% of the patients with positive NSI. Our study suggests the value of a combined angiography-derived assessment of epicardial and microvascular function for the definition of the predominant mechanism of myocardial ischemia in patients with suspected coronary artery disease.
Medienart: |
E-Artikel |
---|
Erscheinungsjahr: |
2024 |
---|---|
Erschienen: |
2024 |
Enthalten in: |
Zur Gesamtaufnahme - volume:217 |
---|---|
Enthalten in: |
The American journal of cardiology - 217(2024) vom: 15. Apr., Seite 144-152 |
Sprache: |
Englisch |
---|
Beteiligte Personen: |
Della Mora, Francesco [VerfasserIn] |
---|
Links: |
---|
Themen: |
Coronary physiology assessment |
---|
Anmerkungen: |
Date Completed 03.04.2024 Date Revised 03.04.2024 published: Print-Electronic Citation Status MEDLINE |
---|
doi: |
10.1016/j.amjcard.2024.01.037 |
---|
funding: |
|
---|---|
Förderinstitution / Projekttitel: |
|
PPN (Katalog-ID): |
NLM369209281 |
---|
LEADER | 01000caa a22002652 4500 | ||
---|---|---|---|
001 | NLM369209281 | ||
003 | DE-627 | ||
005 | 20240403235551.0 | ||
007 | cr uuu---uuuuu | ||
008 | 240304s2024 xx |||||o 00| ||eng c | ||
024 | 7 | |a 10.1016/j.amjcard.2024.01.037 |2 doi | |
028 | 5 | 2 | |a pubmed24n1363.xml |
035 | |a (DE-627)NLM369209281 | ||
035 | |a (NLM)38431052 | ||
035 | |a (PII)S0002-9149(24)00108-5 | ||
040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
041 | |a eng | ||
100 | 1 | |a Della Mora, Francesco |e verfasserin |4 aut | |
245 | 1 | 0 | |a Comprehensive Angiography-Derived Functional Assessment of Epicardial and Microvascular Coronary Disease. Correlation With Non-invasive Myocardial Stress Imaging |
264 | 1 | |c 2024 | |
336 | |a Text |b txt |2 rdacontent | ||
337 | |a ƒaComputermedien |b c |2 rdamedia | ||
338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
500 | |a Date Completed 03.04.2024 | ||
500 | |a Date Revised 03.04.2024 | ||
500 | |a published: Print-Electronic | ||
500 | |a Citation Status MEDLINE | ||
520 | |a Copyright © 2024 Elsevier Inc. All rights reserved. | ||
520 | |a Coronary angiography (CA) is poorly correlated with non-invasive myocardial stress imaging (NSI) and myocardial ischemia is often observed in patients with unobstructed coronary arteries. Moreover, the diagnostic performance of combined epicardial and microcirculatory angiography-derived physiological assessment and its correlation with NSI remains unknown. A total of 917 coronary vessels in 319 patients who underwent both CA and NSI were included in this multicenter observational retrospective analysis. Quantitative flow ratio (QFR) and angiography-derived index of microcirculatory resistance (IMRangio) analyses were performed to estimate coronary epicardial and microcirculatory function respectively. NSI demonstrated evidence of myocardial ischemia in 76% of the cases. IMRangio (36 [22 to 50] vs 29 [21 to 41], p <0.001) was significantly higher and QFR (0.92 [0.78 to 0.99] vs 0.97 [0.91 to 0.99], p <0.001) was significantly lower in vessels subtending ischemic territories. Overall, the diagnostic accuracy of QFR was moderate (area under the curve of receiver operating characteristic [AUCROC] 0.632 [95% confidence interval [CI] 0.589 to 0.674], p <0.0001) but it was higher in patients with normal microcirculatory function (AUCROC = 0.726 [95% CI 0.669 to 0.784], p <0.0001, p Value for AUCROC comparison = 0.009). Combined QFR/IMRangio assessment provided incremental diagnostic performance compared with the evaluation of epicardial or microcirculatory districts in isolation (p Value for AUC comparison <0.0001) and it was able to identify the predominant mechanism of myocardial ischemia in 77% of the patients with positive NSI. Our study suggests the value of a combined angiography-derived assessment of epicardial and microvascular function for the definition of the predominant mechanism of myocardial ischemia in patients with suspected coronary artery disease | ||
650 | 4 | |a Observational Study | |
650 | 4 | |a Multicenter Study | |
650 | 4 | |a Journal Article | |
650 | 4 | |a QFR | |
650 | 4 | |a SPECT | |
650 | 4 | |a coronary physiology assessment | |
650 | 4 | |a index of microcirculatory resistance | |
650 | 4 | |a myocardial stress imaging | |
650 | 4 | |a stress-echocardiography | |
700 | 1 | |a Portolan, Leonardo |e verfasserin |4 aut | |
700 | 1 | |a Terentes-Printzios, Dimitrios |e verfasserin |4 aut | |
700 | 1 | |a Vicerè, Andrea |e verfasserin |4 aut | |
700 | 1 | |a Andreaggi, Stefano |e verfasserin |4 aut | |
700 | 1 | |a Biasin, Marco |e verfasserin |4 aut | |
700 | 1 | |a Pesarini, Gabriele |e verfasserin |4 aut | |
700 | 1 | |a Tavella, Domenico |e verfasserin |4 aut | |
700 | 1 | |a Maffeis, Caterina |e verfasserin |4 aut | |
700 | 1 | |a Tafciu, Elvin |e verfasserin |4 aut | |
700 | 1 | |a Benfari, Giovanni |e verfasserin |4 aut | |
700 | 1 | |a Oikonomou, Dimitrios |e verfasserin |4 aut | |
700 | 1 | |a Gkini, Konstantia-Paraskevi |e verfasserin |4 aut | |
700 | 1 | |a Galante, Domenico |e verfasserin |4 aut | |
700 | 1 | |a Tsioufis, Konstantinos |e verfasserin |4 aut | |
700 | 1 | |a Vlachopoulos, Charalambos |e verfasserin |4 aut | |
700 | 1 | |a Leone, Antonio Maria |e verfasserin |4 aut | |
700 | 1 | |a Ribichini, Flavio |e verfasserin |4 aut | |
700 | 1 | |a Scarsini, Roberto |e verfasserin |4 aut | |
773 | 0 | 8 | |i Enthalten in |t The American journal of cardiology |d 1958 |g 217(2024) vom: 15. Apr., Seite 144-152 |w (DE-627)NLM000025364 |x 1879-1913 |7 nnns |
773 | 1 | 8 | |g volume:217 |g year:2024 |g day:15 |g month:04 |g pages:144-152 |
856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.amjcard.2024.01.037 |3 Volltext |
912 | |a GBV_USEFLAG_A | ||
912 | |a GBV_NLM | ||
951 | |a AR | ||
952 | |d 217 |j 2024 |b 15 |c 04 |h 144-152 |