Serial fractional flow reserve, coronary flow reserve and index of microcirculatory resistance after percutaneous coronary intervention in patients treated for stable angina pectoris assessed with PET.
Journal
Coronary artery disease
ISSN: 1473-5830
Titre abrégé: Coron Artery Dis
Pays: England
ID NLM: 9011445
Informations de publication
Date de publication:
11 Dec 2023
11 Dec 2023
Historique:
pubmed:
27
11
2023
medline:
27
11
2023
entrez:
27
11
2023
Statut:
aheadofprint
Résumé
Cardiac 15 O-water PET is a noninvasive method to evaluate epicardial and microvascular dysfunction and further quantitate absolute myocardial blood flow (MBF). The aim of this study was to assess the impact of revascularization on MBF and myocardial flow reserve (MFR) assessed with 15 O-water PET and invasive flow and pressure measurements. In 21 patients with single-vessel disease referred for percutaneous coronary intervention (PCI), serial PET perfusion imaging and fractional flow reserve (FFR), coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) were performed during PCI and after 3 months. In the affected myocardium, stress MBF and MFR increased significantly from before revascularization to 3 months after revascularization: stress MBF 2.4 ± 0.8 vs. 3.2 ± 0.8; P < 0.001 and MFR 2.5 ± 0.8 vs. 3.4 ± 1.1; P = 0.004. FFR and CFR increased significantly from baseline to after revascularization and remained stable from after revascularization to 3-month follow-up: FFR 0.64 ± 0.20 vs. 0.91 ± 0.06 vs. 0.91 ± 0.07; P < 0.001; CFR 2.4 ± 1.2 vs. 3.6 ± 1.9 vs. 3.6 ± 1.9; P < 0.001, whereas IMR did not change significantly: 30.3 ± 22.9 vs. 30.1 ± 25.3 vs. 31.9 ± 25.2; P = ns. After revascularization, an increase in stress MBF was associated with an increase in FFR ( r = 0.732; P < 0.001) and an increase in MFR ( r = 0.499; P = 0.021). IMR measured before PCI was inversely associated with improvement in stress MBF, ( r = -0.616; P = 0.004). Recovery of myocardial perfusion after PCI was associated with an increase in FFR 3 months after revascularization. Microcirculatory dysfunction was associated with less improvement in myocardial perfusion.
Sections du résumé
BACKGROUND
BACKGROUND
Cardiac 15 O-water PET is a noninvasive method to evaluate epicardial and microvascular dysfunction and further quantitate absolute myocardial blood flow (MBF).
AIM
OBJECTIVE
The aim of this study was to assess the impact of revascularization on MBF and myocardial flow reserve (MFR) assessed with 15 O-water PET and invasive flow and pressure measurements.
METHODS
METHODS
In 21 patients with single-vessel disease referred for percutaneous coronary intervention (PCI), serial PET perfusion imaging and fractional flow reserve (FFR), coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) were performed during PCI and after 3 months.
RESULTS
RESULTS
In the affected myocardium, stress MBF and MFR increased significantly from before revascularization to 3 months after revascularization: stress MBF 2.4 ± 0.8 vs. 3.2 ± 0.8; P < 0.001 and MFR 2.5 ± 0.8 vs. 3.4 ± 1.1; P = 0.004. FFR and CFR increased significantly from baseline to after revascularization and remained stable from after revascularization to 3-month follow-up: FFR 0.64 ± 0.20 vs. 0.91 ± 0.06 vs. 0.91 ± 0.07; P < 0.001; CFR 2.4 ± 1.2 vs. 3.6 ± 1.9 vs. 3.6 ± 1.9; P < 0.001, whereas IMR did not change significantly: 30.3 ± 22.9 vs. 30.1 ± 25.3 vs. 31.9 ± 25.2; P = ns. After revascularization, an increase in stress MBF was associated with an increase in FFR ( r = 0.732; P < 0.001) and an increase in MFR ( r = 0.499; P = 0.021). IMR measured before PCI was inversely associated with improvement in stress MBF, ( r = -0.616; P = 0.004).
CONCLUSION
CONCLUSIONS
Recovery of myocardial perfusion after PCI was associated with an increase in FFR 3 months after revascularization. Microcirculatory dysfunction was associated with less improvement in myocardial perfusion.
Identifiants
pubmed: 38009377
doi: 10.1097/MCA.0000000000001308
pii: 00019501-990000000-00163
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
Références
Tousoulis D, Androulakis E, Kontogeorgou A, Papageorgiou N, Charakida M, Siama K, et al. Insight to the pathophysiology of stable angina pectoris. Curr Pharm Des 2013; 19:1593–1600.
Schwartz L, Bourassa MG. Evaluation of patients with chest pain and normal coronary angiograms. Arch Intern Med 2001; 161:1825–1833.
Marzilli M, Merz CN, Boden WE, Bonow RO, Capozza PG, Chilian WM, et al. Obstructive coronary atherosclerosis and ischemic heart disease: an elusive link! J Am Coll Cardiol 2012; 60:951–956.
Pries AR, Badimon L, Bugiardini R, Camici PG, Dorobantu M, Duncker DJ, et al. Coronary vascular regulation, remodelling, and collateralization: mechanisms and clinical implications on behalf of the working group on coronary pathophysiology and microcirculation. Eur Heart J 2015; 36:3134–3146.
Lee JM, Jung JH, Hwang D, Park J, Fan Y, Na SH, et al. Coronary flow reserve and microcirculatory resistance in patients with intermediate coronary stenosis. J Am Coll Cardiol 2016; 67:1158–1169.
Pries AR, Reglin B. Coronary microcirculatory pathophysiology: can we afford it to remain a black box? Eur Heart J 2017; 38:478–488.
Danad I, Uusitalo V, Kero T, Saraste A, Raijmakers PG, Lammertsma AA, et al. Quantitative assessment of myocardial perfusion in the detection of significant coronary artery disease: cutoff values and diagnostic accuracy of quantitative [(15)O]H2O PET imaging. J Am Coll Cardiol 2014; 64:1464–1475.
Gould KL, Johnson NP, Bateman TM, Beanlands RS, Bengel FM, Bober R, et al. Anatomic versus physiologic assessment of coronary artery disease Role of coronary flow reserve, fractional flow reserve, and positron emission tomography imaging in revascularization decision-making. J Am Coll Cardiol 2013; 62:1639–1653.
Thomassen A, Petersen H, Diederichsen AC, Mickley H, Jensen LO, Johansen A, et al. Hybrid CT angiography and quantitative 15O-water PET for assessment of coronary artery disease: comparison with quantitative coronary angiography. Eur J Nucl Med Mol Imaging 2013; 40:1894–1904.
Kajander S, Joutsiniemi E, Saraste M, Pietila M, Ukkonen H, Saraste A, et al. Cardiac positron emission tomography/computed tomography imaging accurately detects anatomically and functionally significant coronary artery disease. Circulation 2010; 122:603–613.
Johnson NP, Toth GG, Lai D, Zhu H, Acar G, Agostoni P, et al. Prognostic value of fractional flow reserve: linking physiologic severity to clinical outcomes. J Am Coll Cardiol 2014; 64:1641–1654.
Pijls NH, De Bruyne B, Peels K, Van Der Voort PH, Bonnier HJ, Bartunek JKJJ, et al. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med 1996; 334:1703–1708.
Fearon WF, Shilane D, Pijls NH, Boothroyd DB, Tonino PA, Barbato E, et al.; Fractional Flow Reserve Versus Angiography for Multivessel Evaluation 2 (FAME 2) Investigators. Cost-effectiveness of percutaneous coronary intervention in patients with stable coronary artery disease and abnormal fractional flow reserve. Circulation 2013; 128:1335–1340.
Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990; 15:827–832.
Diederichsen AC, Petersen H, Jensen LO, Thayssen P, Gerke O, Sandgaard NC, et al. Diagnostic value of cardiac 64-slice computed tomography: importance of coronary calcium. Scand Cardiovasc J 2009; 43:337–344.
Thomassen A, Petersen H, Johansen A, Braad PE, Diederichsen AC, Mickley H, et al. Quantitative myocardial perfusion by O-15-water PET: individualized vs standardized vascular territories. Eur Heart J Cardiovasc Imaging 2015; 16:970–976.
Nesterov SV, Han C, Maki M, Kajander S, Naum AG, Helenius H, et al. Myocardial perfusion quantitation with 15O-labelled water PET: high reproducibility of the new cardiac analysis software (Carimas). Eur J Nucl Med Mol Imaging 2009; 36:1594–1602.
Yong AS, Layland J, Fearon WF, Ho M, Shah MG, Daniels D, et al. Calculation of the index of microcirculatory resistance without coronary wedge pressure measurement in the presence of epicardial stenosis. JACC Cardiovasc Interv 2013; 6:53–58.
Schumacher SP, Driessen RS, Stuijfzand WJ, Raijmakers PG, Danad I, Dens J, et al. Recovery of myocardial perfusion after percutaneous coronary intervention of chronic total occlusions is comparable to hemodynamically significant non-occlusive lesions. Catheter Cardiovasc Interv 2018; 93:1059–1066.
Driessen RS, Danad I, Stuijfzand WJ, Schumacher SP, Knuuti J, Maki M, et al. Impact of revascularization on absolute myocardial blood flow as assessed by serial [(15)O]H2O positron emission tomography imaging: a comparison with fractional flow reserve. Circ Cardiovasc Imaging 2019; 11:e007417.
Bober RM, Thompson CD, Morin DP. The effect of coronary revascularization on regional myocardial blood flow as assessed by stress positron emission tomography. J Nucl Cardiol 2017; 24:961–974.
Uren NG, Crake T, Lefroy DC, de Silva R, Davies GJ, Maseri A. Delayed recovery of coronary resistive vessel function after coronary angioplasty. J Am Coll Cardiol 1993; 21:612–621.
Rampat R, Williams T, Hildick-Smith D, Cockburn J. The effect of elective implantation of the ABSORB bioresorbable vascular scaffold on coronary microcirculation: serial assessment using the index of microcirculatory resistance. Microcirculation 2019; 3:e12521.
Murai T, Lee T, Kanaji Y, Matsuda J, Usui E, Araki M, et al. The influence of elective percutaneous coronary intervention on microvascular resistance: a serial assessment using the index of microcirculatory resistance. Am J Physiol Heart Circ Physiol 2016; 311:H520–H531.
Fearon WF, Balsam LB, Farouque HM, Caffarelli AD, Robbins RC, Fitzgerald PJ, et al. Novel index for invasively assessing the coronary microcirculation. Circulation 2003; 107:3129–3132.
Aarnoudse W, Fearon WF, Manoharan G, Geven M, van de Vosse F, Rutten M, et al. Epicardial stenosis severity does not affect minimal microcirculatory resistance. Circulation 2004; 110:2137–2142.
Yong AS, Ho M, Shah MG, Ng MK, Fearon WF. Coronary microcirculatory resistance is independent of epicardial stenosis. Circ Cardiovasc Interv 2012; 5:103–8, S1.
Layland J, MacIsaac AI, Burns AT, Somaratne JB, Leitl G, Whitbourn RJ, et al. When collateral supply is accounted for epicardial stenosis does not increase microvascular resistance. Circ Cardiovasc Interv 2012; 5:97–102.
Verhoeff BJ, Siebes M, Meuwissen M, Atasever B, Voskuil M, de Winter RJ, et al. Influence of percutaneous coronary intervention on coronary microvascular resistance index. Circulation 2005; 111:76–82.
Kajander SA, Joutsiniemi E, Saraste M, Pietila M, Ukkonen H, Saraste A, et al. Clinical value of absolute quantification of myocardial perfusion with (15)O-water in coronary artery disease. Circ Cardiovasc Imaging 2011; 4:678–684.
Kini AS, Baber U, Kovacic JC, Limaye A, Ali ZA, Sweeny J, et al. Changes in plaque lipid content after short-term intensive versus standard statin therapy: the YELLOW trial (reduction in yellow plaque by aggressive lipid-lowering therapy). J Am Coll Cardiol 2013; 62:21–29.
Thuesen AL, Riber LP, Veien KT, Christiansen EH, Jensen SE, Modrau I, et al. Fractional flow reserve versus angiographically-guided coronary artery bypass grafting. J Am Coll Cardiol 2018; 72:2732–2743.
Xaplanteris P, Ntalianis A, De Bruyne B, Strisciuglio T, Pellicano M, Ciccarelli G, et al. Coronary lesion progression as assessed by fractional flow reserve (FFR) and angiography. EuroIntervention 2018; 14:907–914.