Prevalence of coronary microcirculatory dysfunction in patients with chronic coronary syndromes and moderate coronary stenosis
Abstract
Background: Coronary microcirculatory dysfunction (CMD) is an emerging topic in the contemporary treatment of patients with chronic coronary syndromes (CCS), with influence both on diagnosis and patient outcome. Data on CMD prevalence according to current guidelines is scarce.
Aims: We aimed to assess prevalence of CMD in patients with CCS and moderate lesions in coronary angiography using thermodilution method.
Methods: The study was a prospective registry including patients undergoing coronary angiography for CCS who was diagnosed with moderate coronary stenosis. Patients with significant epicardial stenosis were excluded. All patients underwent fractional flow reserve, coronary flow reserve and index of microcirculatory resistance (IMR) assessment.
Results: We enrolled a total of 101 patients. CMD was diagnosed in 45% of cases, with a particular difference between groups without any significant lesions and with at least one vessel causing significant ischemia (55% vs. 24%; P = 0.03). In the CMD group, there were lower coronary flow reserve and higher IMR median values compared with no CMD group (1.6 vs. 2.6; P <0.001 and 29 vs. 15; P <0.001 respectively). In logistic regression models, higher resting full-cycle ratio values (P = 0.006) and the presence of diastolic dysfunction (P = 0.03) were independent predictors of CMD presence.
Conclusions: In patients with CCS and moderate coronary stenosis CMD is highly prevalent, independent of the level of diameter stenosis. The presence of CMD in 34% of patients qualified for revascularization may influence persistent angina after revascularization. As there are no specific predictors of CMD, more common functional testing in these patients should be advised.
Keywords: chronic coronary syndromescoronary flow reservecoronary microcirculatory dysfunctionfractional flow reserveindex of microcirculatory resistance
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