Blood haemoglobin, renal insufficiency, fractional flow reserve and plasma NT-proBNP is associated with index of microcirculatory resistance in chronic coronary syndrome. (15th October 2020)

• Record Type: Journal Article
• Authors: Östlund-Papadogeorgos, Nikolaos; Ekenbäck, Christina; Jokhaji, Fadi; Mir-Akbari, Habib; Witt, Nils; Jernberg, Tomas; Wallén, Håkan; Linder, Rikard; Törnerud, Mattias; Samad, Bassem A.; Persson, Jonas
• Is Part Of: International journal of cardiology. Volume 317(2020)
• Page Start: 1
• Page End: 6
• Publication Date: 2020-10-15
• Subjects: Coronary microvascular dysfunction -- Haemoglobin -- Chronic coronary syndrome -- Coronary artery -- Index of microcirculatory resistance -- Renal insufficiency -- NT-proBNP; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2020.05.037
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Coronary microvascular dysfunction (CMVD) is associated with adverse cardiovascular outcome. We aimed to determine the prevalence of CMVD and factors related to index of microcirculatory resistance (IMR) in consecutive patients with chronic coronary syndrome (CCS) undergoing elective coronary angiography. Methods and results: Non-interventional physicians enrolled 274 patients with CCS before angiography, to minimize selection bias by PCI-operators. Fractional flow reserve (FFR) and IMR were measured in the LAD. Subjects with extensively diseased LAD, no measures due to technical reasons or violation of protocol were excluded from the analysis ( n = 54). The proportion of patients with IMR corrected for collateral flow (IMRcorr ) >25 units was 25% (95% confidence interval [CI] 19%–31%) in all 220 patients. In subjects with FFR ≤0.80 in the LAD the proportion of IMRcorr > 25 units was 21% (95% CI 13%–30%) as compared to subjects with FFR >0.80, 29% (95% CI 21%–36%), p = .268. Haemoglobin ( p < .005; r2 = 0.084), FFR in the LAD ( p = .001; r2 = 0.049), creatinine clearance ( p = .001; r 2 = 0.049; inversely), and NT-proBNP ( p = .038; r 2 = 0.021) were independently associated with IMRcorr in multivariate linear regression analysis. Conclusions: We report that IMRcorr is associated with renal dysfunction, NT-proBNP, FFR in the LAD and, for the first time, blood haemoglobin. One in four of patients referred for coronary angiography due to CCS have CMVD defined as IMRcorr > 25 in the LAD. Graphical abstract: Unlabelled Image Highligths: IMR is associated with blood haemoglobin, renal dysfunction, NT-proBNP and FFR. One in four patients undergoing elective coronary angiography have CMVD. IMR assessment is associated with use of 19 ml contrast and 2.1 min fluoroscopy.