Dataset Information

The role of the angiography-derived index of microcirculatory resistance in the prognosis of patients with dilated cardiomyopathy.

ABSTRACT:

Background

The coronary angiography-derived index of microcirculatory resistance (caIMR) is a novel noninvasive method to assess coronary microvascular dysfunction (CMD). However, the association between caIMR and the prognosis of patients with dilated cardiomyopathy (DCM) is unclear. We aimed to explore the role of the caIMR in evaluating the outcome of patients with DCM.

Methods

We consecutively and retrospectively enrolled patients with DCM in the Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China, from January 2013 to January 2018. The caIMR was calculated for eligible patients. The primary end point in this study was composite events, including rehospitalization related to heart failure (HF), device implantation, heart transplantation, or cardiac death. Patients were categorized into groups based on whether they had composite events (the events and no-events groups), and differences in the baseline and end points between these two groups were analyzed.

Results

A total of 95 eligible patients with DCM were enrolled in the study, 36 of whom had end point events. The best cutoff values of the caIMR for the left anterior descending (LAD) artery, left circumflex (LCX) artery, and right coronary artery (RCA) were >29.8 with an area under the curve (AUC) of 0.828, >25.5 with an AUC of 0.720, and >29.7 with an AUC of 0.717, respectively (all P values <0.001). Patients were then classified into the higher caIMR group and the lower caIMR group based on the cutoff value. Kaplan-Meier analyses showed that patients with a higher caIMR had increased cumulative risks of end point events regardless of the cutoff values for the LAD, LCX, and RCA (all log-rank P values <0.001). After adjustment for confounders, Cox regression analyses indicated that LAD-caIMR was an independent risk factor for end point events in patients with DCM [hazard ratio (HR) =1.11; 95% CI: 1.06-1.16].

Conclusions

A higher caIMR was significantly associated with the poor prognosis of patients with DCM.

SUBMITTER: Li M

PROVIDER: S-EPMC10102743 | biostudies-literature | 2023 Apr

REPOSITORIES: biostudies-literature

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Publications

The role of the angiography-derived index of microcirculatory resistance in the prognosis of patients with dilated cardiomyopathy.

Li Menghuan M Su Hu H Zuo Zhi Z Zhang Zhiyong Z Li Mengna M Su Fen F Yao Wenming W He Yuan Y Kong Xiangqing X Wang Hui H

Quantitative imaging in medicine and surgery 20230315 4

<h4>Background</h4>The coronary angiography-derived index of microcirculatory resistance (caIMR) is a novel noninvasive method to assess coronary microvascular dysfunction (CMD). However, the association between caIMR and the prognosis of patients with dilated cardiomyopathy (DCM) is unclear. We aimed to explore the role of the caIMR in evaluating the outcome of patients with DCM.<h4>Methods</h4>We consecutively and retrospectively enrolled patients with DCM in the Department of Cardiology, the ...[more]

PMID: 37064388

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Project description:BackgroundMyocardial ischaemia with non-obstructive coronary arteries (INOCA) represents a challenging and frequent, but largely underdiagnosed, condition.AimsWe aimed to investigate the feasibility and diagnostic value of angiography-derived coronary microcirculatory resistance in patients with INOCA syndrome.MethodsThis is an investigator-driven, prospective and blinded study. The diagnostic yield of angiography-derived index of coronary microcirculatory resistance (angio-IMR) was investigated against thermodilution-derived IMR (thermo-IMR) in patients with clinically indicated coronary angiography due to suspected myocardial ischaemia and angiographically normal or non-obstructive coronary arteries. The angio-IMR was derived from resting angiograms (contrast-flow angio-IMR [cAngio-IMR]) by an expert analyst blinded to the thermo-IMR. An independent, blinded, physiology core laboratory analysed the raw intracoronary physiology data and provided the final thermo-IMR values.ResultsA total of 104 patients (108 coronary vessels) were analysed after fulfilling predefined inclusion criteria. Most patients were female (67%). Obstructive epicardial disease was angiographically (percent diameter stenosis <50%) and physiologically (fractional flow reserve>0.80) ruled out in all cases. Median thermo-IMR and cAngio-IMR were 16.6 (12.7, 23.0) and 16.8 (12.8, 23.1) units, respectively (median difference -0.31, 95% confidence interval: -1.53 to 1.00; p=0.654). cAngio-IMR showed good correlation (Pearson coefficient 0.76; p<0.001), agreement (mean bias 0.4), discriminatory power (area under the curve from the receiver operator characteristics 0.865; p<0.001) and accuracy (85%), compared to thermo-IMR (≥25 U).ConclusionsEvaluating coronary microcirculatory resistance in patients with INOCA syndrome using cAngio-IMR is feasible and accurate. By circumventing the need of coronary instrumentation and hyperaemic drugs, this method may facilitate the assessment of coronary microcirculatory resistance in patients with suspected INOCA.Clinicaltrialsgov: NCT04827498.

Project description:Coronary microvascular dysfunction (CMD) has been proposed as a key driver in the etiopathogenesis of Takotsubo syndrome (TTS), likely related to an "adrenergic storm" upon a susceptible microvascular circulation. The aim of our manuscript was to assess CMD in patients with TTS through the computation of the angiography-derived index of microcirculatory resistance (IMR) and its correlation with clinical presentation. Coronary angiograms of 41 consecutive TTS patients were retrospectively analyzed to derive angiography-based indices of CMD. Three indices (NH-IMRangio, AngioIMR and A-IMR) were calculated based on quantitative flow ratio. CMD was defined as an IMRangio value ≥ 25 units. The correlation between CMD and clinical presentation was then assessed. Median age was 76 years, 85.7% were women and mean left ventricular ejection fraction (LVEF) at first echocardiogram was 41.2%. Angiography-derived IMR was higher in left anterior descending artery (LAD) than circumflex and right coronary artery with either NH-IMRangio (53.9 ± 19.8 vs 35.8 ± 15.4 vs 40.8 ± 18.5, p-value < 0.001), AngioIMR (47.2 ± 17.3 vs 31.8 ± 12.2 vs 37.3 ± 13.7, p-value < 0.001) or A-IMR (52.7 ± 19 vs 36.1 ± 14.1 vs 41.8 ± 16.1, p-value < 0.001). All patients presented CMD with angiography-derived IMR ≥ 25 in at least one territory with each formula. Angiography-derived IMR in LAD territory was significantly higher in patients presenting with LVEF impairment (≤ 40%) than in those with preserved ventricular global function (NH-IMRangio: 59.3 ± 18.1 vs 46.3 ± 16.0 p-value = 0.030; AngioIMR: 52.9 ± 17.8 vs 41.4 ± 14.2, p-value = 0.037; A-IMR: 59.2 ± 18.6 vs 46.3 ± 17.0, p-value = 0.035). CMD assessed with angiography-derived IMR is a common finding in TTS and it is inversely correlated with LV function. The available formulas have a substantial superimposable diagnostic performance in assessing coronary microvascular function.

Project description:BackgroundThe association between coronary slow flow (CSF) and coronary microvascular dysfunction (CMD) remains unclear. The objective of this study was to evaluate the correlation between the corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) and the index of microcirculatory resistance (IMR).MethodsWe consecutively enrolled patients with CSF from January 2017 to March 2018. Concurrently, we randomly selected control participants with normal flow arteries at a ratio of 3:1. Two cardiologists performed the measurements of CTFC. Coronary angiography-derived IMR (caIMR) was used to assess CMD. The caIMR was analyzed by an independent agency, with CMD being defined as caIMR >40 U.ResultsA total of 111 patients with CSF and 39 patients without CSF were enrolled in this retrospective study. Compared with the non-CSF group, the CSF group had a greater proportion of males (65.8% vs. 23.1%; P<0.001) and a lower prevalence of hypertension (47.7% vs. 67.7%; P=0.042). Additionally, the CSF group had higher CTFC, coronary angiography-derived fractional flow reserve (caFFR), and caIMR regardless of left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA) (all P values <0.001). A strong correlation between CTFC and caIMR was observed for all arteries (all P values <0.001). In the univariate analysis, male sex [hazard ratio (HR) =2.63, 95% CI: 1.30-5.31], E/e' (HR =0.88, 95% CI: 0.78-0.99), CTFC (HR =1.12, 95% CI: 1.09-1.16), and caFFR (HR =1.81, 95% CI: 1.50-2.17) were significantly correlated with CMD. After adjusting for covariates, male sex (HR =2.72, 95% CI: 1.22-6.06), CTFC (HR =1.10, 95% CI: 1.07-1.14), and caFFR (HR =1.22, 95% CI: 1.00-1.50) were independent predictors for CMD. Additionally, the best cutoff value of CTFC of all arteries for predicting CMD was 38 frames, with an area under the curve of 0.873, a sensitivity of 92.8%, and a specificity of 63.8% (P<0.001). Moreover, the best cutoff value of CTFC of LAD, LCX, and RCA to identify CMD was 35 frames, 52 frames, and 50 frames, respectively (all P values <0.001).ConclusionsCTFC correlated well with caIMR and had a strong predictive power to identify CMD.

Dataset Information

The role of the angiography-derived index of microcirculatory resistance in the prognosis of patients with dilated cardiomyopathy.

Background

Methods

Results

Conclusions

Publications

The role of the angiography-derived index of microcirculatory resistance in the prognosis of patients with dilated cardiomyopathy.

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