AI Article Synopsis
- The study focused on examining the incidence of coronary microvascular dysfunction (CMD) in patients suspected of having coronary artery disease (CAD) but without significant blockages.
- Out of 407 patients assessed, 34 were found to have impaired modified coronary flow capacity (mCFC), and subsequent analysis showed that this impairment was linked to a significantly higher risk of cardiovascular death and major adverse cardiovascular events (MACEs).
- The findings indicate that nearly 25% of these patients had impaired mCFC, highlighting its importance as a prognostic tool in predicting future cardiovascular risks in this population.
Article Abstract
Background: Vasodilator capacity of coronary circulation is an important diagnostic and prognostic tool in patients with coronary artery disease (CAD). We aimed to clarify the incidence of coronary microvascular dysfunction (CMD), defined as impaired modified coronary flow capacity (mCFC) proposed by Johnson and Gould and measured by N-ammonia myocardial perfusion positron emission tomography (PET), in patients without obstructive CAD and to evaluate the risk of future cardiovascular events.
Methods: This retrospective study recruited 407 consecutive CAD-suspected patients who underwent both pharmacological stress/rest N-ammonia PET and coronary angiography. Of the 407 patients, 137 patients (median age, 70 years; 63 women) were eligible and followed up (median, 19.8 months). Endpoints were defined as cardiovascular death or major adverse cardiovascular events (MACEs), such as cardiovascular death, nonfatal myocardial infarction, unplanned hospitalization for any cardiac reasons, and unplanned coronary revascularization. The impaired mCFC group included patients with mildly to severely reduced regional CFC in, at least, one vascular territory (n=34), while the remaining patients (n=103) were categorized as having preserved mCFC.
Results: Overall, cardiovascular death and MACEs occurred in five (4%) patients. The Kaplan-Meier curve showed a significant reduction in event-free survival for cardiovascular death (p=0.004) and MACEs (p<0.0001) in the impaired mCFC group, compared to the preserved mCFC group. Impaired mCFC was independently associated with the incidence of both cardiovascular death and MACEs after propensity-score adjustments [hazard ratio (HR), 10.7; 95% confidence interval (CI), 1.0-106.0; p=0.04 and HR, 9.5; 95% CI, 2.5-36.2; p<0.001, respectively].
Conclusions: In CAD-suspected patients without obstructive coronary arteries, impaired mCFC was observed in approximately 25% and was associated with a higher risk of cardiovascular death and MACEs. The mCFC concept can help identify patients who would benefit from specific therapies or lifestyle modifications to prevent future MACEs and can clarify potential mechanisms of CMD.
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| http://dx.doi.org/10.1016/j.jjcc.2021.09.001 | DOI Listing |
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