Coronary microvascular dysfunction in patients with stable coronary artery disease: The CE-MARC 2 coronary physiology sub-study.pdf (1006.06 kB)
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Coronary microvascular dysfunction in patients with stable coronary artery disease: The CE-MARC 2 coronary physiology sub-study.

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posted on 05.07.2019, 13:06 by D Corcoran, R Young, D Adlam, A McConnachie, K Mangion, D Ripley, D Cairns, J Brown, C Bucciarelli-Ducci, A Baumbach, R Kharbanda, KG Oldroyd, GP McCann, JP Greenwood, C Berry
BACKGROUND: In patients with angina undergoing invasive management, no obstructive coronary artery disease (NOCAD) is a common finding, and angina may persist following percutaneous coronary intervention (PCI). Coronary microvascular dysfunction may be relevant. We aimed to assess the proportion of patients presenting with suspected CAD who had coronary microvascular dysfunction. METHODS: Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2 (CE-MARC 2) was a prospective multicenter randomised controlled trial of functional imaging versus guideline-based management in patients with suspected CAD. Invasive coronary angiography was protocol-directed. Fractional flow reserve (FFR) and parameters of microvascular function (coronary flow reserve (CFR), index of microcirculatory resistance (IMR), resistance reserve ratio (RRR)) were measured in major epicardial coronary arteries with ≥40-≤90% diameter stenosis. An FFR value ≤0.80 indicated the presence of obstructive CAD. RESULTS: 267/1202 (22.2%) patients underwent angiography and 81 (30%) patients had FFR measured. 63 (78%) of these patients had microvascular function assessed in 85 arteries (mean age 58.5 ± 8.2 years; 47 (75%) male). 25/63 (40%) patients had NOCAD, and of these, 17 (68%) had an abnormality ≥1 parameter of microvascular function (abnormal IMR (≥25), abnormal CFR (<2.0), and abnormal RRR (<2.0) occurred in 10 (40%), 12 (48%), and 11 (44%), respectively). 38/63 (60%) patients had obstructive epicardial CAD. Of these patients, 15/38 (39%), 20/38 (53%), and 12/38 (32%) had an abnormal IMR, CFR and RRR, respectively. CONCLUSIONS: Coronary microvascular dysfunction is common in patients with angina. Invasive assessment of microvascular function may be informative and relevant for decision-making in patients with both NOCAD and obstructive epicardial CAD. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01664858.

Funding

This study was funded by the British Heart Foundation (Clinical Research Training Fellowship to D.C. [FS/14/15/30661]; Special Project Grant [SP/12/1/29062]). Additional support was received from the Leeds Teaching Hospital Charitable Foundation and the National Institute for Health Research, through the Local Clinical Research Networks and the Leeds Clinical Research Facility.

History

Citation

International Journal of Cardiology, 2018, 266, pp. 7-14

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Cardiovascular Sciences

Version

VoR (Version of Record)

Published in

International Journal of Cardiology

Publisher

Elsevier

eissn

1874-1754

Acceptance date

13/04/2018

Copyright date

2017

Available date

05/07/2019

Notes

Supplementary data is available as Annex A from the website of the Version of Record via the publisher: https://doi.org/10.1016/j.ijcard.2018.04.061

Language

en