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Primary versus iatrogenic (post-PCI) coronary microvascular dysfunction: a wire-based multimodal comparison

BACKGROUND: Although there are studies examining each one separately, there are no data in the literature comparing the magnitudes of the iatrogenic, percutaneous coronary intervention (PCI)-induced, microvascular dysfunction (Type-4 CMD) and coronary microvascular dysfunction (CMD) in the setting o...

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Autores principales: Hasdemir, Hakan, Taş, Ahmet, Cevik, Erdem, Alan, Yaren, Broyd, Christopher J, Ozcan, Alp, Sonsoz, Mehmet R, Kara, Ilke, Demirtakan, Zeynep G, Parker, Kim, Perera, Divaka, Umman, Sabahattin, Sezer, Murat
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10685972/
https://www.ncbi.nlm.nih.gov/pubmed/38011991
http://dx.doi.org/10.1136/openhrt-2023-002437
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author Hasdemir, Hakan
Taş, Ahmet
Cevik, Erdem
Alan, Yaren
Broyd, Christopher J
Ozcan, Alp
Sonsoz, Mehmet R
Kara, Ilke
Demirtakan, Zeynep G
Parker, Kim
Perera, Divaka
Umman, Sabahattin
Sezer, Murat
author_facet Hasdemir, Hakan
Taş, Ahmet
Cevik, Erdem
Alan, Yaren
Broyd, Christopher J
Ozcan, Alp
Sonsoz, Mehmet R
Kara, Ilke
Demirtakan, Zeynep G
Parker, Kim
Perera, Divaka
Umman, Sabahattin
Sezer, Murat
author_sort Hasdemir, Hakan
collection PubMed
description BACKGROUND: Although there are studies examining each one separately, there are no data in the literature comparing the magnitudes of the iatrogenic, percutaneous coronary intervention (PCI)-induced, microvascular dysfunction (Type-4 CMD) and coronary microvascular dysfunction (CMD) in the setting of ischaemia in non-obstructed coronary arteries (INOCA) (Type-1 CMD). OBJECTIVES: We aimed to compare the characteristics of Type-1 and Type-4 CMD subtypes using coronary haemodynamic (resistance and flow-related parameters), thermodynamic (wave energy-related parameters) and hyperemic ECG changes. METHODS: Coronary flow reserve (CFR) value of <2.5 was defined as CMD in both groups. Wire-based multimodal perfusion markers were comparatively analysed in 35 patients (21 INOCA/CMD and 14 CCS/PCI) enrolled in NCT05471739 study. RESULTS: Both groups had comparably blunted CFR values per definition (2.03±0.22 vs 2.11±0.37; p: 0.518) and similar hyperemic ST shift in intracoronary ECG (0.16±0.09 vs 0.18±0.07 mV; p: 0.537). While the Type-1 CMD was characterised with impaired hyperemic blood flow acceleration (46.52+12.83 vs 68.20+28.63 cm/s; p: 0.017) and attenuated diastolic microvascular decompression wave magnitudes (p=0.042) with higher hyperemic microvascular resistance (p<0.001), Type-4 CMD had blunted CFR mainly due to higher baseline flow velocity due to post-occlusive reactive hyperemia (33.6±13.7 vs 22.24±5.3 cm/s; p=0.003). CONCLUSIONS: The perturbations in the microvascular milieu seen in CMD in INOCA setting (Type-1 CMD) seem to be more prominent than that of seen following elective PCI (Type-4 CMD), although resulting reversible ischaemia is equally severe in the downstream myocardium.
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spelling pubmed-106859722023-11-30 Primary versus iatrogenic (post-PCI) coronary microvascular dysfunction: a wire-based multimodal comparison Hasdemir, Hakan Taş, Ahmet Cevik, Erdem Alan, Yaren Broyd, Christopher J Ozcan, Alp Sonsoz, Mehmet R Kara, Ilke Demirtakan, Zeynep G Parker, Kim Perera, Divaka Umman, Sabahattin Sezer, Murat Open Heart Coronary Artery Disease BACKGROUND: Although there are studies examining each one separately, there are no data in the literature comparing the magnitudes of the iatrogenic, percutaneous coronary intervention (PCI)-induced, microvascular dysfunction (Type-4 CMD) and coronary microvascular dysfunction (CMD) in the setting of ischaemia in non-obstructed coronary arteries (INOCA) (Type-1 CMD). OBJECTIVES: We aimed to compare the characteristics of Type-1 and Type-4 CMD subtypes using coronary haemodynamic (resistance and flow-related parameters), thermodynamic (wave energy-related parameters) and hyperemic ECG changes. METHODS: Coronary flow reserve (CFR) value of <2.5 was defined as CMD in both groups. Wire-based multimodal perfusion markers were comparatively analysed in 35 patients (21 INOCA/CMD and 14 CCS/PCI) enrolled in NCT05471739 study. RESULTS: Both groups had comparably blunted CFR values per definition (2.03±0.22 vs 2.11±0.37; p: 0.518) and similar hyperemic ST shift in intracoronary ECG (0.16±0.09 vs 0.18±0.07 mV; p: 0.537). While the Type-1 CMD was characterised with impaired hyperemic blood flow acceleration (46.52+12.83 vs 68.20+28.63 cm/s; p: 0.017) and attenuated diastolic microvascular decompression wave magnitudes (p=0.042) with higher hyperemic microvascular resistance (p<0.001), Type-4 CMD had blunted CFR mainly due to higher baseline flow velocity due to post-occlusive reactive hyperemia (33.6±13.7 vs 22.24±5.3 cm/s; p=0.003). CONCLUSIONS: The perturbations in the microvascular milieu seen in CMD in INOCA setting (Type-1 CMD) seem to be more prominent than that of seen following elective PCI (Type-4 CMD), although resulting reversible ischaemia is equally severe in the downstream myocardium. BMJ Publishing Group 2023-11-27 /pmc/articles/PMC10685972/ /pubmed/38011991 http://dx.doi.org/10.1136/openhrt-2023-002437 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Coronary Artery Disease
Hasdemir, Hakan
Taş, Ahmet
Cevik, Erdem
Alan, Yaren
Broyd, Christopher J
Ozcan, Alp
Sonsoz, Mehmet R
Kara, Ilke
Demirtakan, Zeynep G
Parker, Kim
Perera, Divaka
Umman, Sabahattin
Sezer, Murat
Primary versus iatrogenic (post-PCI) coronary microvascular dysfunction: a wire-based multimodal comparison
title Primary versus iatrogenic (post-PCI) coronary microvascular dysfunction: a wire-based multimodal comparison
title_full Primary versus iatrogenic (post-PCI) coronary microvascular dysfunction: a wire-based multimodal comparison
title_fullStr Primary versus iatrogenic (post-PCI) coronary microvascular dysfunction: a wire-based multimodal comparison
title_full_unstemmed Primary versus iatrogenic (post-PCI) coronary microvascular dysfunction: a wire-based multimodal comparison
title_short Primary versus iatrogenic (post-PCI) coronary microvascular dysfunction: a wire-based multimodal comparison
title_sort primary versus iatrogenic (post-pci) coronary microvascular dysfunction: a wire-based multimodal comparison
topic Coronary Artery Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10685972/
https://www.ncbi.nlm.nih.gov/pubmed/38011991
http://dx.doi.org/10.1136/openhrt-2023-002437
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