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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...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2023
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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. |
format | Online Article Text |
id | pubmed-10685972 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
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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