PMID- 33950329 OWN - NLM STAT- MEDLINE DCOM- 20211015 LR - 20211015 IS - 1875-8312 (Electronic) IS - 1569-5794 (Linking) VI - 37 IP - 6 DP - 2021 Jun TI - Angiography-derived index of microcirculatory resistance (IMR(angio)) as a novel pressure-wire-free tool to assess coronary microvascular dysfunction in acute coronary syndromes and stable coronary artery disease. PG - 1801-1813 LID - 10.1007/s10554-021-02254-8 [doi] AB - To investigate the diagnostic accuracy of (1) hyperaemic angiography-derived index of microcirculatory resistance (IMR(angio)) in defining coronary microvascular dysfunction (CMD) across patients with acute coronary syndromes (ST-elevation myocardial infarction [STEMI]; non-ST elevation acute coronary syndrome [NSTE-ACS]) and stable chronic coronary syndrome [CCS]) and (2) the accuracy of non-hyperaemic IMR(angio) (NH-IMR(angio)) to detect CMD in STEMI. 145 patients (STEMI = 66; NSTEMI = 43; CCS = 36) were enrolled. 246 pressure-wire IMR measurements were made in 189 coronary vessels. IMR(angio) and NH-IMR(angio) was derived using quantitative flow ratio. In patients with STEMI, cardiac magnetic resonance was performed to quantify microvascular obstruction (MVO). IMR(angio) was correlated with IMR (overall rho = 0.78, p < 0.0001; STEMI, rho = 0.85 p < 0.0001; NSTE-ACS and rho = 0.72, p < 0.0001; CCS, rho = 0.70, p < 0.0001) and demonstrated good diagnostic performance in predicting high IMR (STEMI AUC(ROC) = 0.93 [0.88-0.98]; NSTE-ACS AUC(ROC) = 0.77 [0.63-0.92]; CCS AUC(ROC) = 0.88 [0.79-0.97]). Agreement between the two indices was evident on Bland Altman analysis. In STEMI, NH-IMR(angio) was also well correlated with IMR (rho = 0.64, p < 0.0001), with good diagnostic accuracy in predicting high invasive IMR (AUC(ROC) = 0.82 [0.74-0.90]). Both IMR(angio) (AUC(ROC) = 0.74 [0.59-0.89]) and NH-IMR(angio) (AUC(ROC) = 0.76 [0.54-0.87]) were significantly associated with MVO in STEMI. In conclusions, IMR(angio) is a valid alternative to invasive IMR to detect CMD in patients with acute and stable coronary syndromes, whilst NH-IMR(angio) has a good diagnostic accuracy in STEMI where it could become a user-friendly diagnostic tool as it is adenosine-free. FAU - Scarsini, Roberto AU - Scarsini R AD - Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK. AD - Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy. FAU - Shanmuganathan, Mayooran AU - Shanmuganathan M AD - Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK. AD - Cardiovascular Medicine, University of Oxford, Oxford, UK. FAU - Kotronias, Rafail A AU - Kotronias RA AD - Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK. AD - Cardiovascular Medicine, University of Oxford, Oxford, UK. FAU - Terentes-Printzios, Dimitrios AU - Terentes-Printzios D AD - Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK. FAU - Borlotti, Alessandra AU - Borlotti A AD - Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK. AD - Cardiovascular Medicine, University of Oxford, Oxford, UK. FAU - Langrish, Jeremy P AU - Langrish JP AD - Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK. FAU - Lucking, Andrew J AU - Lucking AJ AD - Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK. CN - OxAMI Study Investigators FAU - Ribichini, Flavio AU - Ribichini F AD - Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy. FAU - Ferreira, Vanessa M AU - Ferreira VM AD - Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK. AD - Cardiovascular Medicine, University of Oxford, Oxford, UK. FAU - Channon, Keith M AU - Channon KM AD - Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK. AD - Cardiovascular Medicine, University of Oxford, Oxford, UK. FAU - Garcia-Garcia, Hector M AU - Garcia-Garcia HM AD - MedStar Washington Hospital Centre, Washington, DC, USA. FAU - Banning, Adrian P AU - Banning AP AD - Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK. AD - Cardiovascular Medicine, University of Oxford, Oxford, UK. FAU - De Maria, Giovanni Luigi AU - De Maria GL AUID- ORCID: 0000-0003-3572-1855 AD - Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford, OX39DU, UK. Giovanniluigi.Demaria@ouh.nhs.uk. AD - Cardiovascular Medicine, University of Oxford, Oxford, UK. Giovanniluigi.Demaria@ouh.nhs.uk. LA - eng GR - CH/16/1/32013/BHF_/British Heart Foundation/United Kingdom GR - RG/13/1/30181/BHF Centre of Research Excellence, Oxford/ PT - Journal Article DEP - 20210505 PL - United States TA - Int J Cardiovasc Imaging JT - The international journal of cardiovascular imaging JID - 100969716 SB - IM MH - *Acute Coronary Syndrome/diagnostic imaging MH - Coronary Angiography MH - *Coronary Artery Disease/diagnostic imaging MH - Coronary Circulation MH - Humans MH - Microcirculation MH - *Percutaneous Coronary Intervention MH - Predictive Value of Tests MH - Vascular Resistance OTO - NOTNLM OT - Coronary microvascular dysfunction OT - IMRangio OT - Index of microcirculatory resistance OT - NSTE-ACS OT - QFR OT - STEMI OT - Stable chronic coronary syndrome EDAT- 2021/05/06 06:00 MHDA- 2021/10/16 06:00 CRDT- 2021/05/05 12:35 PHST- 2021/03/03 00:00 [received] PHST- 2021/04/23 00:00 [accepted] PHST- 2021/05/06 06:00 [pubmed] PHST- 2021/10/16 06:00 [medline] PHST- 2021/05/05 12:35 [entrez] AID - 10.1007/s10554-021-02254-8 [pii] AID - 10.1007/s10554-021-02254-8 [doi] PST - ppublish SO - Int J Cardiovasc Imaging. 2021 Jun;37(6):1801-1813. doi: 10.1007/s10554-021-02254-8. Epub 2021 May 5.