Abstract
A coronary angiography-derived index of microvascular resistance (caIMR) is proposed for physiological assessment of microvasular diseases in coronary circulation. The aim of the study is to assess diagnostic performance of caIMR, using wire-derived index of microvascular resistance (IMR) as the reference standard. IMR was demonstrated in 56 patients (57 vessels) with stable/unstable angina pectoris and no obstructive coronary arteries in three centers using the Certus pressure wire. Based on the aortic pressure wave and coronary angiograms from two projections, the caIMR was computed and assessed in blinded fashion against the IMR at an independent core laboratory. Diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of the caIMR with a cutoff value of 25 were 84.2% (95% CI: 72.1% to 92.5%), 86.1% (95% CI: 70.5% to 95.3%), 81.0% (95% CI: 58.1% to 94.6%), 88.6% (95% CI: 76.1% to 95.0%), and 77.3% (95% CI: 59.5% to 88.7%) against the IMR with a cutoff value of 25. The receiver-operating curve had area under the curve of 0.919 and the correlation coefficient equaled to 0.746 between caIMR and wire-derived IMR. Hence, caIMR could eliminate the need of a pressure wire, reduce technical error, and potentially increase adoption of physiological assessment of microvascular diseases in patients with ischemic heart disease.
Highlights
Microvascular diseases have recently shown an increase in importance for the diagnosis and management of patients with chronic coronary syndrome (Kaski et al, 2018; Ford et al, 2020a; Knuuti et al, 2020; Kunadian et al, 2020)
The retrospective clinical trial was approved by the Institutional Review Boards (IRB) in Beijing Hospital, PLA General Hospital and Peking University First Hospital at Beijing, China, which conforms the declaration of Helsinki and Good Clinical Practice Guidelines of the China Food and Drug Administration
We have developed a specially designed CFD model to carry out the steady-state laminar flow simulation across the stenotic blood vessel in 10–30 s (Li et al, 2020), which is described in Appendix B
Summary
Microvascular diseases have recently shown an increase in importance for the diagnosis and management of patients with chronic coronary syndrome (Kaski et al, 2018; Ford et al, 2020a; Knuuti et al, 2020; Kunadian et al, 2020). Microvascular angina (MVA) features patients with normal coronary arteries and evidence of myocardial ischemia owing to coronary microvascular dysfunctions (Cannon and Epstein, 1988; Kunadian et al, 2020). This type of patients constitute >20% patients in the cardiac catheterization laboratory (Ford et al, 2018, 2020b). Multiple non-invasive methods, such as PET and cardiac MRI, were suggested for assessment of the MVA (Kunadian et al, 2020), invasive methods are considered the gold standard.
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