The quantitative relationship between coronary microcirculatory resistance and myocardial ischemia in patients with coronary artery disease

Abstract

It was hypothesized that the microcirculatory resistance of resting state (Rm-res) might be a good predictor for ischemia. In this study, the quantitative relationship between Rm-res and myocardial ischemia in different stenosed degrees was explored and verified through retrospective analysis, and the diagnostic performance was evaluated. 136 patients were screened and divided into a training set (90 patients) and a validation set (46 patients). In the training set, Rm-res was calculated, and thresholds were determined by exploring the relationship between Rm-res and myocardial ischemia in different stenosed degrees. In the validation set, the diagnostic performance of the thresholds was verified. It was found that the 90 data mean difference (95%CI) of Rm-res between the ischemic group and the non-ischemic group was 63.03 (95 %CI: 25.72–100.34), p < 0.05. In the training set with stenosed degree 41–60%, 61–70%, 71–80%, and >81%, the average of Rm-res in the ischemic and non-ischemic groups were (80.79, 136.87), (96.41, 172.62), (128.99, 198.94) and (175.95, 310.79) mmHg/s/ml. The Rm-res thresholds were 87.18, 118.96, 142.35, and 177.39 mmHg/s/ml. In the validation set, the overall sensitivity, specificity, PPV, NPV, and accuracy were 73.3%, 77.4%, 61.1%, 85.7%, and 76.1%. In conclusion, Rm-res had a significant predictor on myocardial ischemia. As a smaller Rm-res represents greater myocardial mass perfusion, it is more likely that a stenosis will have a functional impact. Threshold analysis showed that Rm-res of different stenosed degrees was a quantitative predictor of myocardial ischemia, which could assist physicians with clinical treatment strategies.