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Influence of resistance in the microcirculation on fractional flow reserve during increased hyperemia - in patients with stable angina

Session Poster session 1

Speaker Louise Brugmann Jessen

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : LB Jessen (Odense,DK), KT Veien (Odense,DK), J Ellert (Odense,DK), K Bendix (Odense,DK), AL Thuesen (Odense,DK), O Ahlehoff (Odense,DK), A Aziz (Odense,DK), A Junker (Odense,DK), KE Pedersen (Odense,DK), KN Hansen (Odense,DK), HS Hansen (Odense,DK), LO Jensen (Odense,DK)

L.B. Jessen1 , K.T. Veien1 , J. Ellert1 , K. Bendix1 , A.L. Thuesen1 , O. Ahlehoff1 , A. Aziz1 , A. Junker1 , K.E. Pedersen1 , K.N. Hansen1 , H.S. Hansen1 , L.O. Jensen1 , 1Odense University Hospital, Cardiology - Odense - Denmark ,

European Heart Journal ( 2017 ) 38 ( Supplement ), 195

Background: Abnormalities in the coronary microcirculation may contribute to myocardial ischemia, but the coronary microcirculation cannot be visualized using angiography. With a pressure wire Fractional Flow Reserve (FFR) and the Index of Microcirculatory Resistance (IMR) can be measured invasively to assess the microcirculatory function. It is not previously investigated if increased resistance in the microcirculation affects the hyperemia response of adenosine.

Purpose: To evaluate if microvascular dysfunction affects the hyperemic response of adenosine during FFR measurements in patients with stable angina.

Methods: FFR, coronary flow reserve (CFR) and IMR were measured in 41 patients with stable angina referred to a coronary angiogram. Mean transit time at rest (TmnR) was obtained with thermodilution curves by 3 injections of 3 mL of saline. Hyperemia was induced using adenosine infusion (140 μg/kg per minute) in 2 minutes through a central vein. Proximal arterial pressure (Pa), distal arterial pressure (Pd), and mean transit time during hyperemia (TmnH) were recorded. FFR was calculated by mean Pd/Pa during hyperemia, and coronary flow reserve was calculated by TmnR/TmnH. The IMR was calculated as Pd x TmnH. Afterwards adenosine was increased to 200μg/kg/min in 2 minutes and FFR was calculated again. IMR >24 was defined as abnormal and increased IMR.

Results: A total of 41 patients with stable angina and intermediate coronary stenosis were studied. The mean FFR was 0.81±0.11, mean IMR was 29.0±17.3 and mean CFR was 2.4±0.95. Half of the patients (n=21 [51.2%]) had an abnormal and increased IMR. CFR (2.5±0.92 vs. 2.3±1.00, (p=0.60) and FFR (0.80±0.10 vs. 0.82±0.13, p=0.62) did not differ significantly between patients with normal and abnormal IMR. Overall, FFR decreased significantly from 0.81±0.11 at standard dose of adenosine 140μg/kg/min to 0.79±0.11 at increased dose of adenosine 200μg/kg/min (p=0.001). In 12 patients the FFR did not change further during increased adenosine dose. For patients with IMR >24, the mean FFR decreased from 0.82±0.13 to 0.79±0.12 (p=0.006) vs. a decrease from 0.80±0.10 to 0.79±0.10 (p=0.060) in patients with IMR <24.

Conclusion: Overall FFR decreased significntly during increased adenosine dose. Howerver, in one third of the patients the standard adenosin dose was sufficient to achive maximal hyperemia. In patients with an abnormal IMR, the increased adenosine dose was associated with a larger FFR reduction compared to patient with a normal microcirculation.

FFR and IMR measurements

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