Coronary microvascular dysfunction in patients with stable coronary artery disease: the CE-MARC 2 coronary physiology sub-study

Corcoran, D. et al. (2018) Coronary microvascular dysfunction in patients with stable coronary artery disease: the CE-MARC 2 coronary physiology sub-study. International Journal of Cardiology, 266, pp. 7-14. (doi:10.1016/j.ijcard.2018.04.061) (PMID:29716756) (PMCID:PMC6008494)

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Abstract

In patients with angina undergoing invasive management, no obstructive coronary artery disease (NOCAD) is a common finding, and angina may persist following percutaneous coronary intervention (PCI). Coronary microvascular dysfunction may be relevant. We aimed to assess the proportion of patients presenting with suspected CAD who had coronary microvascular dysfunction. Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2 (CE-MARC 2) was a prospective multicenter randomised controlled trial of functional imaging versus guideline-based management in patients with suspected CAD. Invasive coronary angiography was protocol-directed. Fractional flow reserve (FFR) and parameters of microvascular function (coronary flow reserve (CFR), index of microcirculatory resistance (IMR), resistance reserve ratio (RRR)) were measured in major epicardial coronary arteries with ≥40-≤90% diameter stenosis. An FFR value ≤0.80 indicated the presence of obstructive CAD. 267/1202 (22.2%) patients underwent angiography and 81 (30%) patients had FFR measured. 63 (78%) of these patients had microvascular function assessed in 85 arteries (mean age 58.5 ± 8.2 years; 47 (75%) male). 25/63 (40%) patients had NOCAD, and of these, 17 (68%) had an abnormality ≥1 parameter of microvascular function (abnormal IMR (≥25), abnormal CFR (<2.0), and abnormal RRR (<2.0) occurred in 10 (40%), 12 (48%), and 11 (44%), respectively). 38/63 (60%) patients had obstructive epicardial CAD. Of these patients, 15/38 (39%), 20/38 (53%), and 12/38 (32%) had an abnormal IMR, CFR and RRR, respectively. Coronary microvascular dysfunction is common in patients with angina. Invasive assessment of microvascular function may be informative and relevant for decision-making in patients with both NOCAD and obstructive epicardial CAD. ClinicalTrials.gov Identifier: NCT01664858.

Item Type:Articles
Keywords:Angina, coronary artery disease, coronary microvascular dysfunction, stable ischaemic heart disease.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Oldroyd, Dr Keith and McConnachie, Professor Alex and Young, Dr Robin and Corcoran, Dr David and Mangion, Dr Kenneth
Authors: Corcoran, D., Young, R., Adlam, D., McConnachie, A., Mangion, K., Ripley, D., Cairns, D., Brown, J., Bucciarelli-Ducci, C., Baumbach, A., Kharbanda, R., Oldroyd, K. G., McCann, G. P., Greenwood, J. P., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:International Journal of Cardiology
Publisher:Elsevier
ISSN:0167-5273
ISSN (Online):1874-1754
Published Online:19 April 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in International Journal of Cardiology 266: 7-14
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
628691Microvascular Dysfunction in Patients with Angina: The CE-MARC2 Microvascular SubstudyColin BerryBritish Heart Foundation (BHF)FS/14/15/30661RI CARDIOVASCULAR & MEDICAL SCIENCES
548451Clinical Evaluation of 3T Magnetic Resonance Imaging for the management of patients with Coronary heart disease: the CE-MARC2 studyColin BerryBritish Heart Foundation (BHF)SP/12/1/29062RI CARDIOVASCULAR & MEDICAL SCIENCES