Hyperaemic microvascular resistance predicts clinical outcome and microvascular injury after myocardial infarction

Guus A. de Waard, Gregor Fahrni, Douwe de Wit, Hironori Kitabata, Rupert Williams, Niket Patel, Paul F. Teunissen, Peter M. van de Ven, Sabahattin Umman, Paul Knaapen, Divaka Perera, Takashi Akasaka, Murat Sezer, Rajesh K. Kharbanda, Niels van Royen

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objectives: Early detection of microvascular dysfunction after acute myocardial infarction (AMI) could identify patients at high risk of adverse clinical outcome, who may benefit from adjunctive treatment. Our objective was to compare invasively measured coronary flow reserve (CFR) and hyperaemic microvascular resistance (HMR) for their predictive power of long-term clinical outcome and cardiac magnetic resonance (CMR)-defined microvascular injury (MVI).Methods: Simultaneous intracoronary Doppler flow velocity and pressure measurements acquired immediately after revascularisation for AMI from five centres were pooled. Clinical follow-up was completed for 176 patients (mean age 60±10 years; 140(80%) male; ST-elevation myocardial infarction (STEMI) 130(74%) and non-ST-segment elevation myocardial infarction 46(26%)) with median follow-up time of 3.2 years. In 110 patients with STEMI, additional CMR was performed.Results: The composite end point of death and hospitalisation for heart failure occurred in 17 patients (10%). Optimal cut-off values to predict the composite end point were 1.5 for CFR and 3.0 mm Hg cm-1•sfor HMR. CFR <1.5 was predictive for the composite end point (HR 3.5;95% CI 1.1 to 10.8), but not for its individual components. HMR ≥3.0 mm Hg cm-1 s was predictive for the composite end point (HR 7.0;95% CI 1.5 to 33.7) as well as both individual components. HMR had significantly greater area under the receiver operating characteristic curve for MVI than CFR. HMR remained an independent predictor of adverse clinical outcome and MVI, whereas CFR did not.Conclusions: HMR measured immediately following percutaneous coronary intervention for AMI with a cut-off value of 3.0 mm Hg cm-1 s, identifies patients with MVI who are at high risk of adverse clinical outcome. For this purpose, HMR is superior to CFR.

Original languageEnglish
Pages (from-to)127-134
Number of pages8
JournalHeart
Volume104
Issue number2
DOIs
Publication statusPublished - 1 Jan 2018

Cite this

de Waard, Guus A. ; Fahrni, Gregor ; de Wit, Douwe ; Kitabata, Hironori ; Williams, Rupert ; Patel, Niket ; Teunissen, Paul F. ; van de Ven, Peter M. ; Umman, Sabahattin ; Knaapen, Paul ; Perera, Divaka ; Akasaka, Takashi ; Sezer, Murat ; Kharbanda, Rajesh K. ; van Royen, Niels. / Hyperaemic microvascular resistance predicts clinical outcome and microvascular injury after myocardial infarction. In: Heart. 2018 ; Vol. 104, No. 2. pp. 127-134.
@article{9620854fb740437eb0c62a2fd3ca7bc5,
title = "Hyperaemic microvascular resistance predicts clinical outcome and microvascular injury after myocardial infarction",
abstract = "Objectives: Early detection of microvascular dysfunction after acute myocardial infarction (AMI) could identify patients at high risk of adverse clinical outcome, who may benefit from adjunctive treatment. Our objective was to compare invasively measured coronary flow reserve (CFR) and hyperaemic microvascular resistance (HMR) for their predictive power of long-term clinical outcome and cardiac magnetic resonance (CMR)-defined microvascular injury (MVI).Methods: Simultaneous intracoronary Doppler flow velocity and pressure measurements acquired immediately after revascularisation for AMI from five centres were pooled. Clinical follow-up was completed for 176 patients (mean age 60±10 years; 140(80{\%}) male; ST-elevation myocardial infarction (STEMI) 130(74{\%}) and non-ST-segment elevation myocardial infarction 46(26{\%})) with median follow-up time of 3.2 years. In 110 patients with STEMI, additional CMR was performed.Results: The composite end point of death and hospitalisation for heart failure occurred in 17 patients (10{\%}). Optimal cut-off values to predict the composite end point were 1.5 for CFR and 3.0 mm Hg cm-1•sfor HMR. CFR <1.5 was predictive for the composite end point (HR 3.5;95{\%} CI 1.1 to 10.8), but not for its individual components. HMR ≥3.0 mm Hg cm-1 s was predictive for the composite end point (HR 7.0;95{\%} CI 1.5 to 33.7) as well as both individual components. HMR had significantly greater area under the receiver operating characteristic curve for MVI than CFR. HMR remained an independent predictor of adverse clinical outcome and MVI, whereas CFR did not.Conclusions: HMR measured immediately following percutaneous coronary intervention for AMI with a cut-off value of 3.0 mm Hg cm-1 s, identifies patients with MVI who are at high risk of adverse clinical outcome. For this purpose, HMR is superior to CFR.",
keywords = "Acute myocardial infarction, Cardiac magnetic resonance (CMR) imaging, Percutaneous coronary intervention",
author = "{de Waard}, {Guus A.} and Gregor Fahrni and {de Wit}, Douwe and Hironori Kitabata and Rupert Williams and Niket Patel and Teunissen, {Paul F.} and {van de Ven}, {Peter M.} and Sabahattin Umman and Paul Knaapen and Divaka Perera and Takashi Akasaka and Murat Sezer and Kharbanda, {Rajesh K.} and {van Royen}, Niels",
year = "2018",
month = "1",
day = "1",
doi = "10.1136/heartjnl-2017-311431",
language = "English",
volume = "104",
pages = "127--134",
journal = "Heart",
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de Waard, GA, Fahrni, G, de Wit, D, Kitabata, H, Williams, R, Patel, N, Teunissen, PF, van de Ven, PM, Umman, S, Knaapen, P, Perera, D, Akasaka, T, Sezer, M, Kharbanda, RK & van Royen, N 2018, 'Hyperaemic microvascular resistance predicts clinical outcome and microvascular injury after myocardial infarction' Heart, vol. 104, no. 2, pp. 127-134. https://doi.org/10.1136/heartjnl-2017-311431

Hyperaemic microvascular resistance predicts clinical outcome and microvascular injury after myocardial infarction. / de Waard, Guus A.; Fahrni, Gregor; de Wit, Douwe; Kitabata, Hironori; Williams, Rupert; Patel, Niket; Teunissen, Paul F.; van de Ven, Peter M.; Umman, Sabahattin; Knaapen, Paul; Perera, Divaka; Akasaka, Takashi; Sezer, Murat; Kharbanda, Rajesh K.; van Royen, Niels.

In: Heart, Vol. 104, No. 2, 01.01.2018, p. 127-134.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Hyperaemic microvascular resistance predicts clinical outcome and microvascular injury after myocardial infarction

AU - de Waard, Guus A.

AU - Fahrni, Gregor

AU - de Wit, Douwe

AU - Kitabata, Hironori

AU - Williams, Rupert

AU - Patel, Niket

AU - Teunissen, Paul F.

AU - van de Ven, Peter M.

AU - Umman, Sabahattin

AU - Knaapen, Paul

AU - Perera, Divaka

AU - Akasaka, Takashi

AU - Sezer, Murat

AU - Kharbanda, Rajesh K.

AU - van Royen, Niels

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objectives: Early detection of microvascular dysfunction after acute myocardial infarction (AMI) could identify patients at high risk of adverse clinical outcome, who may benefit from adjunctive treatment. Our objective was to compare invasively measured coronary flow reserve (CFR) and hyperaemic microvascular resistance (HMR) for their predictive power of long-term clinical outcome and cardiac magnetic resonance (CMR)-defined microvascular injury (MVI).Methods: Simultaneous intracoronary Doppler flow velocity and pressure measurements acquired immediately after revascularisation for AMI from five centres were pooled. Clinical follow-up was completed for 176 patients (mean age 60±10 years; 140(80%) male; ST-elevation myocardial infarction (STEMI) 130(74%) and non-ST-segment elevation myocardial infarction 46(26%)) with median follow-up time of 3.2 years. In 110 patients with STEMI, additional CMR was performed.Results: The composite end point of death and hospitalisation for heart failure occurred in 17 patients (10%). Optimal cut-off values to predict the composite end point were 1.5 for CFR and 3.0 mm Hg cm-1•sfor HMR. CFR <1.5 was predictive for the composite end point (HR 3.5;95% CI 1.1 to 10.8), but not for its individual components. HMR ≥3.0 mm Hg cm-1 s was predictive for the composite end point (HR 7.0;95% CI 1.5 to 33.7) as well as both individual components. HMR had significantly greater area under the receiver operating characteristic curve for MVI than CFR. HMR remained an independent predictor of adverse clinical outcome and MVI, whereas CFR did not.Conclusions: HMR measured immediately following percutaneous coronary intervention for AMI with a cut-off value of 3.0 mm Hg cm-1 s, identifies patients with MVI who are at high risk of adverse clinical outcome. For this purpose, HMR is superior to CFR.

AB - Objectives: Early detection of microvascular dysfunction after acute myocardial infarction (AMI) could identify patients at high risk of adverse clinical outcome, who may benefit from adjunctive treatment. Our objective was to compare invasively measured coronary flow reserve (CFR) and hyperaemic microvascular resistance (HMR) for their predictive power of long-term clinical outcome and cardiac magnetic resonance (CMR)-defined microvascular injury (MVI).Methods: Simultaneous intracoronary Doppler flow velocity and pressure measurements acquired immediately after revascularisation for AMI from five centres were pooled. Clinical follow-up was completed for 176 patients (mean age 60±10 years; 140(80%) male; ST-elevation myocardial infarction (STEMI) 130(74%) and non-ST-segment elevation myocardial infarction 46(26%)) with median follow-up time of 3.2 years. In 110 patients with STEMI, additional CMR was performed.Results: The composite end point of death and hospitalisation for heart failure occurred in 17 patients (10%). Optimal cut-off values to predict the composite end point were 1.5 for CFR and 3.0 mm Hg cm-1•sfor HMR. CFR <1.5 was predictive for the composite end point (HR 3.5;95% CI 1.1 to 10.8), but not for its individual components. HMR ≥3.0 mm Hg cm-1 s was predictive for the composite end point (HR 7.0;95% CI 1.5 to 33.7) as well as both individual components. HMR had significantly greater area under the receiver operating characteristic curve for MVI than CFR. HMR remained an independent predictor of adverse clinical outcome and MVI, whereas CFR did not.Conclusions: HMR measured immediately following percutaneous coronary intervention for AMI with a cut-off value of 3.0 mm Hg cm-1 s, identifies patients with MVI who are at high risk of adverse clinical outcome. For this purpose, HMR is superior to CFR.

KW - Acute myocardial infarction

KW - Cardiac magnetic resonance (CMR) imaging

KW - Percutaneous coronary intervention

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U2 - 10.1136/heartjnl-2017-311431

DO - 10.1136/heartjnl-2017-311431

M3 - Article

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JO - Heart

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SN - 1355-6037

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