Doppler Versus Thermodilution-Derived Coronary Microvascular Resistance to Predict Coronary Microvascular Dysfunction in Patients with Acute Myocardial Infarction or Stable Angina Pectoris

Rupert P. Williams; Guus de Waard; Kalpa De Silva; Matthew Lumley; Kaleab Asrress; Satpal Arri; Howard Ellis; Awais Mir; Brian Clapp; Amedeo Chiribiri; Sven Plein; Paul Teunissen; Maurits Hollander; Michael Marber; Simon Redwood; Niels van Royen; Divaka Perera

doi:10.1016/j.amjcard.2017.09.012

Doppler Versus Thermodilution-Derived Coronary Microvascular Resistance to Predict Coronary Microvascular Dysfunction in Patients with Acute Myocardial Infarction or Stable Angina Pectoris

Rupert P. Williams, Guus de Waard, Kalpa De Silva, Matthew Lumley, Kaleab Asrress, Satpal Arri, Howard Ellis, Awais Mir, Brian Clapp, Amedeo Chiribiri, Sven Plein, Paul Teunissen, Maurits Hollander, Michael Marber, Simon Redwood, Niels van Royen, Divaka Perera

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Abstract

Abstract Coronary microvascular resistance is increasingly measured as a predictor of clinical outcomes, but there is no accepted gold-standard measurement. We compared the diagnostic accuracy of two invasive indices of microvascular resistance, Doppler-derived hyperemic microvascular resistance (hMR) and thermodilution-derived index of microcirculatory resistance (IMR), at predicting microvascular dysfunction. 54 patients (61±10 years) undergoing cardiac catheterization, for stable coronary artery disease (n=10) or acute myocardial infarction (AMI, n=44), had simultaneous intracoronary pressure, Doppler flow velocity and thermodilution flow data acquired from 74 unobstructed vessels, at rest and hyperemia. Three independent measures of microvascular function were assessed, using predefined dichotomous thresholds: i) CFR, the average value of Doppler- and thermodilution-derived coronary flow reserve (CFR), and cardiovascular magnetic resonance derived: ii) Myocardial Perfusion Reserve Index (MPRI) and iii) Microvascular Obstruction (MVO). hMR correlated with IMR (rho = 0.41, p<0.0001). hMR had better diagnostic accuracy than IMR to predict CFR (area under curve, (AUC) 0.82 versus 0.58, p<0.001, sensitivity/specificity 77/77% versus 51/71%) and MPRI (AUC 0.85 versus 0.72, p=0.19, sensitivity/specificity 82/80% versus 64/75%). In AMI patients, the AUCs of hMR and IMR at predicting extensive MVO were 0.83 and 0.72 respectively (p=0.22, sensitivity/specificity 78/74% versus 44/91%). We measured two invasive indices of coronary microvascular resistance to predict multiple distinct measures of microvascular dysfunction. We found these two invasive indices only correlate modestly and so cannot be considered equivalent. In our study, the correlation between independent invasive and non-invasive measures of microvascular function was better with hMR than with IMR.

Original language	English
Journal	American Journal of Cardiology
Early online date	10 Oct 2017
DOIs	https://doi.org/10.1016/j.amjcard.2017.09.012
Publication status	E-pub ahead of print - 10 Oct 2017

Keywords

Coronary microvascular resistance
myocardial infarction
hyperemic microvascular resistance (hMR)
index of microcirculatory resistance (IMR)

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Doppler Versus Thermodilution-Derived _WILLIAMS_Publishedonline10October2017_GREEN AAM (CC BY-NC-ND)Accepted author manuscript, 1.19 MBLicence: CC BY-NC-ND

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Williams, R. P., de Waard, G., De Silva, K., Lumley, M., Asrress, K., Arri, S., Ellis, H., Mir, A., Clapp, B., Chiribiri, A., Plein, S., Teunissen, P., Hollander, M., Marber, M., Redwood, S., van Royen, N., & Perera, D. (2017). Doppler Versus Thermodilution-Derived Coronary Microvascular Resistance to Predict Coronary Microvascular Dysfunction in Patients with Acute Myocardial Infarction or Stable Angina Pectoris. American Journal of Cardiology. Advance online publication. https://doi.org/10.1016/j.amjcard.2017.09.012

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title = "Doppler Versus Thermodilution-Derived Coronary Microvascular Resistance to Predict Coronary Microvascular Dysfunction in Patients with Acute Myocardial Infarction or Stable Angina Pectoris",

abstract = "Abstract Coronary microvascular resistance is increasingly measured as a predictor of clinical outcomes, but there is no accepted gold-standard measurement. We compared the diagnostic accuracy of two invasive indices of microvascular resistance, Doppler-derived hyperemic microvascular resistance (hMR) and thermodilution-derived index of microcirculatory resistance (IMR), at predicting microvascular dysfunction. 54 patients (61±10 years) undergoing cardiac catheterization, for stable coronary artery disease (n=10) or acute myocardial infarction (AMI, n=44), had simultaneous intracoronary pressure, Doppler flow velocity and thermodilution flow data acquired from 74 unobstructed vessels, at rest and hyperemia. Three independent measures of microvascular function were assessed, using predefined dichotomous thresholds: i) CFR, the average value of Doppler- and thermodilution-derived coronary flow reserve (CFR), and cardiovascular magnetic resonance derived: ii) Myocardial Perfusion Reserve Index (MPRI) and iii) Microvascular Obstruction (MVO). hMR correlated with IMR (rho = 0.41, p<0.0001). hMR had better diagnostic accuracy than IMR to predict CFR (area under curve, (AUC) 0.82 versus 0.58, p<0.001, sensitivity/specificity 77/77% versus 51/71%) and MPRI (AUC 0.85 versus 0.72, p=0.19, sensitivity/specificity 82/80% versus 64/75%). In AMI patients, the AUCs of hMR and IMR at predicting extensive MVO were 0.83 and 0.72 respectively (p=0.22, sensitivity/specificity 78/74% versus 44/91%). We measured two invasive indices of coronary microvascular resistance to predict multiple distinct measures of microvascular dysfunction. We found these two invasive indices only correlate modestly and so cannot be considered equivalent. In our study, the correlation between independent invasive and non-invasive measures of microvascular function was better with hMR than with IMR.",

keywords = "Coronary microvascular resistance, myocardial infarction, hyperemic microvascular resistance (hMR), index of microcirculatory resistance (IMR)",

author = "Williams, {Rupert P.} and {de Waard}, Guus and {De Silva}, Kalpa and Matthew Lumley and Kaleab Asrress and Satpal Arri and Howard Ellis and Awais Mir and Brian Clapp and Amedeo Chiribiri and Sven Plein and Paul Teunissen and Maurits Hollander and Michael Marber and Simon Redwood and {van Royen}, Niels and Divaka Perera",

year = "2017",

month = oct,

day = "10",

doi = "10.1016/j.amjcard.2017.09.012",

language = "English",

journal = "American Journal of Cardiology",

issn = "0002-9149",

publisher = "Elsevier Inc.",

}

Williams, RP, de Waard, G, De Silva, K , Lumley, M , Asrress, K , Arri, S , Ellis, H, Mir, A, Clapp, B , Chiribiri, A , Plein, S, Teunissen, P, Hollander, M, Marber, M , Redwood, S, van Royen, N & Perera, D 2017, 'Doppler Versus Thermodilution-Derived Coronary Microvascular Resistance to Predict Coronary Microvascular Dysfunction in Patients with Acute Myocardial Infarction or Stable Angina Pectoris', American Journal of Cardiology. https://doi.org/10.1016/j.amjcard.2017.09.012

TY - JOUR

T1 - Doppler Versus Thermodilution-Derived Coronary Microvascular Resistance to Predict Coronary Microvascular Dysfunction in Patients with Acute Myocardial Infarction or Stable Angina Pectoris

AU - Williams, Rupert P.

AU - de Waard, Guus

AU - De Silva, Kalpa

AU - Lumley, Matthew

AU - Asrress, Kaleab

AU - Arri, Satpal

AU - Ellis, Howard

AU - Mir, Awais

AU - Clapp, Brian

AU - Chiribiri, Amedeo

AU - Plein, Sven

AU - Teunissen, Paul

AU - Hollander, Maurits

AU - Marber, Michael

AU - Redwood, Simon

AU - van Royen, Niels

AU - Perera, Divaka

PY - 2017/10/10

Y1 - 2017/10/10

N2 - Abstract Coronary microvascular resistance is increasingly measured as a predictor of clinical outcomes, but there is no accepted gold-standard measurement. We compared the diagnostic accuracy of two invasive indices of microvascular resistance, Doppler-derived hyperemic microvascular resistance (hMR) and thermodilution-derived index of microcirculatory resistance (IMR), at predicting microvascular dysfunction. 54 patients (61±10 years) undergoing cardiac catheterization, for stable coronary artery disease (n=10) or acute myocardial infarction (AMI, n=44), had simultaneous intracoronary pressure, Doppler flow velocity and thermodilution flow data acquired from 74 unobstructed vessels, at rest and hyperemia. Three independent measures of microvascular function were assessed, using predefined dichotomous thresholds: i) CFR, the average value of Doppler- and thermodilution-derived coronary flow reserve (CFR), and cardiovascular magnetic resonance derived: ii) Myocardial Perfusion Reserve Index (MPRI) and iii) Microvascular Obstruction (MVO). hMR correlated with IMR (rho = 0.41, p<0.0001). hMR had better diagnostic accuracy than IMR to predict CFR (area under curve, (AUC) 0.82 versus 0.58, p<0.001, sensitivity/specificity 77/77% versus 51/71%) and MPRI (AUC 0.85 versus 0.72, p=0.19, sensitivity/specificity 82/80% versus 64/75%). In AMI patients, the AUCs of hMR and IMR at predicting extensive MVO were 0.83 and 0.72 respectively (p=0.22, sensitivity/specificity 78/74% versus 44/91%). We measured two invasive indices of coronary microvascular resistance to predict multiple distinct measures of microvascular dysfunction. We found these two invasive indices only correlate modestly and so cannot be considered equivalent. In our study, the correlation between independent invasive and non-invasive measures of microvascular function was better with hMR than with IMR.

AB - Abstract Coronary microvascular resistance is increasingly measured as a predictor of clinical outcomes, but there is no accepted gold-standard measurement. We compared the diagnostic accuracy of two invasive indices of microvascular resistance, Doppler-derived hyperemic microvascular resistance (hMR) and thermodilution-derived index of microcirculatory resistance (IMR), at predicting microvascular dysfunction. 54 patients (61±10 years) undergoing cardiac catheterization, for stable coronary artery disease (n=10) or acute myocardial infarction (AMI, n=44), had simultaneous intracoronary pressure, Doppler flow velocity and thermodilution flow data acquired from 74 unobstructed vessels, at rest and hyperemia. Three independent measures of microvascular function were assessed, using predefined dichotomous thresholds: i) CFR, the average value of Doppler- and thermodilution-derived coronary flow reserve (CFR), and cardiovascular magnetic resonance derived: ii) Myocardial Perfusion Reserve Index (MPRI) and iii) Microvascular Obstruction (MVO). hMR correlated with IMR (rho = 0.41, p<0.0001). hMR had better diagnostic accuracy than IMR to predict CFR (area under curve, (AUC) 0.82 versus 0.58, p<0.001, sensitivity/specificity 77/77% versus 51/71%) and MPRI (AUC 0.85 versus 0.72, p=0.19, sensitivity/specificity 82/80% versus 64/75%). In AMI patients, the AUCs of hMR and IMR at predicting extensive MVO were 0.83 and 0.72 respectively (p=0.22, sensitivity/specificity 78/74% versus 44/91%). We measured two invasive indices of coronary microvascular resistance to predict multiple distinct measures of microvascular dysfunction. We found these two invasive indices only correlate modestly and so cannot be considered equivalent. In our study, the correlation between independent invasive and non-invasive measures of microvascular function was better with hMR than with IMR.

KW - Coronary microvascular resistance

KW - myocardial infarction

KW - hyperemic microvascular resistance (hMR)

KW - index of microcirculatory resistance (IMR)

U2 - 10.1016/j.amjcard.2017.09.012

DO - 10.1016/j.amjcard.2017.09.012

M3 - Article

SN - 0002-9149

JO - American Journal of Cardiology

JF - American Journal of Cardiology

ER -

Doppler Versus Thermodilution-Derived Coronary Microvascular Resistance to Predict Coronary Microvascular Dysfunction in Patients with Acute Myocardial Infarction or Stable Angina Pectoris

Abstract

Keywords

UN SDGs

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