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. 2022 Aug 10:13:922264.
doi: 10.3389/fendo.2022.922264. eCollection 2022.

Prognostic impact of coronary microvascular dysfunction assessed by caIMR in overweight with chronic coronary syndrome patients

Cailin Feng  1 , Fuad A Abdu  1 , Abdul-Quddus Mohammed  1 , Wen Zhang  1 , Lu Liu  1 , Guoqing Yin  1 , Yundi Feng  2 , Ayman A Mohammed  1 , Redhwan M Mareai  1 , Xian Lv  1 , Tingting Shi  1 , Yawei Xu  1 , Xuejing Yu  1 , Wenliang Che  1   3
Affiliations

Prognostic impact of coronary microvascular dysfunction assessed by caIMR in overweight with chronic coronary syndrome patients

Cailin Feng et al. Front Endocrinol (Lausanne). .

Abstract

Objective: Coronary microvascular dysfunction (CMD) may associate with adverse cardiovascular events in obese patients. Coronary angiography-derived index of microcirculatory resistance (caIMR) is proposed as a less-invasive and pressure-wire-free index to assess CMD. We aimed to investigate the impact of coronary microvascular function assessed by caIMR in patients with overweight and chronic coronary syndrome (CCS).

Methods: CCS patients who underwent coronary angiography between 2015 to 2018 were included. Overweight was defined as BMI≥24.0kg/m². Impaired coronary microvascular function was defined as caIMR≥25U. The patients were classified according to BMI and caIMR. The primary endpoint was major adverse cardiac events (MACE). Kaplan-Meier and Cox regression analyses evaluated the association between caIMR and MACE.

Results: Two hundred and eighty-two CCS patients were enrolled. Among these, 169 (59.93%) were overweight. Impaired coronary microvascular function was higher in overweight patients than in patients with normal weight (49.70% vs. 38.05%; P=0.035). During 35 months of follow-up, 33 MACE had occurred. Among the total CCS population, MACE was higher in patients with high caIMR than in low caIMR (18.11% vs. 6.45%, P=0.003). In subgroups analysis, MACE was higher in overweight patients with high caIMR than low caIMR (20.24% vs. 7.06%, P=0.014), while there were no significant differences in normal-weight patients. Multivariate Cox analysis demonstrated that caIMR≥25 was independently associated with MACE in overweight patients (HR, 2.87; 95% CI, 1.12-7.30; P=0.027) but not in the normal-weight patients. In addition, caIMR showed a significant predictive value for adverse outcomes in overweight patients and provided an incremental prediction when added to a prediction model with BMI.

Conclusions: Impaired coronary microvascular function assessed by caIMR was common and is an independent predictor of MACE in overweight patients with CCS.

Keywords: chronic coronary syndrome; clinical outcomes; coronary angiography-derived index of microcirculatory resistance; coronary microvascular dysfunction; overweight.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of patients enrolled. CAG, coronary angiography;CCS, chronic coronary syndrome; BMI, body mass index.
Figure 2
Figure 2
(A) Kaplan-Meier survival curves for MACE in CCS patients with high caIMR vs. low caIMR. (B) Kaplan-Meier survival curves for ischemia-driven revascularization in CCS patients with high caIMR vs. low caIMR. (C) Kaplan-Meier survival curves for heart failure in CCS patients with high caIMR vs. low caIMR. MACE, major adverse cardiovascular events; caIMR, coronary angiography−derived index of microcirculatory resistance.
Figure 3
Figure 3
Kaplan-Meier survival curves for MACE in overweight patients with high caIMR vs. low caIMR. caIMR: coronary angiography−derived index of microcirculatory resistance; BMI: body mass index.
Figure 4
Figure 4
Kaplan-Meier survival curves for MACE in normal weight patients with high caIMR vs. low caIMR. caIMR, coronary angiography−derived index of microcirculatory resistance; BMI, body mass index.
Figure 5
Figure 5
Receiver operating characteristic curves of caIMR for predicting adverse events in overweight patients. AUC, area under thecurve; CI, confidence interval.
See this image and copyright information in PMC

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