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. 2024 Mar 1;35(2):92-98.
doi: 10.1097/MCA.0000000000001308. Epub 2023 Dec 11.

Serial fractional flow reserve, coronary flow reserve and index of microcirculatory resistance after percutaneous coronary intervention in patients treated for stable angina pectoris assessed with PET

Kristoffer Bendix  1 , Anders Thomassen  2 , Anders Junker  1 , Karsten Tange Veien  1 , Lisette Okkels Jensen  1   3
Affiliations

Serial fractional flow reserve, coronary flow reserve and index of microcirculatory resistance after percutaneous coronary intervention in patients treated for stable angina pectoris assessed with PET

Kristoffer Bendix et al. Coron Artery Dis. .

Abstract

Background: Cardiac 15 O-water PET is a noninvasive method to evaluate epicardial and microvascular dysfunction and further quantitate absolute myocardial blood flow (MBF).

Aim: The aim of this study was to assess the impact of revascularization on MBF and myocardial flow reserve (MFR) assessed with 15 O-water PET and invasive flow and pressure measurements.

Methods: In 21 patients with single-vessel disease referred for percutaneous coronary intervention (PCI), serial PET perfusion imaging and fractional flow reserve (FFR), coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) were performed during PCI and after 3 months.

Results: In the affected myocardium, stress MBF and MFR increased significantly from before revascularization to 3 months after revascularization: stress MBF 2.4 ± 0.8 vs. 3.2 ± 0.8; P < 0.001 and MFR 2.5 ± 0.8 vs. 3.4 ± 1.1; P = 0.004. FFR and CFR increased significantly from baseline to after revascularization and remained stable from after revascularization to 3-month follow-up: FFR 0.64 ± 0.20 vs. 0.91 ± 0.06 vs. 0.91 ± 0.07; P < 0.001; CFR 2.4 ± 1.2 vs. 3.6 ± 1.9 vs. 3.6 ± 1.9; P < 0.001, whereas IMR did not change significantly: 30.3 ± 22.9 vs. 30.1 ± 25.3 vs. 31.9 ± 25.2; P = ns. After revascularization, an increase in stress MBF was associated with an increase in FFR ( r = 0.732; P < 0.001) and an increase in MFR ( r = 0.499; P = 0.021). IMR measured before PCI was inversely associated with improvement in stress MBF, ( r = -0.616; P = 0.004).

Conclusion: Recovery of myocardial perfusion after PCI was associated with an increase in FFR 3 months after revascularization. Microcirculatory dysfunction was associated with less improvement in myocardial perfusion.

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Conflict of interest statement

L.O.J. has received research grants from Biotronik, Biosensors, Abbott Vascular and Terumo to her institution and honoraria from Biotronik. For the remaining authors, there are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Changes of perfusion 3 months after revascularization. (a) Myocardial blood flow (MBF) stress, (b) myocardial flow reserve (MFR).
Fig. 2
Fig. 2
Scatter plots demonstrating the relationship after revascularization, (a) the absolute perfusion stress MBF in the revascularized correlated to the absolute perfusion stress MBF in the reference vessel. (b) MFR in the revascularized coronary artery correlated to the MFR in the reference vessel. MBF, myocardial blood flow; MFR, myocardial flow reserve.
Fig. 3
Fig. 3
Changes of flow and pressure measurements 3 months after revascularization. (a) Fractional flow reserve (FFR), (b) Coronary flow reserve (CFR), (c) Index of microcirculatory resistance (IMR).
Fig. 4
Fig. 4
Association of changes myocardial blood flow (MBF), fractional flow reserve (FFR) and myocardial flow reserve (MFR) after revascularization with PCI. (a) improvement in MBF correlated with improvement in FFR (a) and MFR (b). PCI, percutaneous coronary intervention.
Fig. 5
Fig. 5
Relationship between index of microcirculatory resistance (IMR) before revascularization and improvement in myocardial blood flow (MBF).
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