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Observational Study
. 2025 Sep 1;21(17):e1005-e1014.
doi: 10.4244/EIJ-D-24-01155.

Coronary microvascular disease in patients referred to coronary angiography following coronary computed tomography angiography

Jelmer Westra  1   2 , Laust Dupont Rasmussen  3   4 , Salma Raghad Karim  1   5 , Rebekka Viberg Jensen  1   5 , June Anita Ejlersen  5 , Lars Christian Gormsen  6   7 , Morten Bøttcher  3   7 , Ashkan Eftekhari  4 , Simon Winther  3   5 , Evald Høj Christiansen  1   5
Affiliations
Observational Study

Coronary microvascular disease in patients referred to coronary angiography following coronary computed tomography angiography

Jelmer Westra et al. EuroIntervention. .

Abstract

Background: Ischaemia without obstructive epicardial coronary artery disease (CAD) is common and is often related to coronary microvascular disease (CMD). Previous studies primarily focused on functional assessment in patients with established ischaemia without obstructive epicardial CAD.

Aims: We sought to assess the prevalence of CMD and compare clinical and procedural characteristics including myocardial perfusion imaging, as derived from rubidium-82 positron emission tomography (82Rb-PET), and health status according to CAD classification.

Methods: We conducted a prospective, observational study of symptomatic patients with suspected obstructive epicardial CAD on coronary computed tomography angiography. All patients were referred to 82Rb-PET and invasive coronary angiography with bolus thermodilution. CMD was defined as the absence of obstructive epicardial CAD (fractional flow reserve>0.80 or diameter stenosis <90%) combined with coronary flow reserve <2.5 and/or index of microvascular resistance ≥25. Main analyses included myocardial perfusion characteristics by 82Rb-PET and health status at baseline and at 3-month follow-up according to CAD classification (no disease, obstructive epicardial CAD, isolated CMD or combined obstructive epicardial CAD and CMD).

Results: Among 561 patients, isolated CMD was diagnosed in 131 patients (prevalence 0.23, 95% confidence interval [CI]: 0.20-0.27). Vessel territories with isolated CMD were characterised by similar perfusion characteristics to non-diseased vessels (mean difference in hyperaemic myocardial blood flow 0.03 [95% CI: -0.13 to 0.06] mL/min/g). Patients with isolated epicardial disease on both patient and vessel levels had reduced stress myocardial blood flow compared to patients without disease. The probability of being angina-free at 3 months tended to be lower for the CMD group (odds ratio [OR] 0.56, 95% CI: 0.31-1.00) and higher for the revascularised epicardial disease group (OR 1.52, 95% CI: 0.94-2.48) compared to the group classified as not diseased.

Conclusions: CMD, as identified with bolus thermodilution, is common in patients referred to invasive coronary angiography based on suspected obstructive epicardial CAD even in patients with normal stress myocardial blood flow by 82Rb-PET. (ClinicalTrials.gov: NCT02264717 and NCT04707859).

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Conflict of interest statement

J. Westra acknowledges support in terms of a research grant (RÖ-1006004) from Region Östergötland; and a research grant from Lions forskningsfond mot folksjukdomer. L. Dupont Rasmussen acknowledges support in terms of a research grant (PD5Y-2023001-DCA) from the Danish Cardiovascular Academy, which is funded by the Novo Nordisk Foundation (grant number NNF20SA0067242) and The Danish Heart Foundation. E. Høj Christiansen acknowledges a research grant from Abbott. The other authors have no conflicts of interest to declare.

References

    1. Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O’Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;144:e368–454. - PubMed
    1. Vrints C, Andreotti F, Koskinas KC, Rossello X, Adamo M, Ainslie J, Banning AP, Budaj A, Buechel RR, Chiariello GA, Chieffo A, Christodorescu RM, Deaton C, Doenst T, Jones HW, Kunadian V, Mehilli J, Milojevic M, Piek JJ, Pugliese F, Rubboli A, Semb AG, Senior R, Ten Berg, Van Belle, Van Craenenbroeck, Vidal-Perez R, Winther S ESC Scientific Document Group. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024;45:3415–537. - PubMed
    1. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, Prescott E, Storey RF, Deaton C, Cuisset T, Agewall S, Dickstein K, Edvardsen T, Escaned J, Gersh BJ, Svitil P, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Valgimigli M, Achenbach S, Bax JJ ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41:407–77. - PubMed
    1. Rasmussen LD, Winther S, Eftekhari A, Karim SR, Westra J, Isaksen C, Brix L, Ejlersen JA, Murphy T, Milidonis X, Nyegaard M, Benovoy M, Johansen JK, Søndergaard HM, Hammid O, Mortensen J, Knudsen LL, Gormsen LC, Christiansen EH, Chiribiri A, Petersen SE, Böttcher M. Second-Line Myocardial Perfusion Imaging to Detect Obstructive Stenosis: Head-to-Head Comparison of CMR and PET. JACC Cardiovasc Imaging. 2023;16:642–55. - PubMed
    1. Boden WE, Marzilli M, Crea F, Mancini GBJ, Weintraub WS, Taqueti VR, Pepine CJ, Escaned J, Al-Lamee R, Gowdak LHW, Berry C, Kaski JC Chronic Myocardial Ischemic Syndromes Task Force. Evolving Management Paradigm for Stable Ischemic Heart Disease Patients: JACC Review Topic of the Week. J Am Coll Cardiol. 2023;81:505–14. - PMC - PubMed

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