Fractional flow reserve with dobutamine challenge and coronary microvascular endothelial dysfunction in symptomatic myocardial bridging

Satoshi Yoshino, Andrew Cassar, Yoshiki Matsuo, Joerg Herrmann, Rajiv Gulati, Abhiram Prasad, Ryan J. Lennon, Lilach O. Lerman, Amir Lerman

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

Background: Myocardial bridging (MB) results in compression of the coronary artery lumen in systole, extending into diastole with resultant hemodynamic alternation as reflected by fractional flow reserve (FFR). MB has also been associated with coronary endothelial dysfunction. The objective of this study was to investigate relationship between FFR with dobutamine challenge and coronary microvascular endothelial dysfunction in symptomatic MB. Methods and Results: Seventeen consecutive patients who had cardiac catheterization assessment of MB were enrolled. The patients were divided into 2 groups according to normal (% increase in coronary blood flow [%CBF] ≥50%, n=7) or impaired (%CBF <50%, n=10) coronary microvascular endothelial function assessed on vasoreactivity in the coronary artery with intracoronary infusion of acetylcholine (Ach). Myocardial ischemia was then assessed using FFR at rest and during i.v. dobutamine infusion challenge across the MB with intracoronary pressure wires. FFR was significantly decreased at peak dobutamine infusion compared to at rest in the impaired group (0.85±0.06 vs. 0.91±0.05, P=0.001), but not in the normal group (0.93±0.05 vs. 0.91±0.07, P=0.618). Both FFR at rest and at peak dobutamine infusion had a positive correlation with %CBF by Ach in the impaired group (r2=0.46, P=0.030; r2=0.52, P=0.018, respectively). Conclusions: Microvascular endothelial dysfunction was associated with decreased FFR at peak dobutamine stress in patients with symptomatic MB.

Original languageEnglish (US)
Pages (from-to)687-692
Number of pages6
JournalCirculation Journal
Volume78
Issue number3
DOIs
StatePublished - 2014

Keywords

  • Coronary flow
  • Coronary hemodynamics
  • Coronary physiology
  • Endothelial function
  • Fractional flow reserve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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