TY - JOUR
T1 - Risk stratification of patients with nonobstructive coronary artery disease using resistive reserve ratio
AU - Toya, Takumi
AU - Ahmad, Ali
AU - Corban, Michel T.
AU - Ӧzcan, Ilke
AU - Sara, Jaskanwal D.
AU - Sebaali, Faten
AU - Escaned, Javier
AU - Lerman, Lilach O.
AU - Lerman, Amir
N1 - Funding Information:
This study was partly supported by National Institute of Health (NIH grants number DK120292 and DK122734) and the Mayo Foundation.
Publisher Copyright:
© 2021, American Heart Association Inc.. All rights reserved.
PY - 2021
Y1 - 2021
N2 - BACKGROUND: Resistive reserve ratio (RRR), or the ratio of baseline to hyperemic microvascular resistance, has prognostic implications in predicting clinical outcomes in patients with obstructive coronary artery disease. However, its value in patients with angina or ischemia with nonobstructive coronary artery disease is unknown. METHODS AND RESULTS: We included 1692 patients with nonobstructive coronary artery disease who underwent invasive coronary vasoreactivity testing. Abnormal coronary flow reserve (CFR, the ratio of hyperemic and baseline resting flow velocities) and RRR were defined as <2.5 and <2.62, respectively. The mortality rate was marginally higher in patients with abnormal CFR (428 patients [25%]) than those with normal CFR (38 [9%] versus 81 [6%]; P=0.08), and was significantly higher in patients with abnormal RRR (716 patients [42%]) than those with normal RRR (70 [10%] versus 49 [5%], P=0.0002) over the median follow-up of 11.3 years. Patients with abnormal CFR had marginally lower survival than those with normal CFR (log-rank P=0.08). In contrast, patients with abnormal RRR had significantly lower survival than those with normal RRR (log-rank P=0.001). Abnormal RRR was associated with shorter time to death even after adjustment for other covariates (adjusted hazard ratio, 1.63; 95% CI, 1.11–2.38; P=0.01). CONCLUSIONS: In patients with no obstructive coronary artery disease, RRR was superior to CFR in predicting long-term survival. An RRR <2.62 was associated with 1.6 times increased risk of death in patients with nonobstructive coronary artery disease. Indices of coronary microcirculatory resistive reserve comprising flow-and pressure-derived values may reflect un-derlying microvascular pathology more faithfully than flow-alone indices like CFR.
AB - BACKGROUND: Resistive reserve ratio (RRR), or the ratio of baseline to hyperemic microvascular resistance, has prognostic implications in predicting clinical outcomes in patients with obstructive coronary artery disease. However, its value in patients with angina or ischemia with nonobstructive coronary artery disease is unknown. METHODS AND RESULTS: We included 1692 patients with nonobstructive coronary artery disease who underwent invasive coronary vasoreactivity testing. Abnormal coronary flow reserve (CFR, the ratio of hyperemic and baseline resting flow velocities) and RRR were defined as <2.5 and <2.62, respectively. The mortality rate was marginally higher in patients with abnormal CFR (428 patients [25%]) than those with normal CFR (38 [9%] versus 81 [6%]; P=0.08), and was significantly higher in patients with abnormal RRR (716 patients [42%]) than those with normal RRR (70 [10%] versus 49 [5%], P=0.0002) over the median follow-up of 11.3 years. Patients with abnormal CFR had marginally lower survival than those with normal CFR (log-rank P=0.08). In contrast, patients with abnormal RRR had significantly lower survival than those with normal RRR (log-rank P=0.001). Abnormal RRR was associated with shorter time to death even after adjustment for other covariates (adjusted hazard ratio, 1.63; 95% CI, 1.11–2.38; P=0.01). CONCLUSIONS: In patients with no obstructive coronary artery disease, RRR was superior to CFR in predicting long-term survival. An RRR <2.62 was associated with 1.6 times increased risk of death in patients with nonobstructive coronary artery disease. Indices of coronary microcirculatory resistive reserve comprising flow-and pressure-derived values may reflect un-derlying microvascular pathology more faithfully than flow-alone indices like CFR.
KW - Coronary flow reserve
KW - Coronary microvascular resistance
KW - Nonobstructive coronary artery disease
KW - Resistive reserve ratio
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U2 - 10.1161/JAHA.120.020464
DO - 10.1161/JAHA.120.020464
M3 - Article
C2 - 33998253
AN - SCOPUS:85107390930
VL - 10
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
SN - 2047-9980
IS - 11
M1 - e020464
ER -