Integrated Physiologic Assessment of Ischemic Heart Disease in Real-World Practice Using Index of Microcirculatory Resistance and Fractional Flow Reserve

作者：Joo Myung Lee, Jamie John Layland, Ji-Hyun Jung, Hyun‐Jung Lee, Mauro Echavarria Pinto, Stuart Watkins, Andy S.C. Yong, Joon‐Hyung Doh, Chang‐Wook Nam, Eun‐Seok Shin, Bon‐Kwon Koo, Martin K. Ng, Javier Escaned, William Fuller Fearon, Keith G. Oldroyd · 发表于：Circulation Cardiovascular Interventions · 年份：2015 · DOI：10.1161/circinterventions.115.002857 · 被引用次数：127 · 研究领域：Coronary Interventions and Diagnostics、Cardiac Imaging and Diagnostics、Sepsis Diagnosis and Treatment

BACKGROUND: The index of microcirculatory resistance (IMR) is a quantitative and specific index for coronary microcirculation. However, the distribution and determinants of IMR have not been fully investigated in patients with ischemic heart disease (IHD). METHODS AND RESULTS: Consecutive patients who underwent elective measurement of both fractional flow reserve (FFR) and IMR were enrolled from 8 centers in 5 countries. Patients with acute myocardial infarction were excluded. To adjust for the influence of collateral flow, IMR values were corrected with Yong's formula (IMRcorr). High IMR was defined as greater than the 75th percentile in each of the major coronary arteries. FFR≤0.80 was defined as an ischemic value. 1096 patients with 1452 coronary arteries were analyzed (mean age 61.1, male 71.2%). Mean FFR was 0.84 and median IMRcorr was 16.6 U (Q1, Q3 12.4 U, 23.0 U). There was no correlation between IMRcorr and FFR values (r=0.01, P=0.62), and the categorical agreement of FFR and IMRcorr was low (kappa value=-0.04, P=0.10). There was no correlation between IMRcorr and angiographic % diameter stenosis (r=-0.03, P=0.25). Determinants of high IMR were previous myocardial infarction (odds ratio [OR] 2.16, 95% confidence interval [CI] 1.24-3.74, P=0.01), right coronary artery (OR 2.09, 95% CI 1.54-2.84, P<0.01), female (OR 1.67, 95% CI 1.18-2.38, P<0.01), and obesity (OR 1.80, 95% CI 1.31-2.49, P<0.01). Determinants of FFR ≤0.80 were left anterior descending coronary artery (...