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Boerhout CKM, Vink CEM, Lee JM, de Waard GA, Mejia-Renteria H, Lee SH, Jung JH, Hoshino M, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Eftekhari A, Effat MA, Murai T, Marques K, Doh JH, Christiansen EH, Banerjee R, Nam CW, Niccoli G, Nakayama M, Tanaka N, Shin ES, Appelman Y, Beijk MAM, van Royen N, Chamuleau SAJ, Knaapen P, Escaned J, Kakuta T, Koo BK, Piek JJ, van de Hoef TP. Impact of sex on the assessment of the microvascular resistance reserve. Int J Cardiol 2024; 402:131832. [PMID: 38316189 DOI: 10.1016/j.ijcard.2024.131832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/29/2023] [Accepted: 02/01/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND The microvascular resistance reserve (MRR) is an innovative index to assess the vasodilatory capacity of the coronary circulation while accounting for the presence of concomitant epicardial disease. The MRR has shown to be a valuable diagnostic and prognostic tool in the general coronary artery disease (CAD) population. However, considering the fundamental aspects of its assessment and the unique hemodynamic characteristics of women, it is crucial to provide additional considerations for evaluating the MRR specifically in women. AIM The aim of this study was to assess the diagnostic and prognostic applicability of the MRR in women and assess the potential differences across different sexes. METHODS From the ILIAS Registry, we enrolled all patients with a stable indication for invasive coronary angiography, ensuring complete physiological and follow-up data. We analyzed the diagnostic value by comparing differences between sexes and evaluated the prognostic value of the MRR specifically in women, comparing it to that in men. RESULTS A total of 1494 patients were included of which 26% were women. The correlation between MRR and CFR was good and similar between women (r = 0.80, p < 0.005) and men (r = 0.81, p < 0.005). The MRR was an independent and important predictor of MACE in both women (HR 0.67, 0.47-0.96, p = 0.027) and men (HR 0.84, 0.74-0.95, p = 0.007). The optimal cut-off value for MRR in women was 2.8 and 3.2 in men. An abnormal MRR similarly predicted MACE at 5-year follow-up in both women and men. CONCLUSION The MRR seems to be equally applicable in both women and men with stable coronary artery disease.
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Affiliation(s)
| | - C E M Vink
- Heart Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Seoul, Republic of Korea
| | | | - Hernan Mejia-Renteria
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ji-Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea
| | - Masahiro Hoshino
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
| | - Mauro Echavarria-Pinto
- Hospital General ISSSTE Querétaro - Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, Mexico
| | | | - Hitoshi Matsuo
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
| | | | - Ashkan Eftekhari
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - Mohamed A Effat
- Division of Cardiovascular Health and Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Tadashi Murai
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura City, Japan
| | - Koen Marques
- Heart Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | | | - Rupak Banerjee
- Mechanical and Materials Engineering Department, University of Cincinnati Cincinnati, OH, USA; Research Services, Veteran Affairs Medical Center, Cincinnati, OH, USA
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University, Daegu, South Korea
| | - Giampaolo Niccoli
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Institute of Cardiology, Rome, Italy
| | - Masafumi Nakayama
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan; Toda Central General Hospital, Cardiovascular Center, Toda, Japan
| | - Nobuhiro Tanaka
- Tokyo Medical University Hachioji Medical Center, Department of Cardiology, Tokyo, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | | | | | - Niels van Royen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Paul Knaapen
- Heart Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Tsunekazu Kakuta
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura City, Japan
| | - Bon Kwon Koo
- Seoul National University Hospital, Department of Internal Medicine, Cardiovascular Center, Seoul, Republic of Korea
| | - Jan J Piek
- Heart Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Tim P van de Hoef
- Department of Cardiology, University Medical Centre Utrecht, the Netherlands.
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Eftekhari A, van de Hoef TP, Hoshino M, Lee JM, Boerhout CKM, de Waard GA, Jung JH, Lee SH, Mejia-Renteria H, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Effat MA, Marques K, Doh JH, Banerjee R, Nam CW, Niccoli G, Murai T, Nakayama M, Tanaka N, Shin ES, Knaapen P, van Royen N, Escaned J, Koo BK, Chamuleau SAJ, Kakuta T, Piek JJ, Christiansen EH. Changes in microvascular resistance following percutaneous coronary intervention - From the ILIAS global registry. Int J Cardiol 2023; 392:131296. [PMID: 37633364 DOI: 10.1016/j.ijcard.2023.131296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/08/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Microvascular resistance (MR) has prognostic value in acute and chronic coronary syndromes following percutaneous coronary intervention (PCI), however anatomic and physiologic determinants of the relative changes of MR and its association to target vessel failure (TVF) has not been investigated previously. This study aims to evaluate the association between changes in MR and TVF. METHODS This is a sub-study of the Inclusive Invasive Physiological Assessment in Angina Syndromes (ILIAS) registry which is a global multi-centre initiative pooling lesion-level coronary pressure and flow data. RESULTS Paired pre-post PCI haemodynamic data were available in n = 295 vessels out of n = 828 PCI treated patients and of these paired data on MR was present in n = 155 vessels. Vessels were divided according to increase vs. decrease % in microvascular resistance following PCI (ΔMR % ≤ 0 vs. ΔMR > 0%). Decreased microvascular resistance ΔMR % ≤ 0 occurred in vessels with lower pre-PCI fractional flow reserve (0.67 ± 0.15 vs. 0.72 ± 0.09 p = 0.051), coronary flow reserve (1.9 ± 0.8 vs. 2.6 ± 1.8 p < 0.0001) and higher hyperemic microvascular resistance (2.76 ± 1.3 vs. 1.62 ± 0.74 p = 0.001) and index of microvascular resistance (24.4 IQ (13.8) vs. 15. 8 IQ (13.2) p = 0.004). There was no difference in angiographic parameters between ΔMR % ≤ 0 vs. ΔMR > 0%. In a cox regression model ΔMR % > 0 was associated with increased rate of TVF (hazard ratio 95% CI 3.6 [1.2; 10.3] p = 0.018). CONCLUSION Increased MR post-PCI was associated with lesions of less severe hemodynamic influence at baseline and higher rates of TVF at follow-up.
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Affiliation(s)
- Ashkan Eftekhari
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
| | - Tim P van de Hoef
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Masahiro Hoshino
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura City, Japan
| | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Medicine Hearth Vascular Stroke Institute Seoul, Republic of Korea
| | - Coen K M Boerhout
- Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
| | - Guus A de Waard
- Department of Cardiology, Amsterdam UMC- Location VUmc, Amsterdam, the Netherlands
| | - Ji-Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hernan Mejia-Renteria
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Mauro Echavarria-Pinto
- Hospital General Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estad Querétaro, Facultad de Medicina Universidad Autónoma de Querétaro, Querétaro, Mexico
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Hearth Center, Gifu, Japan
| | | | - Mohamed A Effat
- Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, OH, USA
| | - Koen Marques
- Department of Cardiology, Amsterdam UMC- Location VUmc, Amsterdam, the Netherlands
| | - Joon-Hyung Doh
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Rupak Banerjee
- Mechanical and Materials Engineering Department, University of Cincinnati, Veterans Affairs Medical Center, Cincinnati, OH, USA
| | - Chang-Wook Nam
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | | | - Tadashi Murai
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura City, Japan
| | - Masafumi Nakayama
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan; Cardiovascular Center, Toda Central General Hospital, Toda, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC- Location VUmc, Amsterdam, the Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Javier Escaned
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Bon Kwon Koo
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Steven A J Chamuleau
- Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC- Location VUmc, Amsterdam, the Netherlands
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura City, Japan
| | - Jan J Piek
- Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
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3
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Yang S, Hwang D, Lee JM, Lee SH, Boerhout CK, Woudstra J, Vink CE, de Waard GA, Jung JH, Renteria HM, Hoshino M, Pinto ME, Meuwissen M, Matsuo H, Cambero MM, Eftekhari A, Effat MA, Murai T, Marques K, Appelman Y, Doh JH, Christiansen EH, Banerjee R, Kim HK, Nam CW, Niccoli G, Nakayama M, Tanaka N, Shin ES, Beijk MA, Chamuleau SA, van Royen N, Knaapen P, Kakuta T, Escaned J, Piek JJ, van de Hoef TP, Koo BK. Prognostic Implications of Individual and Combinations of Resting and Hyperemic Coronary Pressure and Flow Parameters. JACC Asia 2023; 3:865-877. [PMID: 38155797 PMCID: PMC10751649 DOI: 10.1016/j.jacasi.2023.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/11/2023] [Accepted: 07/15/2023] [Indexed: 12/30/2023]
Abstract
Background Coronary pressure- and flow-derived parameters have prognostic value. Objectives This study aims to investigate the individual and combined prognostic relevance of pressure and flow parameters reflecting resting and hyperemic conditions. Methods A total of 1,971 vessels deferred from revascularization after invasive pressure and flow assessment were included from the international multicenter registry. Abnormal resting pressure and flow were defined as distal coronary pressure/aortic pressure ≤0.92 and high resting flow (1/resting mean transit time >2.4 or resting average peak flow >22.7 cm/s), and abnormal hyperemic pressure and flow as fractional flow reserve ≤0.80 and low hyperemic flow (1/hyperemic mean transit time <2.2 or hyperemic average peak flow <25.0 cm/s), respectively. The clinical endpoint was target vessel failure (TVF), myocardial infarction (MI), or cardiac death at 5 years. Results The mean % diameter stenosis was 46.8% ± 16.5%. Abnormal pressure and flow were independent predictors of TVF and cardiac death/MI (all P < 0.05). The risk of 5-year TVF or MI/cardiac death increased proportionally with neither, either, and both abnormal resting pressure and flow, and abnormal hyperemic pressure and flow (all P for trend < 0.001). Abnormal resting pressure and flow were associated with a higher rate of TVF or MI/cardiac death in vessels with normal fractional flow reserve; this association was similar for abnormal hyperemic pressure and flow in vessels with normal resting distal coronary pressure/aortic pressure (all P < 0.05). Conclusions Abnormal resting and hyperemic pressure and flow were independent prognostic predictors. The abnormal flow had an additive prognostic value for pressure in both resting and hyperemic conditions with complementary prognostic between resting and hyperemic parameters.
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Affiliation(s)
- Seokhun Yang
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Doyeon Hwang
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Coen K.M. Boerhout
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Janneke Woudstra
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Caitlin E.M. Vink
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Guus A. de Waard
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Ji Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Korea
| | - Hernan Mejia Renteria
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Masahiro Hoshino
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura city, Japan
| | - Mauro Echavarria Pinto
- Hospital General ISSSTE Querétaro Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, México
| | | | - Hitoshi Matsuo
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
| | | | - Ashkan Eftekhari
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - Mohamed A. Effat
- Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, Ohio, USA
| | - Tadashi Murai
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura city, Japan
| | - Koen Marques
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Joon Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | | | - Rupak Banerjee
- Department of Mechanical and Materials Engineering, University of Cincinnati, Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - Hyun Kuk Kim
- Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
| | - Chang Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | | | - Masafumi Nakayama
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
- Toda Central General Hospital, Cardiovascular Center, Toda, Japan
| | - Nobuhiro Tanaka
- Tokyo Medical University Hachioji Medical Center, Department of Cardiology, Tokyo, Japan
| | - Eun Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Marcel A.M. Beijk
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Steven A.J. Chamuleau
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Tsunekazu Kakuta
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura city, Japan
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Jan J. Piek
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Tim P. van de Hoef
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Department of Cardiology, NoordWest Ziekenhuisgroep, the Netherlands
| | - Bon-Kwon Koo
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Vink CEM, Woudstra J, Lee JM, Boerhout CKM, Cook CM, Hoshino M, Mejia-Renteria H, Lee SH, Jung JH, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Eftekhari A, Effat MA, Murai T, Marques K, Beijk MAM, Doh JH, Piek JJ, van de Hoef TP, Christiansen EH, Banerjee R, Nam CW, Niccoli G, Nakayama M, Tanaka N, Shin ES, van Royen N, Chamuleau SAJ, Knaapen P, Escaned J, Kakuta T, Koo BK, Appelman Y, de Waard GA. Sex differences in prevalence and outcomes of the different endotypes of chronic coronary syndrome in symptomatic patients undergoing invasive coronary angiography: Insights from the global ILIAS invasive coronary physiology registry. Atherosclerosis 2023; 384:117167. [PMID: 37558604 DOI: 10.1016/j.atherosclerosis.2023.06.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND AND AIMS The management of chronic coronary syndrome (CCS) is informed by studies predominantly including men. This study investigated the relationship between patients sex and different endotypes of CCS, including sex-specific clinical outcomes. METHODS In patients with CCS undergoing coronary angiography, invasive Fractional Flow Reserve (FFR) and Coronary Flow Reserve (CFR) were measured. Patients were stratified into groups: 1) obstructive coronary artery disease (oCAD) (FFR≤0.80, no revascularization), 2) undergoing revascularization, 3) non-obstructive coronary artery disease with coronary microvascular dysfunction (CMD) (FFR>0.80, CFR≤2.5), and 4) non-obstructive coronary artery disease without CMD (FFR>0.80 and CFR>2.5). RESULTS 1836 patients (2335 vessels) were included, comprising 1359 (74.0%) men and 477 (26.0%) women. oCAD was present in 14.1% and was significantly less prevalent in women than in men (10.3% vs 15.5%, respectively p < 0.01). Revascularization was present in 30.9% and was similarly prevalent in women and men (28.2% vs. 31.9%, respectively p = 0.13). CMD was present in 24.2% and was significantly more prevalent in women than men (28.6% vs 22.6%, respectively p < 0.01). Normal invasive measurements were found in 564 patients (33.0% women vs 30.0% men, p = 0.23). Male sex was associated with an increased risk of target vessel failure compared to women (HR.1.89, 95% CI 1.12-3.18, p = 0.018), regardless of CCS-endotype. CONCLUSIONS Sex differences exist in the prevalence and outcomes of different endotypes of CCS in symptomatic patients undergoing invasive coronary angiography. In particular, oCAD (and subsequent revascularization) were more prevalent in men. Conversely, CMD was more prevalent in women. Overall, men experienced a worse cardiovascular outcome compared to women, independent of any specific CCS endotype.
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Affiliation(s)
- Caitlin E M Vink
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands
| | - Janneke Woudstra
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Coen K M Boerhout
- Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
| | - Christopher M Cook
- The Essex Cardiothoracic Centre, Essex, United Kingdom; Anglia Ruskin University, Essex, United Kingdom
| | - Masahiro Hoshino
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
| | - Hernan Mejia-Renteria
- Hospital Clínico San Carlos, IDISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ji-Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea
| | - Mauro Echavarria-Pinto
- Hospital General ISSSTE Querétaro - Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, Mexico
| | | | - Hitoshi Matsuo
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea
| | | | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mohamed A Effat
- Division of Cardiovascular Health and Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Tadashi Murai
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura City, Japan
| | - Koen Marques
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
| | - Marcel A M Beijk
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
| | - Joon-Hyung Doh
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Jan J Piek
- Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
| | - Tim P van de Hoef
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands; Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Rupak Banerjee
- Mechanical and Materials Engineering Department, University of Cincinnati, Cincinnati, OH, USA; Research Services, Veteran Affairs Medical Center, Cincinnati, OH, USA
| | - Chang-Wook Nam
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Giampaolo Niccoli
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Institute of Cardiology, Rome, Italy
| | - Masafumi Nakayama
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea; Cardiovascular Center, Toda Central General Hospital, Toda, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Steven A J Chamuleau
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Tsunekazu Kakuta
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura City, Japan
| | - Bon-Kwon Koo
- Department of Internal Medicine, Seoul National University Hospital, Cardiovascular Center, Seoul, Republic of Korea
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands
| | - Guus A de Waard
- Department of Cardiology, Amsterdam UMC - Location VUmc, Amsterdam, the Netherlands.
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5
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Boerhout CKM, Lee JM, de Waard GA, Mejia-Renteria H, Lee SH, Jung JH, Hoshino M, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Eftekhari A, Effat MA, Murai T, Marques K, Doh JH, Christiansen EH, Banerjee R, Nam CW, Niccoli G, Nakayama M, Tanaka N, Shin ES, Appelman Y, Beijk MAM, van Royen N, Knaapen P, Escaned J, Kakuta T, Koo BK, Piek JJ, van de Hoef TP. Microvascular resistance reserve: diagnostic and prognostic performance in the ILIAS registry. Eur Heart J 2023; 44:2862-2869. [PMID: 37350567 PMCID: PMC10406337 DOI: 10.1093/eurheartj/ehad378] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/06/2023] [Accepted: 05/24/2023] [Indexed: 06/24/2023] Open
Abstract
AIMS The microvascular resistance reserve (MRR) was introduced as a means to characterize the vasodilator reserve capacity of the coronary microcirculation while accounting for the influence of concomitant epicardial disease and the impact of administration of potent vasodilators on aortic pressure. This study aimed to evaluate the diagnostic and prognostic performance of MRR. METHODS AND RESULTS A total of 1481 patients with stable symptoms and a clinical indication for coronary angiography were included from the global ILIAS Registry. MRR was derived as a function of the coronary flow reserve (CFR) divided by the fractional flow reserve (FFR) and corrected for driving pressure. The median MRR was 2.97 [Q1-Q3: 2.32-3.86] and the overall relationship between MRR and CFR was good [correlation coefficient (Rs) = 0.88, P < 0.005]. The difference between CFR and MRR increased with decreasing FFR [coefficient of determination (R2) = 0.34; Coef.-2.88, 95% confidence interval (CI): -3.05--2.73; P < 0.005]. MRR was independently associated with major adverse cardiac events (MACE) at 5-year follow-up [hazard ratio (HR) 0.78; 95% CI 0.63-0.95; P = 0.024] and with target vessel failure (TVF) at 5-year follow-up (HR 0.83; 95% CI 0.76-0.97; P = 0.047). The optimal cut-off value of MRR was 3.0. Based on this cut-off value, only abnormal MRR was significantly associated with MACE and TVF at 5-year follow-up in vessels with functionally significant epicardial disease (FFR <0.75). CONCLUSION MRR seems a robust indicator of the microvascular vasodilator reserve capacity. Moreover, in line with its theoretical background, this study suggests a diagnostic advantage of MRR over other indices of vasodilatory capacity in patients with hemodynamically significant epicardial coronary artery disease.
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Affiliation(s)
- Coen K M Boerhout
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Joo Myung Lee
- Samsung Medical Center, Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine, Heart Vascular Stroke Institute, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Guus A de Waard
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Hernan Mejia-Renteria
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Calle del Prof Martín Lagos, S/N, 28040 Madrid, Spain
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, South Korea
| | - Ji-Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, 20 Gyeyangmunhwa-ro, Gyeyang-gu, Incheon, South Korea
| | - Masahiro Hoshino
- Department of Cardiovascular Medicine, Gifu Heart Center, 4 Chome-14-4 Yabutaminami, Gifu, 500-8384, Japan
| | - Mauro Echavarria-Pinto
- Hospital General ISSSTE Querétaro—Facultad de Medicina, Universidad Autónoma de Querétaro, Av Tecnológico 101, Las Campanas, 76000 Santiago de Querétaro, México
| | - Martijn Meuwissen
- Department of Cardiology, Amphia Hospital, Molengracht 21, 4818 CK Breda, The Netherlands
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, 4 Chome-14-4 Yabutaminami, Gifu, 500-8384, Japan
| | - Maribel Madera-Cambero
- Department of Cardiology, Tergooi Hospital, Laan van Tergooi 2, 1212 VG Hilversum, The Netherlands
| | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Mohamed A Effat
- Division of Cardiovascular Health and Diseases, Department of Internal Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45229, USA
| | - Tadashi Murai
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4 Chome-1-1 Otsuno, Tsuchiura, Ibaraki 300-0028, Tsuchiura city, Japan
| | - Koen Marques
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyangsi, Gyeonggi-do, Goyang, South Korea
| | - Evald H Christiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Rupak Banerjee
- Mechanical and Materials Engineering Department, University of Cincinnati, 2901 Woodside Drive, Cincinnati, OH 45219, USA
- Research Services, Veteran Affairs Medical Center, 3200 Vine St, Cincinnati, OH 45220, USA
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University, 1095 Dalgubeol-daero, Sindang-dong, Dalseo-gu, Daegu, South Korea
| | - Giampaolo Niccoli
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Institute of Cardiology, 296-12 Changgyeonggung-ro, Jongno-gu, Seoul, Rome, Italy
| | - Masafumi Nakayama
- Department of Cardiovascular Medicine, Gifu Heart Center, 4 Chome-14-4 Yabutaminami, Gifu, 500-8384, Japan
- Cardiovascular Center, Toda Central General Hospital, 1 Chome-19-3 Honcho, Toda, Saitama 335-0023, Toda, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0998, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Zuid-Korea, Ulsan, Dong-gu 25, South Korea
| | - Yolande Appelman
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marcel A M Beijk
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Paul Knaapen
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Calle del Prof Martín Lagos, S/N, 28040 Madrid, Spain
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4 Chome-1-1 Otsuno, Tsuchiura, Ibaraki 300-0028, Tsuchiura city, Japan
| | - Bon Kwon Koo
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Yeongeon-dong, Jongno-gu, Seoul, South Korea
| | - Jan J Piek
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Tim P van de Hoef
- Heart Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Moore C, Devlin L, Crabtree C, Farris A, Feygin Y, Sumy M, Marques K. Disposable pressure transducer to identify central pressure measurements in umbilical lines for preterm and term infants in the neonatal intensive care unit. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00672-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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7
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Hoshino M, van de Hoef TP, Lee JM, Hamaya R, Kanaji Y, Boerhout CKM, de Waard GA, Jung JH, Lee SH, Mejia-Renteria H, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Eftekhari A, Effat MA, Marques K, Doh JH, Christiansen EH, Banerjee R, Nam CW, Niccoli G, Murai T, Nakayama M, Tanaka N, Shin ES, Sasano T, Appelman Y, Beijk M, Knaapen P, van Royen N, Escaned J, Koo BK, Piek JJ, Kakuta T. Abnormal physiological findings after FFR-based revascularisation deferral are associated with worse prognosis in women. Sci Rep 2023; 13:1027. [PMID: 36658168 PMCID: PMC9852478 DOI: 10.1038/s41598-023-28146-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
The prognostic value of abnormal resting Pd/Pa and coronary flow reserve (CFR) after fractional flow reserve (FFR)-guided revascularisation deferral according to sex remains unknown. From the ILIAS Registry composed of 20 hospitals globally from 7 countries, patients with deferred lesions following FFR assessment (FFR > 0.8) were included. (NCT04485234) The primary clinical endpoint was target vessel failure (TVF) at 2-years follow-up. We included 1392 patients with 1759 vessels (n = 564 women, 31.9%). Although resting Pd/Pa was similar between the sexes (p = 0.116), women had lower CFR than men (2.5 [2.0-3.2] vs. 2.7 [2.1-3.5]; p = 0.004). During a 2-year follow-up period, TVF events occurred in 56 vessels (3.2%). The risk of 2-year TVF was significantly higher in women with low versus high resting Pd/Pa (HR: 9.79; p < 0.001), whereas this trend was not seen in men. (Sex: P-value for interaction = 0.022) Furthermore, resting Pd/Pa provided an incremental prognostic value for 2-year TVF over CFR assessment only in women. After FFR-based revascularisation deferral, low resting Pd/Pa is associated with higher risk of TVF in women, but not in men. The predictive value of Pd/Pa increases when stratified according to CFR values, with significantly high TVF rates in women in whom both indices are concordantly abnormal.Clinical Trial Registration: Inclusive Invasive Physiological Assessment in Angina Syndromes Registry (ILIAS Registry), NCT04485234.
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Affiliation(s)
- Masahiro Hoshino
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura City, Ibaraki, 300-0028, Japan
| | - Tim P van de Hoef
- Department of Cardiology, Amsterdam UMC - location AMC, Amsterdam, The Netherlands.,Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands.,Department of Cardiology, NoordWest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Rikuta Hamaya
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yoshihisa Kanaji
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura City, Ibaraki, 300-0028, Japan
| | - Coen K M Boerhout
- Department of Cardiology, Amsterdam UMC - location AMC, Amsterdam, The Netherlands
| | - Guus A de Waard
- Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
| | - Ji-Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Korea
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hernan Mejia-Renteria
- Hospital Clínico San Carlos, IDISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Mauro Echavarria-Pinto
- Hospital General ISSSTE Querétaro - Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, México
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | | | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mohamed A Effat
- Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, OH, USA
| | - Koen Marques
- Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | | | - Rupak Banerjee
- Division of Cardiovascular Health and Diseases, Veteran Affairs Medical Center, University of Cincinnati Medical Center, Cincinnati, USA
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Giampaolo Niccoli
- Department of Cardiovascular Medicine, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Tadashi Murai
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Masafumi Nakayama
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan.,Cardiovascular Center, Toda Central General Hospital, Toda, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
| | - Marcel Beijk
- Department of Cardiology, Amsterdam UMC - location AMC, Amsterdam, The Netherlands.,Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Bon Kwon Koo
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jan J Piek
- Department of Cardiology, Amsterdam UMC - location AMC, Amsterdam, The Netherlands
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura City, Ibaraki, 300-0028, Japan.
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8
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Boerhout CKM, de Waard GA, Lee JM, Mejia-Renteria H, Lee SH, Jung JH, Hoshino M, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Eftekhari A, Effat MA, Murai T, Marques K, Doh JH, Christiansen EH, Banerjee R, Nam CW, Niccoli G, Nakayama M, Tanaka N, Shin ES, Chamuleau SAJ, van Royen N, Knaapen P, Escaned J, Kakuta T, Koo BK, Piek JJ, van de Hoef TP. Combined use of hyperemic and non-hyperemic pressure ratios for revascularization decision-making: From the ILIAS registry. Int J Cardiol 2023; 370:105-111. [PMID: 36372287 DOI: 10.1016/j.ijcard.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/27/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the diagnostic and prognostic value of non-hyperaemic Pd/Pa and to determine its additional value when combined with the gold standard hyperaemic pressure ratio (FFR) to guide revascularization. METHODS In a large, multi-center, retrospective registry, we included a total of 2141 patients with a clinical indication for coronary angiography providing physiological data in 2726 vessels. A classification was made based on the FFR (cut-off value: 0.80) and non-hyperaemic Pd/Pa (cut-off value: 0.92) values and the primary outcome was target-vessel failure (TVF) at 5-year follow-up. RESULTS Mean age was 63 ± 10.0 and 75% of the study population were men. Regression analysis showed an overall good correlation between FFR and non-hyperaemic Pd/Pa (r = 0.73, p < 0.005) and discordance was present in 17% of the vessels. Resting Pd/Pa was independently associated with TVF at 5-year follow-up (HR 0.08, 95%CI: 0.02-0.27; p < 0.005). The risk for TVF was the lowest in vessles with concordant normal pressure ratio's, with the highest risk in vessels with any abnormal pressure ratio in which revascularization was deferred. In these vessels, there was no difference in risk for TVF between the discordant and concordant abnormal values. CONCLUSION Abnormal pressure ratios in both non-hyperemic and hyperemic conditions portend important prognostic value. Combined application of FFR and non-hyperemic Pd/Pa efficiently identifies those vessels with concordant normal resting and hyperemic pressure ratios of which long-term clinical outcomes are excellent. These data lead to hypothesize that the decision to defer revascularization should potentially be based on combined non-hyperemic and hyperemic pressure ratios. CLINICAL TRIAL REGISTRATION Inclusive Invasive Physiological Assessment in Angina Syndromes Registry (ILIAS Registry), NCT04485234.
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Affiliation(s)
| | | | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Seoul, Republic of Korea
| | - Hernan Mejia-Renteria
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ji-Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea
| | - Masahiro Hoshino
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
| | - Mauro Echavarria-Pinto
- Hospital General ISSSTE Querétaro - Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, Mexico
| | | | - Hitoshi Matsuo
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
| | | | - Ashkan Eftekhari
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - Mohamed A Effat
- Division of Cardiovascular Health and Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Tadashi Murai
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura city, Japan
| | - Koen Marques
- Heart Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Joon-Hyung Doh
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | | | - Rupak Banerjee
- Mechanical and Materials Engineering Department, University of Cincinnati Cincinnati, OH, USA; Research Services, Veteran Affairs Medical Center, Cincinnati, OH, USA
| | - Chang-Wook Nam
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Giampaolo Niccoli
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Institute of Cardiology, Rome, Italy
| | - Masafumi Nakayama
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan; Toda Central General Hospital, Cardiovascular Center, Toda, Japan
| | - Nobuhiro Tanaka
- Tokyo Medical University Hachioji Medical Center, Department of Cardiology, Tokyo, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | | | - Niels van Royen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Paul Knaapen
- Heart Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Tsunekazu Kakuta
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura city, Japan
| | - Bon Kwon Koo
- Seoul National University Hospital, Department of Internal Medicine, Cardiovascular Center, Seoul, Republic of Korea
| | - Jan J Piek
- Heart Center, Amsterdam UMC, Amsterdam, The Netherlands
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Boerhout CKM, de Waard GA, Lee JM, Mejia-Renteria H, Lee SH, Jung JH, Hoshino M, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Eftekhari A, Effat MA, Murai T, Marques K, Appelman Y, Doh JH, Christiansen EH, Banerjee R, Nam CW, Niccoli G, Nakayama M, Tanaka N, Shin ES, Beijk MAM, Knaapen P, Escaned J, Kakuta T, Koo BK, Piek JJ, van de Hoef TP. Prognostic value of structural and functional coronary microvascular dysfunction in patients with non-obstructive coronary artery disease; from the multicentre international ILIAS registry. EUROINTERVENTION 2022; 18:719-728. [PMID: 35694826 PMCID: PMC10241297 DOI: 10.4244/eij-d-22-00043] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/02/2022] [Indexed: 07/21/2023]
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) is an important contributor to angina syndromes. Recently, two distinct endotypes were identified using combined assessment of coronary flow reserve (CFR) and minimal microvascular resistance (MR), termed structural and functional CMD. AIMS We aimed to assess the relevance of the combined assessment of CFR and MR in patients with angina and no obstructive coronary arteries. METHODS Patients with chronic coronary syndromes (CCS) and non-obstructive coronary artery disease (fractional flow reserve [FFR] ≥0.80) were selected (N=1,102). Functional CMD was defined as abnormal CFR in combination with normal MR and structural CMD as abnormal CFR with abnormal MR. Clinical endpoints were the incidence of major adverse cardiac events (MACE) and target vessel failure (TVF) at 5-year follow-up. RESULTS Abnormal CFR was associated with an increased risk of MACE and TVF at 5-year follow-up. Microvascular resistance parameters were not associated with MACE or TVF at 5-year follow-up. The risk of MACE and TVF at 5-year follow-up was similarly increased for patients with structural or functional CMD compared with patients with normal microvascular function. There were no differences between both endotypes (p=0.88 for MACE, and p=0.55 for TVF). CONCLUSIONS Coronary microvascular dysfunction, identified by an impaired CFR, was unequivocally associated with increased MACE and TVF rates over a 5-year follow-up period. In contrast, impaired MR was not associated with 5-year adverse clinical events. Moreover, there was no significant difference in the risk of MACE and TVF between a low CFR accompanied by pathologically increased MR (structural CMD) or not (functional CMD). CLINICALTRIALS gov: NCT04485234.
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Affiliation(s)
- Coen K M Boerhout
- Department of Cardiology, Amsterdam UMC - location AMC, Amsterdam, the Netherlands
| | - Guus A de Waard
- Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, the Netherlands
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hernan Mejia-Renteria
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ji-Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea
| | - Masahiro Hoshino
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
| | - Mauro Echavarria-Pinto
- Hospital General ISSSTE Querétaro - Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, Mexico
| | | | - Hitoshi Matsuo
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
| | | | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mohamed A Effat
- Division of Cardiovascular Health and Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Tadashi Murai
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura City, Japan
| | - Koen Marques
- Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, the Netherlands
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, the Netherlands
| | - Joon-Hyung Doh
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | | | - Rupak Banerjee
- Mechanical and Materials Engineering Department, University of Cincinnati, Cincinnati, OH, USA; and Research Services, Veteran Affairs Medical Center, Cincinnati, OH, USA
| | - Chang-Wook Nam
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Giampaolo Niccoli
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Institute of Cardiology, Rome, Italy
| | - Masafumi Nakayama
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
- Cardiovascular Center, Toda Central General Hospital, Toda, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Marcel A M Beijk
- Department of Cardiology, Amsterdam UMC - location AMC, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, the Netherlands
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Tsunekazu Kakuta
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura City, Japan
| | - Bon-Kwon Koo
- Department of Internal Medicine, Seoul National University Hospital, Cardiovascular Center, Seoul, Republic of Korea
| | - Jan J Piek
- Department of Cardiology, Amsterdam UMC - location AMC, Amsterdam, the Netherlands
| | - Tim P van de Hoef
- Department of Cardiology, Amsterdam UMC - location AMC, Amsterdam, the Netherlands
- Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, the Netherlands
- Department of Cardiology, NoordWest Ziekenhuisgroep, the Netherlands
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van der Sangen N, Claessen B, Küçük IT, Hartog AD, Baan J, Beijk M, Delewi R, van de Hoef T, Knaapen P, Lemkes J, Marques K, Nap A, Verouden N, Vis MM, de Winter R, Kikkert W, Appelman Y, Henriques J. TCT-17 Single Antiplatelet Therapy Directly After Percutaneous Coronary Intervention in Non–ST-Segment Elevation Acute Coronary Syndrome Patients: The OPTICA Pilot Study. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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11
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Peters E, Berg ST, Bogerd M, Appelman Y, Baan J, Beijk M, Claessen B, Delewi R, Hartog AD, van de Hoef T, Knaapen P, Lemkes J, Marques K, Nap A, Verouden N, Vis MM, Winter R, Vlaar A, Henriques J. TCT-85 Periprocedural Cardiac Arrests Significantly Affect Mortality in Cardiogenic Shock Patients Undergoing PCI. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Joh HS, Shin D, Lee JM, Lee SH, Hong D, Choi KH, Hwang D, Boerhout CKM, de Waard GA, Jung JH, Mejia-Renteria H, Hoshino M, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Eftekhari A, Effat MA, Murai T, Marques K, Doh JH, Christiansen EH, Banerjee R, Kim HK, Nam CW, Niccoli G, Nakayama M, Tanaka N, Shin ES, Chamuleau SAJ, van Royen N, Knaapen P, Koo BK, Kakuta T, Escaned J, Piek JJ, van de Hoef TP. Prognostic Impact of Coronary Flow Reserve in Patients With Reduced Left Ventricular Ejection Fraction. J Am Heart Assoc 2022; 11:e025841. [PMID: 35876408 PMCID: PMC9375477 DOI: 10.1161/jaha.122.025841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Intracoronary physiologic indexes such as coronary flow reserve (CFR) and left ventricular ejection fraction (LVEF) have been regarded as prognostic indicators in patients with coronary artery disease. The current study evaluated the association between intracoronary physiologic indexes and LVEF and their differential prognostic implications in patients with coronary artery disease. Methods and Results A total of 1889 patients with 2492 vessels with available CFR and LVEF were selected from an international multicenter prospective registry. Baseline physiologic indexes were measured by thermodilution or Doppler methods and LVEF was recorded at the index procedure. The primary outcome was target vessel failure, which was a composite of cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularization over 5 years of follow‐up. Patients with reduced LVEF <50% (162 patients [8.6%], 202 vessels [8.1%]) showed a similar degree of epicardial coronary artery disease but lower CFR values than those with preserved LVEF (2.4±1.2 versus 2.7±1.2, P<0.001), mainly driven by the increased resting coronary flow. Conversely, hyperemic coronary flow, fractional flow reserve, and the degree of microvascular dysfunction were similar between the 2 groups. Reduced CFR (≤2.0) was seen in 613 patients (32.5%) with 771 vessels (30.9%). Reduced CFR was an independent predictor for target vessel failure (hazard ratio, 2.081 [95% CI, 1.385–3.126], P<0.001), regardless of LVEF. Conclusions CFR was lower in patients with reduced LVEF because of increased resting coronary flow. Patients with reduced CFR showed a significantly higher risk of target vessel failure than did those with preserved CFR, regardless of LVEF. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04485234.
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Affiliation(s)
- Hyun Sung Joh
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Doosup Shin
- Division of Cardiology, Department of Internal Medicine Duke University Medical Center Durham NC
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine Chonnam National University Hospital Gwangju Korea
| | - David Hong
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Doyeon Hwang
- Seoul National University Hospital Department of Internal Medicine, Cardiovascular Center Seoul Korea
| | - Coen K M Boerhout
- Department of Cardiology Amsterdam UMC - location AMC Amsterdam the Netherlands
| | - Guus A de Waard
- Department of Cardiology NoordWest Ziekenhuisgroep Alkmaar the Netherlands
| | - Ji-Hyun Jung
- Sejong General Hospital Sejong Heart Institute Bucheon Korea
| | - Hernan Mejia-Renteria
- Hospital Clínico San Carlos IDISSC, and Universidad Complutense de Madrid Madrid Spain
| | - Masahiro Hoshino
- Department of Cardiology Tsuchiura Kyodo General Hospital Tsuchiura city Japan
| | - Mauro Echavarria-Pinto
- Hospital General ISSSTE Querétaro - Facultad de Medicina Universidad Autónoma de Querétaro Querétaro Mexico
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine Gifu Heart Center Gifu Japan
| | | | - Ashkan Eftekhari
- Department of Cardiology Aarhus University Hospital Aarhus Denmark
| | - Mohamed A Effat
- Division of Cardiovascular Health and Disease University of Cincinnati Cincinnati OH
| | - Tadashi Murai
- Cardiovascular Center Yokosuka Kyosai Hospital Yokosuka Japan
| | - Koen Marques
- Department of Cardiology Amsterdam UMC - location VUmc Amsterdam the Netherlands
| | - Joon-Hyung Doh
- Department of Medicine Inje University Ilsan Paik Hospital Goyang Korea
| | | | - Rupak Banerjee
- Department of Mechanical and Materials Engineering University of Cincinnati, Veterans Affairs Medical Center Cincinnati OH
| | - Hyun Kuk Kim
- Department of Internal Medicine and Cardiovascular Center Chosun University Hospital, University of Chosun College of Medicine Gwangju Korea
| | - Chang-Wook Nam
- Department of Medicine Keimyung University Dongsan Medical Center Daegu Korea
| | - Giampaolo Niccoli
- Department of Cardiovascular Medicine, Institute of Cardiology Catholic University of the Sacred Heart Milano Italy
| | - Masafumi Nakayama
- Department of Cardiovascular Medicine Gifu Heart Center Gifu Japan.,Toda Central General Hospital Cardiovascular Center Toda Japan
| | - Nobuhiro Tanaka
- Tokyo Medical University Hachioji Medical Center Department of Cardiology Tokyo Japan
| | - Eun-Seok Shin
- Department of Cardiology Ulsan University Hospital, University of Ulsan College of Medicine Ulsan Korea
| | | | - Niels van Royen
- Department of Cardiology Radboud University Medical Center Nijmegen the Netherlands
| | - Paul Knaapen
- Department of Cardiology Amsterdam UMC - location VUmc Amsterdam the Netherlands
| | - Bon Kwon Koo
- Seoul National University Hospital Department of Internal Medicine, Cardiovascular Center Seoul Korea
| | - Tsunekazu Kakuta
- Department of Cardiology Tsuchiura Kyodo General Hospital Tsuchiura city Japan
| | - Javier Escaned
- Hospital Clínico San Carlos IDISSC, and Universidad Complutense de Madrid Madrid Spain
| | - Jan J Piek
- Department of Cardiology Amsterdam UMC - location AMC Amsterdam the Netherlands
| | - Tim P van de Hoef
- Department of Cardiology Amsterdam UMC - location AMC Amsterdam the Netherlands
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13
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Hamaya R, van de Hoef TP, Lee JM, Hoshino M, Kanaji Y, Murai T, Boerhout CKM, de Waard GA, Jung JH, Lee SH, Mejia Renteria H, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Eftekhari A, Effat MA, Marques K, Doh JH, Christiansen EH, Banerjee R, Nam CW, Niccoli G, Nakayama M, Tanaka N, Shin ES, Sasano T, Chamuleau SAJ, Knaapen P, Escaned J, Koo BK, Piek JJ, Kakuta T. Differential Impact of Coronary Revascularization on Long-Term Clinical Outcome According to Coronary Flow Characteristics: Analysis of the International ILIAS Registry. Circ Cardiovasc Interv 2022; 15:e011948. [PMID: 35603622 DOI: 10.1161/circinterventions.121.011948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary pressure indices such as fractional flow reserve are the standard for guiding elective revascularization. However, considering additional coronary flow parameters could further individualize and optimize the decision on revascularization. We aimed to investigate the potentially differential prognostic associations of elective percutaneous coronary intervention (PCI) according to coronary flow properties represented by coronary flow reserve (CFR), coronary flow capacity (CFC), and baseline CFC (bCFC). METHODS From the ILIAS Registry (Inclusive Invasive Physiological Assessment in Angina Syndromes) composed of 16 hospitals globally from 7 countries, patients with obstructive coronary artery disease who underwent invasive coronary physiological assessment were included (N=2370 vessels). We assessed effect measure modifications of the association of PCI and 5-year target vessel failure according to CFR, CFC, and bCFC either assessed by Doppler-technique or thermodilution-method. RESULTS The mean age of the population was 63.3 years, and there were 1322 (73.6%) males. Median fractional flow reserve was 0.85, and PCI was performed in 600 (25.3%) vessels. Reduced CFR, CFC, and abnormal bCFC were defined in 988 (41.7%), 542 (22.9%), and 600 (25.3%) vessels, respectively. Significant effect measure modifications were observed by CFC either in odds ratio (P=0.0018), additive (P=0.029), and hazard ratio scale (P=0.0002). The absolute risk of 5-year target-vessel failure was higher if treated by PCI in vessels with normal CFC by 1.8 (-1.7 to 5.3) percent, while that was lower by -5.9 (-12 to -0.1) percent in those with reduced CFC. CFR and bCFC were not significant effect modifiers in any scales. Similar associations were observed in per-patient analyses, whereas the findings were less robust. CONCLUSIONS We observed qualitative effect measure modification of PCI and 5-year clinical outcomes according to CFC status in additive scale. CFR and bCFC were not robust effect modifiers. Therefore, CFC could be potentially used to optimize the patient selection for elective PCI treatment combined with fractional flow reserve.
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Affiliation(s)
- Rikuta Hamaya
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.H.).,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (R.H.)
| | - Tim P van de Hoef
- Department of Cardiology, Amsterdam UMC - location AMC, the Netherlands (T.P.v.d.H., C.K.M.B., S.A.J.C., J.J.P.).,Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, the Netherlands (T.P.v.d.H., K.M., S.A.J.C., P.K.).,Department of Cardiology, NoordWest Ziekenhuisgroep, the Netherlands (T.P.v.d.H., G.A.d.W.)
| | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Seoul, Republic of Korea (J.M.L.)
| | - Masahiro Hoshino
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Japan (M.H., Y.K., T.K.)
| | - Yoshihisa Kanaji
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Japan (M.H., Y.K., T.K.)
| | - Tadashi Murai
- Cardiovascular Center, Yokosuka Kyosai Hospital, Japan (T.M.)
| | - Coen K M Boerhout
- Department of Cardiology, Amsterdam UMC - location AMC, the Netherlands (T.P.v.d.H., C.K.M.B., S.A.J.C., J.J.P.)
| | - Guus A de Waard
- Department of Cardiology, NoordWest Ziekenhuisgroep, the Netherlands (T.P.v.d.H., G.A.d.W.)
| | - Ji-Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Korea (J.-H.J.)
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea (S.H.L.)
| | - Hernan Mejia Renteria
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Spain (H.M.R., J.E.)
| | - Mauro Echavarria-Pinto
- Hospital General ISSSTE Querétaro - Facultad de Medicina, Universidad Autónoma de Querétaro, México (M.E.-P.)
| | - Martijn Meuwissen
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.H.)
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Japan (H.M., M.N.)
| | | | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Denmark (A.E., E.H.C.)
| | - Mohamed A Effat
- Division of Cardiovascular Health and Diseases, Department of Internal Medicine (M.A.E.), University of Cincinnati, OH
| | - Koen Marques
- Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, the Netherlands (T.P.v.d.H., K.M., S.A.J.C., P.K.)
| | - Joon-Hyung Doh
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea (J.-H.D.)
| | | | - Rupak Banerjee
- Mechanical and Materials Engineering Department (R.B.), University of Cincinnati, OH.,Research Services, Veteran Affairs Medical Center, Cincinnati, OH (R.B.)
| | - Chang-Wook Nam
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea (C.-W.N.)
| | - Giampaolo Niccoli
- Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Institute of Cardiology, Rome, Italy (G.N.)
| | - Masafumi Nakayama
- Department of Cardiovascular Medicine, Gifu Heart Center, Japan (H.M., M.N.).,Toda Central General Hospital, Cardiovascular Center, Japan (M.N.)
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Japan (N.T.)
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, South Korea (E.-S.S.)
| | - Tetsuo Sasano
- Department of Cardiology, Tokyo Medical and Dental University, Japan (T.S.)
| | - Steven A J Chamuleau
- Department of Cardiology, Amsterdam UMC - location AMC, the Netherlands (T.P.v.d.H., C.K.M.B., S.A.J.C., J.J.P.).,Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, the Netherlands (T.P.v.d.H., K.M., S.A.J.C., P.K.)
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC - location VUmc, Amsterdam, the Netherlands (T.P.v.d.H., K.M., S.A.J.C., P.K.)
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Spain (H.M.R., J.E.)
| | - Bon Kwon Koo
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Republic of Korea (B.K.K.)
| | - Jan J Piek
- Department of Cardiology, Amsterdam UMC - location AMC, the Netherlands (T.P.v.d.H., C.K.M.B., S.A.J.C., J.J.P.)
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Japan (M.H., Y.K., T.K.)
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14
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van de Hoef TP, Lee JM, Boerhout CKM, de Waard GA, Jung JH, Lee SH, Mejía-Rentería H, Hoshino M, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Eftekhari A, Effat MA, Murai T, Marques K, Doh JH, Christiansen EH, Banerjee R, Nam CW, Niccoli G, Nakayama M, Tanaka N, Shin ES, van Royen N, Chamuleau SAJ, Knaapen P, Escaned J, Kakuta T, Koo BK, Piek JJ. Combined Assessment of FFR and CFR for Decision Making in Coronary Revascularization: From the Multicenter International ILIAS Registry. JACC Cardiovasc Interv 2022; 15:1047-1056. [PMID: 35589234 DOI: 10.1016/j.jcin.2022.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The aim of this study was to demonstrate the clinical implications of combined assessment of fractional flow reserve (FFR) and coronary flow reserve (CFR). BACKGROUND Combined assessment of FFR and CFR allows detailed characterization of pathophysiology in chronic coronary syndromes. Data on the clinical implications of distinct FFR and CFR patterns are limited, leading to uncertainty regarding their relevance. METHODS Patients with chronic coronary syndromes and obstructive coronary artery disease were selected from the multicenter ILIAS (Inclusive Invasive Physiological Assessment in Angina Syndromes) registry. Patients were classified into 4 groups on the basis of FFR ≤0.80 and CFR <2.0. The endpoint was the 5-year target vessel failure (TVF) rate. RESULTS A total of 2,143 patients with 2,725 lesions were included. Compared with normal FFR/normal CFR, low FFR/low CFR carried the highest risk for TVF (HR: 5.4; 95% CI: 3.2-9.3; P < 0.001), significantly higher than in revascularized vessels (P = 0.007). Discordance, with either low FFR/normal CFR or normal FFR/low CFR, was associated with increased TVF rates compared with normal FFR/normal CFR (low FFR/normal CFR: HR: 3.5 [95% CI: 2.2-5.4; P < 0.001]; normal FFR/low CFR: HR: 3.0 [95% CI: 1.9-4.7; P < 0.001]). No difference in 5-year TVF was observed between the 2 discordant groups (P = 0.57) or between the discordant groups and the revascularized group (P = 0.26 vs low FFR/normal CFR; P = 0.60 vs normal FFR/low CFR). CONCLUSIONS Impaired coronary hemodynamics are uniformly associated with increased 5-year TVF rates. Nonrevascularized vessels with discordant FFR and CFR are associated with 5-year event rates that are equivalent to those of vessels that undergo revascularization, whereas vessels with combined low FFR and CFR exhibit event rates that are significantly higher than after revascularization. (Inclusive Invasive Physiological Assessment in Angina Syndromes Registry [ILIAS Registry]; NCT04485234).
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Affiliation(s)
- Tim P van de Hoef
- Department of Cardiology, Amsterdam UMC-Location AMC, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC-Location VUmc, Amsterdam, the Netherlands; Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands.
| | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Seoul, Korea
| | - Coen K M Boerhout
- Department of Cardiology, Amsterdam UMC-Location AMC, Amsterdam, the Netherlands
| | - Guus A de Waard
- Department of Cardiology, Amsterdam UMC-Location VUmc, Amsterdam, the Netherlands
| | - Ji-Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Korea
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hernán Mejía-Rentería
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Masahiro Hoshino
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura City, Japan
| | - Mauro Echavarria-Pinto
- Hospital General ISSSTE Querétaro-Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, México
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | | | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mohamed A Effat
- Division of Cardiovascular Health and Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Tadashi Murai
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura City, Japan
| | - Koen Marques
- Department of Cardiology, Amsterdam UMC-Location VUmc, Amsterdam, the Netherlands
| | - Joon-Hyung Doh
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | | | - Rupak Banerjee
- Mechanical and Materials Engineering Department, University of Cincinnati, Cincinnati, Ohio, USA; Research Services, Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - Chang-Wook Nam
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | | | - Masafumi Nakayama
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan; Cardiovascular Center, Toda Central General Hospital, Toda, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Steven A J Chamuleau
- Department of Cardiology, Amsterdam UMC-Location AMC, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC-Location VUmc, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC-Location VUmc, Amsterdam, the Netherlands
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura City, Japan
| | - Bon Kwon Koo
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Jan J Piek
- Department of Cardiology, Amsterdam UMC-Location AMC, Amsterdam, the Netherlands
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15
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Kim J, Shin D, Lee JM, Lee SH, Hong D, Choi KH, Hwang D, Boerhout CKM, de Waard GA, Jung JH, Mejia-Renteria H, Hoshino M, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Eftekhari A, Effat MA, Murai T, Marques K, Doh JH, Christiansen EH, Banerjee R, Kim HK, Nam CW, Niccoli G, Nakayama M, Tanaka N, Shin ES, Chamuleau SAJ, van Royen N, Knaapen P, Koo BK, Kakuta T, Escaned J, Piek JJ, van de Hoef TP. Differential Prognostic Value of Revascularization for Coronary Stenosis With Intermediate FFR by Coronary Flow Reserve. JACC Cardiovasc Interv 2022; 15:1033-1043. [PMID: 35490124 DOI: 10.1016/j.jcin.2022.01.297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The authors sought to evaluate comparative prognosis between deferred versus performed percutaneous coronary intervention (PCI) according to coronary flow reserve (CFR) values of patients with intermediate fractional flow reserve (FFR). BACKGROUND For coronary stenosis with intermediate FFR, the prognostic value of PCI remains controversial. The prognostic impact of PCI may be different according to CFR in patients with intermediate FFR. METHODS From the ILIAS Registry (Inclusive Invasive Physiological Assessment in Angina Syndromes Registry, N = 2,322), 400 patients (412 vessels) with intermediate FFR (0.75-0.80) were selected. Patients were stratified into preserved CFR (>2.0, n = 253) and depressed CFR (≤2.0, n = 147) cohorts. Per-vessel clinical outcomes during 5 years of follow-up were compared between deferred versus performed PCI groups in both cohorts. The primary outcome was target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization. RESULTS Among the study population, PCI was deferred for 210 patients (219 vessels, 53.2%) (deferred group) and performed for 190 patients (193 vessels, 46.8%) (performed group). The risk of TVF was comparable between the deferred and performed groups (12.8% vs 14.2%; adjusted HR: 1.403; 95% CI: 0.584-3.369; P = 0.448). When stratified by CFR, PCI was performed in 39.1% (100/261 vessels) of the preserved CFR cohort and 61.9% (93/151 vessels) of the depressed CFR cohort. Within the preserved CFR cohort, the risk of TVF did not differ significantly between the deferred and performed groups (11.0% vs 13.9%; adjusted HR: 0.770; 95% CI: 0.262-2.266; P = 0.635). However, in the depressed CFR cohort, the deferred group had a significantly higher risk of TVF than the performed group (17.2% vs 14.2%; adjusted HR: 4.932; 95% CI: 1.312-18.53; P = 0.018). A significant interaction was observed between CFR and the treatment decision (interaction P = 0.049). Results were consistent after inverse probability weighting adjustment. CONCLUSIONS In patients with intermediate FFR of 0.75 to 0.80, the prognostic value of PCI differed according to CFR, with a significant interaction. PCI was associated with a lower risk of TVF compared with the deferral strategy when CFR was depressed (≤2.0), but there was no difference when CFR was preserved (>2.0). CFR could be used as an additional risk stratification tool to determine treatment strategies in patients with intermediate FFR. (Inclusive Invasive Physiological Assessment in Angina Syndromes Registry [ILIAS Registry]; NCT04485234).
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Affiliation(s)
- Juwon Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doosup Shin
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - David Hong
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doyeon Hwang
- Seoul National University Hospital, Department of Internal Medicine, Cardiovascular Center, Seoul, Korea
| | - Coen K M Boerhout
- Department of Cardiology, Amsterdam University Medical Center, Academic Medical Center, Amsterdam, the Netherlands
| | - Guus A de Waard
- Department of Cardiology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Ji-Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Korea
| | - Hernan Mejia-Renteria
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Masahiro Hoshino
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura City, Japan
| | - Mauro Echavarria-Pinto
- Hospital General Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estad Querétaro, Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, Mexico
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | | | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mohamed A Effat
- Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, Ohio, USA
| | - Tadashi Murai
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura City, Japan
| | - Koen Marques
- Department of Cardiology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | | | - Rupak Banerjee
- Department of Mechanical and Materials Engineering, University of Cincinnati, Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - Hyun Kuk Kim
- Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | | | - Masafumi Nakayama
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan; Toda Central General Hospital, Cardiovascular Center, Toda, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Steven A J Chamuleau
- Department of Cardiology, Amsterdam University Medical Center, Academic Medical Center, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Bon Kwon Koo
- Seoul National University Hospital, Department of Internal Medicine, Cardiovascular Center, Seoul, Korea
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura City, Japan
| | - Javier Escaned
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Jan J Piek
- Department of Cardiology, Amsterdam University Medical Center, Academic Medical Center, Amsterdam, the Netherlands
| | - Tim P van de Hoef
- Department of Cardiology, Amsterdam University Medical Center, Academic Medical Center, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands; Department of Cardiology, NoordWest Ziekenhuisgroep, the Netherlands
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Lee SH, Shin D, Lee JM, van de Hoef TP, Hong D, Choi KH, Hwang D, Boerhout CKM, de Waard GA, Jung JH, Mejia-Renteria H, Hoshino M, Echavarria-Pinto M, Meuwissen M, Matsuo H, Madera-Cambero M, Eftekhari A, Effat MA, Murai T, Marques K, Doh JH, Christiansen EH, Banerjee R, Kim HK, Nam CW, Niccoli G, Nakayama M, Tanaka N, Shin ES, Chamuleau SAJ, van Royen N, Knaapen P, Koo BK, Kakuta T, Escaned J, Piek JJ. Clinical Relevance of Ischemia with Nonobstructive Coronary Arteries According to Coronary Microvascular Dysfunction. J Am Heart Assoc 2022; 11:e025171. [PMID: 35475358 PMCID: PMC9238617 DOI: 10.1161/jaha.121.025171] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background In the absence of obstructive coronary stenoses, abnormality of noninvasive stress tests (NIT) in patients with chronic coronary syndromes may indicate myocardial ischemia of nonobstructive coronary arteries (INOCA). The differential prognosis of INOCA according to the presence of coronary microvascular dysfunction (CMD) and incremental prognostic value of CMD with intracoronary physiologic assessment on top of NIT information remains unknown. Methods and Results From the international multicenter registry of intracoronary physiologic assessment (ILIAS [Inclusive Invasive Physiological Assessment in Angina Syndromes] registry, N=2322), stable patients with NIT and nonobstructive coronary stenoses with fractional flow reserve >0.80 were selected. INOCA was diagnosed when patients showed positive NIT results. CMD was defined as coronary flow reserve ≤2.5. According to the presence of INOCA and CMD, patients were classified into 4 groups: group 1 (no INOCA nor CMD, n=116); group 2 (only CMD, n=90); group 3 (only INOCA, n=41); and group 4 (both INOCA and CMD, n=40). The primary outcome was major adverse cardiovascular events, a composite of all‐cause death, target vessel myocardial infarction, or clinically driven target vessel revascularization at 5 years. Among 287 patients with nonobstructive coronary stenoses (fractional flow reserve=0.91±0.06), 81 patients (38.2%) were diagnosed with INOCA based on positive NIT. By intracoronary physiologic assessment, 130 patients (45.3%) had CMD. Regardless of the presence of INOCA, patients with CMD showed a significantly lower coronary flow reserve and higher hyperemic microvascular resistance compared with patients without CMD (P<0.001 for all). The cumulative incidence of major adverse cardiovascular events at 5 years were 7.4%, 21.3%, 7.7%, and 34.4% in groups 1 to 4. By documenting CMD (groups 2 and 4), intracoronary physiologic assessment identified patients at a significantly higher risk of major adverse cardiovascular events at 5 years compared with group 1 (group 2: adjusted hazard ratio [HRadjusted], 2.88; 95% CI, 1.52–7.19; P=0.024; group 4: HRadjusted, 4.00; 95% CI, 1.41–11.35; P=0.009). Conclusions In stable patients with nonobstructive coronary stenoses, a diagnosis of INOCA based only on abnormal NIT did not identify patients with higher risk of long‐term cardiovascular events. Incorporating intracoronary physiologic assessment to NIT information in patients with nonobstructive disease allowed identification of patient subgroups with up to 4‐fold difference in long‐term cardiovascular events. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04485234.
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Affiliation(s)
- Seung Hun Lee
- Division of Cardiology Department of Internal Medicine Chonnam National University HospitalChonnam National University Medical School Gwangju Korea
| | - Doosup Shin
- Division of Cardiovascular Medicine Department of Internal Medicine University of Iowa Carver College of Medicine Iowa City IA
| | - Joo Myung Lee
- Division of Cardiology Department of Medicine Heart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of Medicine Seoul Korea
| | - Tim P van de Hoef
- Department of Cardiology Amsterdam UMC - location AMC Amsterdam The Netherlands.,Department of Cardiology Amsterdam UMC - location VUmc Amsterdam The Netherlands.,Department of Cardiology NoordWest Ziekenhuisgroep The Netherlands
| | - David Hong
- Division of Cardiology Department of Medicine Heart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of Medicine Seoul Korea
| | - Ki Hong Choi
- Division of Cardiology Department of Medicine Heart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of Medicine Seoul Korea
| | - Doyeon Hwang
- Department of Internal Medicine Cardiovascular CenterSeoul National University Hospital Seoul Korea
| | - Coen K M Boerhout
- Department of Cardiology Amsterdam UMC - location AMC Amsterdam The Netherlands
| | - Guus A de Waard
- Department of Cardiology Amsterdam UMC - location VUmc Amsterdam The Netherlands
| | - Ji-Hyun Jung
- Sejong General HospitalSejong Heart Institute Bucheon Korea
| | - Hernan Mejia-Renteria
- Hospital Clínico San CarlosIDISSC, and Universidad Complutense de Madrid Madrid Spain
| | - Masahiro Hoshino
- Department of Cardiology Tsuchiura Kyodo General Hospital Tsuchiura City Japan
| | - Mauro Echavarria-Pinto
- Hospital General ISSSTE Querétaro - Facultad de MedicinaUniversidad Autónoma de Querétaro Querétaro México
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine Gifu Heart Center Gifu Japan
| | | | - Ashkan Eftekhari
- Department of Cardiology Aarhus University Hospital Aarhus Denmark
| | - Mohamed A Effat
- Division of Cardiovascular Health and Disease University of Cincinnati Cincinnati Ohio
| | - Tadashi Murai
- Department of Cardiology Tsuchiura Kyodo General Hospital Tsuchiura City Japan
| | - Koen Marques
- Department of Cardiology Amsterdam UMC - location VUmc Amsterdam The Netherlands
| | - Joon-Hyung Doh
- Department of Medicine Inje University Ilsan Paik Hospital Goyang Korea
| | | | - Rupak Banerjee
- Department of Mechanical and Materials Engineering University of CincinnatiVeterans Affairs Medical Center Cincinnati Ohio
| | - Hyun Kuk Kim
- Department of Internal Medicine and Cardiovascular Center Chosun University HospitalUniversity of Chosun College of Medicine Gwangju Korea
| | - Chang-Wook Nam
- Department of Medicine Keimyung University Dongsan Medical Center Daegu Korea
| | | | - Masafumi Nakayama
- Department of Cardiovascular Medicine Gifu Heart Center Gifu Japan.,Toda Central General HospitalCardiovascular Center Toda Japan
| | - Nobuhiro Tanaka
- Department of Cardiology Tokyo Medical University Hachioji Medical Center Tokyo Japan
| | - Eun-Seok Shin
- Department of Cardiology Ulsan University HospitalUniversity of Ulsan College of Medicine Ulsan Korea
| | - Steven A J Chamuleau
- Department of Cardiology Amsterdam UMC - location AMC Amsterdam The Netherlands.,Department of Cardiology Amsterdam UMC - location VUmc Amsterdam The Netherlands
| | - Niels van Royen
- Department of Cardiology Radboud University Medical Center Nijmegen The Netherlands
| | - Paul Knaapen
- Department of Cardiology Amsterdam UMC - location VUmc Amsterdam The Netherlands
| | - Bon Kwon Koo
- Department of Internal Medicine Cardiovascular CenterSeoul National University Hospital Seoul Korea
| | - Tsunekazu Kakuta
- Department of Cardiology Tsuchiura Kyodo General Hospital Tsuchiura City Japan
| | - Javier Escaned
- Hospital Clínico San CarlosIDISSC, and Universidad Complutense de Madrid Madrid Spain
| | - Jan J Piek
- Department of Cardiology Amsterdam UMC - location AMC Amsterdam The Netherlands
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Patel MR, Jeremias A, Maehara A, Matsumura M, Zhang Z, Schneider J, Tang K, Talwar S, Marques K, Shammas NW, Gruberg L, Seto A, Samady H, Sharp ASP, Ali ZA, Mintz G, Davies J, Stone GW. 1-Year Outcomes of Blinded Physiological Assessment of Residual Ischemia After Successful PCI: DEFINE PCI Trial. JACC Cardiovasc Interv 2022; 15:52-61. [PMID: 34991824 DOI: 10.1016/j.jcin.2021.09.042] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to identify the post-percutaneous coronary intervention (PCI) target value of instantaneous wave-free ratio (iFR) that would best discriminate clinical events at 1 year in the DEFINE PCI (Physiologic Assessment of Coronary Stenosis Following PCI) study. BACKGROUND The impact of residual ischemia detected by iFR post-PCI on clinical and symptom-related outcomes is unknown. METHODS Blinded iFR pull back was performed after successful stent implantation in 500 patients. The primary endpoint was the rate of residual ischemia, defined as iFR ≤0.89, after operator-assessed angiographically successful PCI. Secondary endpoints included clinical events at 1 year and change in Seattle Angina Questionnaire angina frequency (SAQ-AF) score during follow-up. RESULTS As reported, 24.0% of patients had residual ischemia (iFR ≤0.89) after successful PCI, with 81.6% of cases attributable to angiographically inapparent focal lesions. Post-PCI iFR ≥0.95 (present in 182 cases [39%]) was associated with a significant reduction in the composite of cardiac death, spontaneous myocardial infarction, or clinically driven target vessel revascularization compared with post-PCI iFR <0.95 (1.8% vs 5.7%; P = 0.04). Baseline SAQ-AF score was 73.3 ± 22.8. For highly symptomatic patients (baseline SAQ-AF score ≤60), SAQ-AF score increased by ≥10 points more frequently in patients with versus without post-PCI iFR ≥0.95 (100.0% vs 88.5%; P = 0.01). CONCLUSIONS In DEFINE PCI, despite angiographically successful PCI, highly symptomatic patients at baseline without residual ischemia by post-PCI iFR had greater reductions in anginal symptoms at 1 year compared with patients with residual ischemia. Achieving post-PCI iFR ≥0.95 was also associated with improved 1-year event-free survival. (Physiologic Assessment of Coronary Stenosis Following PCI [DEFINE PCI]; NCT03084367).
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Affiliation(s)
- Manesh R Patel
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
| | - Allen Jeremias
- St. Francis Hospital, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, New York, USA; Columbia University Medical Center, New York, New York, USA
| | - Mitsuaki Matsumura
- Cardiovascular Research Foundation, New York, New York, USA; Columbia University Medical Center, New York, New York, USA
| | - Zixuan Zhang
- Cardiovascular Research Foundation, New York, New York, USA; Columbia University Medical Center, New York, New York, USA
| | - Joel Schneider
- North Carolina Heart and Vascular, Raleigh, North Carolina, USA
| | - Kare Tang
- Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - Suneel Talwar
- Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Koen Marques
- VU University Medical Center, Amsterdam, the Netherlands
| | | | | | - Arnold Seto
- Veterans Affairs Medical Center of Long Beach, Long Beach, California, USA
| | - Habib Samady
- Emory University Hospital, Atlanta, Georgia, USA
| | - Andrew S P Sharp
- University Hospital of Wales, Cardiff, United Kingdom; University of Exeter, Exeter, United Kingdom
| | - Ziad A Ali
- St. Francis Hospital, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA; Columbia University Medical Center, New York, New York, USA
| | - Gary Mintz
- Cardiovascular Research Foundation, New York, New York, USA; Columbia University Medical Center, New York, New York, USA
| | | | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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18
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Janssens G, Lemkes J, van der Hoeven N, van de Ven P, Marques K, Nap A, Van Leeuwen M, Appelman Y, Knaapen P, Verouden C, Allaart C, Brinckman S, Saraber C, Plomp K, Timmer J, Kedhi E, Hermanides R, Meuwissen M, Schaap J, Van Der Weerdt A, van Rossum A, Nijveldt R, Van Royen N. IMMEDIATE VERSUS DELAYED REVASCULARIZATION IN PATIENTS WITH TRANSIENT ST-ELEVATION MYOCARDIAL INFARCTION: 1-YEAR FOLLOW-UP OF THE RANDOMIZED CLINICAL TRANSIENT TRIAL. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31825-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Elias J, van Dongen IM, Laanmets P, Eriksen E, Meuwissen M, Bax M, Ioanes D, Suttorp M, Strauss B, Barbato E, Marques K, Claessen BE, Hirsch A, van der Schaaf R, Tijssen J, Hoebers LP, Henriques JP. TCT-19 Mid- and long-term outcome of the EXPLORE trial, a Global, Randomized, Prospective, Multicenter Trial Investigating the Impact of Recanalization of a Chronic Total Occlusion in Patients after Primary Percutaneous Coronary Intervention for Acute ST-Elevation Myocardial Infarction. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hassell M, Bax M, van Lavieren M, Nijveldt R, Hirsch A, Robbers L, Marques K, Tijssen J, Zijlstra F, van Rossum A, Delewi R, Piek J. Microvascular dysfunction following ST-elevation myocardial infarction and its recovery over time. EUROINTERVENTION 2017; 13:e578-e584. [DOI: 10.4244/eij-d-16-00818] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Henriques JP, Hoebers L, Råmunddal T, Laanmets P, Eriksen E, Bax M, Ioanes D, Suttorp MJ, Strauss B, Barbato E, Nijveldt R, van Rossum AC, Marques K, Tijssen JG, van der Schaaf RJ. TCT-8 First results of the EXPLORE trial, a Global, Randomized, Prospective, Multicenter Trial Investigating the Impact of Recanalization of a Chronic Total Occlusion on Left Ventricular Function in Patients after Primary Percutaneous Coronary Intervention for Acute ST-Elevation Myocardial Infarction. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Casadonte L, Marques K, Spaan J, Siebes M. Variability in IV Adenosine‐Induced Coronary Microvascular Resistance and Systemic Pressure Compromises FFR Determination despite Stable Stenosis Hemodynamics. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.953.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lorena Casadonte
- Department of Biomedical Engineering and Physics AcademicMedical Center University of AmsterdamAmsterdamNetherlands
| | - Koen Marques
- Department of CardiologyVU University Medical CenterAmsterdamNetherlands
| | - Jos Spaan
- Department of Biomedical Engineering and Physics AcademicMedical Center University of AmsterdamAmsterdamNetherlands
| | - Maria Siebes
- Department of Biomedical Engineering and Physics AcademicMedical Center University of AmsterdamAmsterdamNetherlands
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de Waard GA, Westerhof N, Marques K, Danad I, Teunissen PF, Hollander M, Knaapen P, van Royen N. TCT-322 Implications Of Human Coronary Autoregulation On Functional Assessment Of Coronary Artery Stenosis Significance Under Baseline Conditions. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Teunissen PFA, Hollander M, Robbers L, Danad I, de Waard G, Heymans M, Amier R, Biesbroek S, Lammertsma A, Allaart C, Lemkes J, Appelman Y, Marques K, Bronzwaer J, Horrevoets A, van Rossum A, Beek A, Knaapen P, Van Royen N. DOPPLER-DERIVED HYPEREMIC MICROVASCULAR RESISTANCE PREDICTS THE OCCURRENCE OF MICROVASCULAR INJURY AND MICROVASCULAR PERFUSION DEFICITS AFTER ANGIOGRAPHICALLY SUCCESSFUL PRIMARY PERCUTANEOUS CORONARY INTERVENTION. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60074-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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25
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Stuijfzand W, Uusitalo V, Kero T, Danad I, Saraste A, Raijmakers P, Lammertsma A, Marques K, Kajander S, Pietila M, Sorensen J, Van Royen N, Knuuti J, Knaapen P. NONINVASIVE FRACTIONAL FLOW RESERVE DERIVED FROM QUANTITATIVE PERFUSION POSITRON EMISSION TOMOGRAPHY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Castro V, Marques K, Miranda W, Silva C, Zanetta-Barbosa D, Prado C, Trindade Neto A. Evaluation of three-dimensional condylar morphology in patients undergoing orthognathic surgery with counterclockwise rotation of the maxillomandibular complex. Int J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.ijom.2013.07.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Teunissen PF, Hollander M, Robbers LF, Danad I, de Waard GA, Marques K, Beek AM, van Rossum AC, Knaapen P, van Royen N. TCT-602 Doppler-derived hyperemic microvascular resistance measurements predict the occurrence of CMR-defined microvascular injury after primary percutaneous coronary intervention. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Marques K, deVente JE, Hall T, Gavrilova-Jordan L, Ansah D. Management of a late-presenting complex--an unclassified uterine anomaly in the presence of large leiomyomas. CLIN EXP OBSTET GYN 2013; 40:289-290. [PMID: 23971262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This is a case report of a unique, late-presenting, Müllerian anomaly in an infertile patient. The authors discuss the diagnostic challenges of characterizing distorted gynecological anatomy by Müllerian anomalies in the presence of sizeable coexisting fibroids. This case report adds new insight to the already-existing understanding of Müllerian anomalies by demonstrating how a symptomatic and benign uterine pathology can complicate the diagnosis and management of patients with Müllerian defects.
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Affiliation(s)
- K Marques
- East Carolina University Brody School of Medicine, Department of Obstetrics/Gynecology, Division of General Obstetrics/Gynecology, Greenville, NC, USA
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Marques K, Capelle L, De Geest H. [Nonbacterial thrombotic endocarditis. Case report and literature review]. Acta Clin Belg 1992; 47:238-43. [PMID: 1329412 DOI: 10.1080/17843286.1992.11718237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Nonbacterial thrombotic endocarditis is the most prevalent endocarditis at autopsy. It is a clinically important cause of arterial embolisation. Often it is observed in association with malignancy (mainly gastrointestinal adenocarcinomata), severe infections and other fulminant acute disease processes. A deranged or damaged valvular surface and clotting disorders are important pathogenic factors. The valvular vegetations are pathologically characterized by a bland, fibrin-platelet thrombus; they usually affect the mitral and aortic valve. Neurologic events are the most common clinical manifestations, but any organ may be involved by emboli. The association of venous and arterial thromboses and pulmonary thromboembolism underscores the pathogenetic role of hypercoagulability in the development of nonbacterial thrombotic endocarditis. The clinician must be a vigilant observer in order to make the antemortem diagnosis. If possible, the underlying process should be treated; anticoagulation therapy with heparin sometimes is helpful.
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Affiliation(s)
- K Marques
- Dienst Cardiologie, Universitair Ziekenhuis Gastuisberg, Leuven
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Abstract
The growing rehabilitation and consumer movement toward independent community living for disabled adults has placed new demands on the health care delivery system. Programs must be developed for the disabled adult that provide direct training in adaptive community skills, such as banking, budgeting, consumer advocacy, personal health care, and attendant management. An Independent Living Skills Training Program that uses a psychoeducational model is described. To date, 17 multiply handicapped adults, whose average length of institutionalization was 11.9 years, have participated in the program. Of these 17, 58.8% returned to community living and 23.5% are waiting for openings in accessible housing units.
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