| 박상돈, 장지훈, 양동혁, 예재호, 이명동, 정지중, 신성희, 우성일, 김대혁, 권준, 박금수 |
Purposes: Dysfunction of coronary microcirculation in determining patents outcomes has been demonstrated in a number of clinical settings. However, the influence of atherosclerosis on coronary microcirculatory function remains unclear. The aim of study is to assess coronary microvacular function using the index of microcirculatory resistance (IMR) between patients with and without epicardial atherosclerosis.
METHODS: IMR and fractional flow reserve (FFR) were measured in 63 coronary arteries of 63patients who performed the coronary angiography. Acute coronary syndrome patients were not involved in this study. IMR and FFR by using the pressure-temperature sensor-tipped coronary wire were measured at left anterior descending artery in all patients. If the patients had a significant coronary artery stenosis, IMR measured before angioplasty was used in analysis. Left ventricular (LV) end diastolic volume (LVEDV), end systolic volume (LVESV) and LV ejection fraction (LVEF) were calculated with the modified Simpson’s method. As parameters of diastolic dysfunction, A velocity, E velocity, E/A ratio, E’ and E/E’ were obtained using echo Doppler study.
RESULTS: Twenty six patients (mean age, 60±8 years) had no clinical evidence of atherosclerosis (control group). Thirty seven patients (mean age, 64±9 years) had established atherosclerosis (atheroma group). There were no differences in LVEF (58±8.7 vs. 59±7.0%, p=0.68), LVEDV (82±25 vs. 78±16ml, p=0.52) and LVESV (34±13 vs. 32±8ml, p=0.41) between atheroma and control group. FFR in atheroma group was significantly lower than in control group (0.83±0.11 vs.0.91±0.04, p=0.001). Atheroma group showed the significantly higher mean IMR than the control group (34±23 vs. 21±10, p=0.003). There was no correlation between IMR and FFR (r=0.023; P=0.85), even when results in the control (r=0.24; P=0.23) and atheroma (r=0.16; P=0.34). IMR was significantly correlated A velocity (r=-0.7, p<0.001) and E/A ratio (r=0.56, p=0.02) in all patients.
CONCLUSIONS: Patients with epicardial atherosclerosis showed the higher mean IMR than control group, which would reflect accompanying the coronary microvascular dysfunction in atheroma group. IMR was well correlated with a few parameters of diastolic dysfunction.
|
