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Characteristic findings of microvascular dysfunction on coronary computed tomography angiography in patients with intermediate coronary stenosis

  • Computed Tomography
  • Published:
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Abstract

Objectives

We aimed to assess the prevalence of coexistence of coronary microvascular dysfunction (CMD) in patients with intermediate epicardial stenosis and to explore coronary computed tomography angiography (CCTA)–derived lesion-, vessel-, and cardiac fat–related characteristic findings associated with CMD.

Methods

A retrospective cross-sectional single-center study included a total of 177 patients with intermediate stenosis in the left anterior descending artery (LAD) who underwent CCTA and invasive physiological measurements. The 320-slice CCTA analysis included qualitative and quantitative assessments of plaque, vessel, epicardial fat volume (ECFV) and epicardial fat attenuation (ECFA), and pericoronary fat attenuation (FAI). CMD was defined by the index of microcirculatory resistance (IMR) ≥ 25.

Results

In the entire cohort, median fractional flow reserve (FFR) and median IMR values were 0.77 (0.69–0.84) and 19.0 (13.7–27.7), respectively. The prevalence of CMD was 32.8 % (58/177) in the total cohort. The coexistence of CMD and functionally significant stenosis was 34.3 % (37/108), whereas CMD in nonsignificant intermediate stenosis was 30.4 % (21/69). CMD was significantly associated with greater lumen volume (p = 0.031), greater fibrofatty and necrotic component (FFNC) volume (p = 0.030), and greater ECFV (p = 0.030), but not with FAI (p = 0.832) and ECFA (p = 0.445). On multivariable logistic regression analysis, vessel volume, vessel lumen volume, lesion remodeling index, ECFV, and lesion FFNC volume were independent predictors of CMD.

Conclusions

The prevalence of CMD was about one-third in patients with intermediate stenosis in LAD regardless of the presence or absence of functional stenosis significance. The integrated CCTA assessment may help in the identification of CMD.

Key Points

• The coexistence of coronary microvascular dysfunction (CMD) and functionally significant stenosis was 34.3 %, whereas CMD in nonsignificant intermediate stenosis was 30.4 %.

• Coronary computed tomography angiography (CCTA)-derived CMD characteristics were vessel volume, vessel lumen volume, remodeling index, epicardial fat volume, and fibrofatty necrotic core volume.

• Integrated CCTA assessment may help identify the coexistence of CMD and epicardial stenosis.

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Abbreviations

CABG:

Coronary artery bypass graft surgery

CAD:

Coronary artery disease

CCTA:

Coronary computed tomography angiography

CFR:

Coronary flow reserve

CMD:

Coronary microvascular dysfunction

ECFA:

Epicardial fat attenuation

ECFV:

Epicardial fat volume

ESS:

Endothelial shear stress

FFNC:

Fibrofatty and necrotic component

FFR:

Fractional flow reserve

IMR:

Index of microcirculatory resistance

LAD:

Left anterior descending artery

MVD:

Microvascular dysfunction

PCI:

Percutaneous coronary intervention

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Funding

This study has received funding by an unrestricted research grant from St. Jude Medical (Abbott Vascular) (Santa Clara, CA, USA). The company had no role in study design, conduct, data analysis, or manuscript preparation.

Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura City, Ibaraki, 300-0028, Japan

    Masahiro Hoshino, Tomoyo Sugiyama, Yoshihisa Kanaji, Rikuta Hamaya, Masao Yamaguchi, Masahiro Hada, Tomoki Horie, Kai Nogami, Hiroki Ueno, Toru Misawa & Tsunekazu Kakuta

  2. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea

    Seokhun Yang, Jinlong Zhang, Doyeon Hwang, Joo Myung Lee & Bon-Kwon Koo

  3. Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Rikuta Hamaya

  4. Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan

    Taishi Yonetsu & Tetsuo Sasano

  5. Department of Cardiology, Ulsan Medical Center, Ulsan Hospital, Ulsan, South Korea

    Eun-Seok Shin

  6. Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea

    Joon-Hyung Doh

  7. Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea

    Chang-Wook Nam

Authors
  1. Masahiro Hoshino
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  2. Seokhun Yang
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  3. Tomoyo Sugiyama
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  4. Jinlong Zhang
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  6. Rikuta Hamaya
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  7. Masao Yamaguchi
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  9. Tomoki Horie
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  11. Hiroki Ueno
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  15. Joo Myung Lee
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  19. Bon-Kwon Koo
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  20. Tetsuo Sasano
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  21. Tsunekazu Kakuta
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Corresponding author

Correspondence to Tsunekazu Kakuta.

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Guarantor

The scientific guarantor of this publication is Dr. Tsunekazu Kakuta.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Dr. Bon-Kwon Koo received an institutional research grant from St. Jude Medical (Abbott Vascular) and Philips Volcano. Dr. Joo Myung Lee received a research grant from St. Jude Medical (Abbott Vascular) and Philips Volcano. All other authors declare that there is no conflict of interest relevant to the submitted work.

Statistics and biometry

One of the authors has significant statistical expertise.

Dr. Rikuta Hamaya kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

The present study is the substudy of the multicenter study CCTA-FFR Registry for Risk Prediction, Clinical Trial Registration Information: NCT04037163, and the study population was derived from the institutional CCTA registry of Tsuchiura Kyodo General Hospital, one of the cardiac centers that participated in the aforementioned international multicenter registry. Some study subjects have been previously reported in J Cardiovasc Comput Tomogr. 2020 Feb 6:S1934-5925(19)30733-6.

Methodology

• retrospective

• cross-sectional multicenter study

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Hoshino, M., Yang, S., Sugiyama, T. et al. Characteristic findings of microvascular dysfunction on coronary computed tomography angiography in patients with intermediate coronary stenosis. Eur Radiol 31, 9198–9210 (2021). https://doi.org/10.1007/s00330-021-07909-7

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  • DOI: https://doi.org/10.1007/s00330-021-07909-7

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