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Impact of clinical and haemodynamic factors on coronary flow reserve and invasive coronary flow capacity in non-obstructed coronary arteries: a patient-level pooled analysis of the DEBATE and ILIAS studies

EuroIntervention 2021;16:e1503-e1510. DOI: 10.4244/EIJ-D-19-00774

1. Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; 2. Haga Teaching Hospital, The Hague, the Netherlands; 3. Amphia Hospital, Breda, the Netherlands; 4. University Medical Center Utrecht, Utrecht, the Netherlands; 5. Careggi University Hospital, Florence, Italy; 6. University of Antwerp - Antwerp University Hospital, Antwerp, Belgium; 7. Med. Klinik I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany; 8. Erasmus Medical Center, Rotterdam, the Netherlands; 9. Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; 10. Imperial College London, London, United Kingdom

Aims: Coronary flow reserve (CFR) is a physiological index for the assessment of myocardial flow impairment due to focal or microcirculatory coronary artery disease (CAD). Coronary flow capacity (CFC) is another flow-based concept in diagnosing ischaemic heart disease, based on hyperaemic average peak velocity (hAPV) and CFR. We evaluated clinical and haemodynamic factors which potentially influence CFR and CFC in non-obstructed coronary arteries.

Methods and results: Intracoronary Doppler flow velocity measurements to obtain CFR and CFC were performed after inducing hyperaemia in 390 non-obstructed vessels of patients who were scheduled for elective percutaneous coronary intervention (PCI) of another vessel. Akaike’s information criterion (AIC) revealed age, female gender, history of myocardial infarction, hypercholesterolaemia, diastolic blood pressure, oral nitrates and rate pressure product as independent predictors of CFR and CFC. After regression analysis, age and female gender were associated with lower CFR and age was associated with worse CFC in angiographically non-obstructed vessels.

Conclusions: Age and female gender are associated with lower CFR, and age with worse CFC in an angiographically non-obstructed coronary artery. CFC seems to be less sensitive to variations in clinical and haemodynamic parameters than CFR and is therefore a promising tool in contemporary clinical decision making in the cardiac catheterisation laboratory.

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