Author + information
- Received October 24, 2017
- Accepted November 21, 2017
- Published online April 16, 2018.
- Joo Myung Lee, MD, MPH, PhDa,
- Hyun Kuk Kim, MD, PhDb,
- Kyung Seob Lim, DVM, PhDc,
- Jun-Kyu Park, PhDd,
- Ki Hong Choi, MDa,
- Jonghanne Park, MDe,
- Doyeon Hwang, MDe,
- Tae-Min Rhee, MDf,
- Jeong Hoon Yang, MDa,g,
- Eun-Seok Shin, MD, PhDh,
- Chang-Wook Nam, MD, PhDi,
- Joon-Hyung Doh, MD, PhDj,
- Joo-Yong Hahn, MD, PhDa,
- Bon-Kwon Koo, MD, PhDe,k,∗ ( and )
- Myung Ho Jeong, MD, PhDc,∗∗ ()
- aDivision of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- bDepartment of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
- cDepartment of Internal Medicine and Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
- dCGBio Co. Ltd, Jangseong, Korea
- eDepartment of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
- fNational Maritime Medical Center, Changwon, Korea
- gDepartment of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- hDepartment of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
- iDepartment of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
- jDepartment of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
- kInstitute on Aging, Seoul National University, Seoul, Korea
- ↵∗Address for correspondence:
Dr. Bon-Kwon Koo, Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul 110-744, Korea.
- ↵∗∗Dr. Myung Ho Jeong, Department of Internal Medicine and Cardiovascular Center, Chonnam National University Hospital, 42 Jaebongro, Dong Ku, Gwangju 501-757, Korea.
Objectives The aim of this study was to investigate the influence of microvascular damage in one vessel territory on invasively measured physiological parameters in the other vessel, using a porcine microvascular damage model.
Background Although fractional flow reserve (FFR)-guided decision-making for the nonculprit stenosis in patients with acute myocardial infarction has been reported to be better than angiography-guided revascularization, there have been debates regarding the influence of microvascular dysfunction on measured FFR in nonculprit vessels.
Methods In Yorkshire swine, microvascular damage was induced with selective intracoronary injection of microspheres (100 μm × 105 each) into the left anterior descending artery (LAD). Coronary stenosis was created in both the LAD and the left circumflex artery (LCx) using balloon catheters. Coronary physiological changes were assessed with index of microcirculatory resistance (IMR) and FFR at baseline and at each subsequent injection of microsphere up to a fifth dose in both the LAD and LCx. Measurements were repeated 5 times at each stage, and a total of 424 measurements were made in 12 Yorkshire swine models.
Results The median area stenosis in LAD and LCx was 48.1% (interquartile range: 40.8% to 50.4%) and 47.9% (interquartile range: 31.1% to 62.9%), respectively. At baseline, FFR in the LAD was lower than that in the LCx (0.89 ± 0.01 and 0.94 ± 0.01; p < 0.001). There was no difference in the IMR (18.4 ± 5.8 U and 17.9 ± 1.2 U; p = 0.847). With repeated injections of microspheres, IMR in LAD was significantly increased, up to 77.7 ± 15.7 U (p < 0.001). Given the same stenosis, FFR in the LAD was also significantly increased, up to 0.98 ± 0.01 along with IMR increase (p < 0.001). Conversely, IMR and FFR were not changed in the LCx throughout repeated injury to the LAD territory (p = 0.105 and p = 0.286 for IMR and FFR, respectively). The increase in LAD IMR was mainly driven by the increase in hyperemic mean transit time (p < 0.001).
Conclusions In Yorkshire swine models, local microvascular damage increased both FFR and IMR in a vessel supplying target myocardial territory. However, IMR and FFR were maintained in the other vessel. These physiological results in swine support the concept that FFR measurement might provide useful information for evaluating nonculprit lesions in clinical settings involving significant acute myocardial injury.
- acute coronary syndrome
- fractional flow reserve
- index of microcirculatory resistance
- myocardial infarction
This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (2017R1C1B5017469). The authors have reported that they have no relationships relevant to the contents of this paper to disclose. The first two authors contributed equally to this work.
- Received October 24, 2017.
- Accepted November 21, 2017.
- 2018 American College of Cardiology Foundation
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