Author + information
- Received July 17, 2019
- Revision received August 23, 2019
- Accepted August 27, 2019
- Published online January 6, 2020.
- Tim P. van de Hoef, MD, PhDa,b,∗∗ (, )
- Mauro Echavarria-Pinto, MD, PhDb,c,∗,
- Martijn Meuwissen, MD, PhDd,
- Valerie E. Stegehuis, MDa,
- Javier Escaned, MD, PhDb,e and
- Jan J. Piek, MD, PhDa
- aAmsterdam UMC, University of Amsterdam, Heart Center, Department of Interventional Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- bCardiovascular Institute, Hospital Clínico San Carlos, and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- cHospital General ISSSTE – Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, México
- dDepartment of Cardiology, Amphia Hospital, Breda, the Netherlands
- eFaculty of Medicine, Complutense University, Madrid, Spain
- ↵∗Address for correspondence:
Dr. Tim P. van de Hoef, Academic Medical Center, AMC Heartcenter, Room B2-213, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
Objectives This study sought to investigate the contribution of age-related microcirculatory dysfunction to abnormal coronary hemodynamics in patients with coronary atherosclerosis.
Background Impairment in myocardial blood supply in patients with coronary atherosclerosis can be accentuated due to age-related changes in microcirculatory function.
Methods Intracoronary pressure and flow were measured with the Doppler technique in 299 vessels (228 patients), and the thermodilution technique in 120 vessels (99 patients). In 172 patients, Doppler measurements were also performed in unobstructed vessels. Associations of coronary hemodynamics with aging were studied in both the stenosed and unobstructed arteries.
Results Aging was associated with a progressive increase in minimal microvascular resistance and a progressive decrease in hyperemic flow in both obstructed and nonobstructed coronary arteries. As such, coronary flow reserve decreased with advancing age. Epicardial stenosis severity assessed by resting Pd/Pa, basal stenosis resistance index, and hyperemic stenosis resistance index was equivalent across age groups. By contrast, fractional flow reserve increased with advancing age. Consequently, the adjusted risk of a fractional flow reserve/coronary flow reserve pattern reflective of concomitant focal epicardial and diffuse or microvascular disease (relative risk: 1.6; 95% confidence interval: 1.1 to 2.3; p = 0.017) increased with advancing age, whilst the adjusted risk of a fractional flow reserve/coronary flow reserve pattern reflective of non–flow-limiting stenosis with a healthy microcirculation decreased (relative risk: 0.7; 95% CI: 0.5 to 1.0; p = 0.022).
Conclusions Aging is associated with progressive pan-myocardial impairment of coronary vasodilatory capacity due to an increase in minimal microvascular resistance. Concomitant aging-related impairment in microvascular function impacts the pathophysiology of ischemic heart disease in the individual patient and is not adequately identified by hyperemic coronary pressure measurements alone.
- coronary flow reserve
- coronary microvascular function
- coronary physiology
- fractional flow reserve
- physiological stenosis severity
↵∗ Drs. van de Hoef and Echavarria-Pinto contributed equally to this work.
This study was funded, in part, by the European Community’s Seventh Framework Programme (FP7/2007–2013) under grant agreement no. 224495 (euHeart project), and by grants from the Dutch Heart Foundation (2006B186 and D96.020). Dr. Echavarria-Pinto was supported by a clinical scholarship from Fundación Interhospitalaria Investigacion Cardiovascular, Madrid, Spain. Drs. van de Hoef, Echavarria-Pinto, and Escaned have served as speakers for St. Jude Medical and Volcano Corporation. Dr. Meuwissen has served as a speaker for Volcano Corporation. Dr. Piek has received consulting and personal fees from Philips/Volcano; and has been an advisory board member for Philips/Volcano. Dr. Stegehuis has reported that she has no relationships relevant to the contents of this paper to disclose.
- Received July 17, 2019.
- Revision received August 23, 2019.
- Accepted August 27, 2019.
- 2020 American College of Cardiology Foundation
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