Microvascular resistance reserve: Impact on health status and myocardial perfusion after revascularization in chronic coronary syndrome

Laust Dupont Rasmussen; Jelmer Westra; Salma Raghad Karim; Jonathan Nørtoft Dahl; Jacob Hartmann Søby; June Anita Ejlersen; Lars Christian Gormsen; Ashkan Eftekhari; Evald Høj Christiansen; Morten Bøttcher; Simon Winther

doi:10.1093/eurheartj/ehae604

Microvascular resistance reserve: Impact on health status and myocardial perfusion after revascularization in chronic coronary syndrome

Laust Dupont Rasmussen^*, Jelmer Westra, Salma Raghad Karim, Jonathan Nørtoft Dahl, Jacob Hartmann Søby, June Anita Ejlersen, Lars Christian Gormsen, Ashkan Eftekhari, Evald Høj Christiansen, Morten Bøttcher, Simon Winther

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

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Abstract

Background and Aims: The microvascular resistance reserve (MRR) is a novel invasive index of the microcirculation, which is independent of epicardial stenoses, and has both diagnostic and prognostic implications. This study investigates whether MRR is associated with health status outcomes by revascularization in patients with moderate coronary stenoses. Methods: Consecutive patients with stable chest pain and moderate (30%-90% diameter) stenoses on invasive coronary angiography (n = 222) underwent invasive physiology assessment. Revascularization was performed according to guideline recommendations. At baseline and follow-up, health status and myocardial perfusion were assessed by the Seattle Angina Questionnaire (SAQ) and positron emission tomography. The primary endpoint was freedom from angina at follow-up with secondary endpoints including changes in health status by SAQ domains and myocardial perfusion by MRR and revascularization status. Low MRR was defined as ≤3.0. Results: Freedom from angina occurred in 38/173 patients. In multivariate analyses, MRR was associated with freedom from angina at follow-up (odds ratio 0.860, 95% confidence interval 0.740-0.987). By MRR and revascularization groups, patients with normal MRR who did not undergo revascularization, and patients with abnormal MRR who underwent revascularization, had improved health status of angina frequency [mean difference SAQ angina frequency score 8.5 (3.07-13.11) and 13.5 (2.82-23.16), respectively]. For both groups, health status of physical limitation [mean difference in SAQ physical limitation score 9.7 (4.79-11.93) and 8.7 (0.53-13.88), respectively] and general health status [mean difference in SAQ summary score 9.3 (5.18-12.50) and 10.8 (2.51-17.28), respectively] also improved. Only patients with abnormal MRR who underwent revascularization had improved myocardial perfusion. Conclusions: In patients with moderate coronary stenoses, MRR seems to predict the symptomatic and perfusion benefit of revascularization.

Original language	English
Journal	European Heart Journal
Volume	46
Issue	5
Pages (from-to)	424-435
Number of pages	12
ISSN	0195-668X
DOIs	https://doi.org/10.1093/eurheartj/ehae604
Publication status	Published - 1 Feb 2025

Keywords

Chronic coronary syndrome
Health status
Microvascular resistance reserve
Revascularization

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10.1093/eurheartj/ehae604

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Rasmussen, L. D., Westra, J., Karim, S. R., Dahl, J. N., Søby, J. H., Ejlersen, J. A., Gormsen, L. C., Eftekhari, A., Christiansen, E. H., Bøttcher, M., & Winther, S. (2025). Microvascular resistance reserve: Impact on health status and myocardial perfusion after revascularization in chronic coronary syndrome. European Heart Journal, 46(5), 424-435. https://doi.org/10.1093/eurheartj/ehae604

@article{c2738ed9bc064ec7a56e043dc1da841c,

title = "Microvascular resistance reserve: Impact on health status and myocardial perfusion after revascularization in chronic coronary syndrome",

abstract = "Background and Aims: The microvascular resistance reserve (MRR) is a novel invasive index of the microcirculation, which is independent of epicardial stenoses, and has both diagnostic and prognostic implications. This study investigates whether MRR is associated with health status outcomes by revascularization in patients with moderate coronary stenoses. Methods: Consecutive patients with stable chest pain and moderate (30%-90% diameter) stenoses on invasive coronary angiography (n = 222) underwent invasive physiology assessment. Revascularization was performed according to guideline recommendations. At baseline and follow-up, health status and myocardial perfusion were assessed by the Seattle Angina Questionnaire (SAQ) and positron emission tomography. The primary endpoint was freedom from angina at follow-up with secondary endpoints including changes in health status by SAQ domains and myocardial perfusion by MRR and revascularization status. Low MRR was defined as ≤3.0. Results: Freedom from angina occurred in 38/173 patients. In multivariate analyses, MRR was associated with freedom from angina at follow-up (odds ratio 0.860, 95% confidence interval 0.740-0.987). By MRR and revascularization groups, patients with normal MRR who did not undergo revascularization, and patients with abnormal MRR who underwent revascularization, had improved health status of angina frequency [mean difference SAQ angina frequency score 8.5 (3.07-13.11) and 13.5 (2.82-23.16), respectively]. For both groups, health status of physical limitation [mean difference in SAQ physical limitation score 9.7 (4.79-11.93) and 8.7 (0.53-13.88), respectively] and general health status [mean difference in SAQ summary score 9.3 (5.18-12.50) and 10.8 (2.51-17.28), respectively] also improved. Only patients with abnormal MRR who underwent revascularization had improved myocardial perfusion. Conclusions: In patients with moderate coronary stenoses, MRR seems to predict the symptomatic and perfusion benefit of revascularization.",

keywords = "Chronic coronary syndrome, Health status, Microvascular resistance reserve, Revascularization",

author = "Rasmussen, {Laust Dupont} and Jelmer Westra and Karim, {Salma Raghad} and Dahl, {Jonathan N{\o}rtoft} and S{\o}by, {Jacob Hartmann} and Ejlersen, {June Anita} and Gormsen, {Lars Christian} and Ashkan Eftekhari and Christiansen, {Evald H{\o}j} and Morten B{\o}ttcher and Simon Winther",

year = "2025",

month = feb,

day = "1",

doi = "10.1093/eurheartj/ehae604",

language = "English",

volume = "46",

pages = "424--435",

journal = "European Heart Journal",

issn = "0195-668X",

publisher = "Oxford University Press",

number = "5",

}

Rasmussen, LD , Westra, J , Karim, SR, Dahl, JN, Søby, JH, Ejlersen, JA, Gormsen, LC, Eftekhari, A, Christiansen, EH , Bøttcher, M & Winther, S 2025, 'Microvascular resistance reserve: Impact on health status and myocardial perfusion after revascularization in chronic coronary syndrome', European Heart Journal, vol. 46, no. 5, pp. 424-435. https://doi.org/10.1093/eurheartj/ehae604

Microvascular resistance reserve: Impact on health status and myocardial perfusion after revascularization in chronic coronary syndrome. / Rasmussen, Laust Dupont ; Westra, Jelmer ; Karim, Salma Raghad et al.
In: European Heart Journal, Vol. 46, No. 5, 01.02.2025, p. 424-435.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Microvascular resistance reserve

T2 - Impact on health status and myocardial perfusion after revascularization in chronic coronary syndrome

AU - Rasmussen, Laust Dupont

AU - Westra, Jelmer

AU - Karim, Salma Raghad

AU - Dahl, Jonathan Nørtoft

AU - Søby, Jacob Hartmann

AU - Ejlersen, June Anita

AU - Gormsen, Lars Christian

AU - Eftekhari, Ashkan

AU - Christiansen, Evald Høj

AU - Bøttcher, Morten

AU - Winther, Simon

PY - 2025/2/1

Y1 - 2025/2/1

N2 - Background and Aims: The microvascular resistance reserve (MRR) is a novel invasive index of the microcirculation, which is independent of epicardial stenoses, and has both diagnostic and prognostic implications. This study investigates whether MRR is associated with health status outcomes by revascularization in patients with moderate coronary stenoses. Methods: Consecutive patients with stable chest pain and moderate (30%-90% diameter) stenoses on invasive coronary angiography (n = 222) underwent invasive physiology assessment. Revascularization was performed according to guideline recommendations. At baseline and follow-up, health status and myocardial perfusion were assessed by the Seattle Angina Questionnaire (SAQ) and positron emission tomography. The primary endpoint was freedom from angina at follow-up with secondary endpoints including changes in health status by SAQ domains and myocardial perfusion by MRR and revascularization status. Low MRR was defined as ≤3.0. Results: Freedom from angina occurred in 38/173 patients. In multivariate analyses, MRR was associated with freedom from angina at follow-up (odds ratio 0.860, 95% confidence interval 0.740-0.987). By MRR and revascularization groups, patients with normal MRR who did not undergo revascularization, and patients with abnormal MRR who underwent revascularization, had improved health status of angina frequency [mean difference SAQ angina frequency score 8.5 (3.07-13.11) and 13.5 (2.82-23.16), respectively]. For both groups, health status of physical limitation [mean difference in SAQ physical limitation score 9.7 (4.79-11.93) and 8.7 (0.53-13.88), respectively] and general health status [mean difference in SAQ summary score 9.3 (5.18-12.50) and 10.8 (2.51-17.28), respectively] also improved. Only patients with abnormal MRR who underwent revascularization had improved myocardial perfusion. Conclusions: In patients with moderate coronary stenoses, MRR seems to predict the symptomatic and perfusion benefit of revascularization.

AB - Background and Aims: The microvascular resistance reserve (MRR) is a novel invasive index of the microcirculation, which is independent of epicardial stenoses, and has both diagnostic and prognostic implications. This study investigates whether MRR is associated with health status outcomes by revascularization in patients with moderate coronary stenoses. Methods: Consecutive patients with stable chest pain and moderate (30%-90% diameter) stenoses on invasive coronary angiography (n = 222) underwent invasive physiology assessment. Revascularization was performed according to guideline recommendations. At baseline and follow-up, health status and myocardial perfusion were assessed by the Seattle Angina Questionnaire (SAQ) and positron emission tomography. The primary endpoint was freedom from angina at follow-up with secondary endpoints including changes in health status by SAQ domains and myocardial perfusion by MRR and revascularization status. Low MRR was defined as ≤3.0. Results: Freedom from angina occurred in 38/173 patients. In multivariate analyses, MRR was associated with freedom from angina at follow-up (odds ratio 0.860, 95% confidence interval 0.740-0.987). By MRR and revascularization groups, patients with normal MRR who did not undergo revascularization, and patients with abnormal MRR who underwent revascularization, had improved health status of angina frequency [mean difference SAQ angina frequency score 8.5 (3.07-13.11) and 13.5 (2.82-23.16), respectively]. For both groups, health status of physical limitation [mean difference in SAQ physical limitation score 9.7 (4.79-11.93) and 8.7 (0.53-13.88), respectively] and general health status [mean difference in SAQ summary score 9.3 (5.18-12.50) and 10.8 (2.51-17.28), respectively] also improved. Only patients with abnormal MRR who underwent revascularization had improved myocardial perfusion. Conclusions: In patients with moderate coronary stenoses, MRR seems to predict the symptomatic and perfusion benefit of revascularization.

KW - Chronic coronary syndrome

KW - Health status

KW - Microvascular resistance reserve

KW - Revascularization

UR - http://www.scopus.com/inward/record.url?scp=85217032016&partnerID=8YFLogxK

U2 - 10.1093/eurheartj/ehae604

DO - 10.1093/eurheartj/ehae604

M3 - Journal article

C2 - 39217607

SN - 0195-668X

VL - 46

SP - 424

EP - 435

JO - European Heart Journal

JF - European Heart Journal

IS - 5

ER -

Microvascular resistance reserve: Impact on health status and myocardial perfusion after revascularization in chronic coronary syndrome

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