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Structural invasively-assessed coronary microvascular dysfunction phenotype associates with the presence of myocardial fibrosis in cardiac magnetic resonance
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 13 - FRONTEIRAS INOVADORAS NO DIAGNÓSTICO DA DOENÇA ARTERIAL CORONÁRIA E AVALIAÇÃO DE RISCO: DA IMAGEM AVANÇADA AOS RESULTADOS CLÍNICOS
Speaker:
Miguel Marques Antunes
Congress:
CPC 2025
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.1 Invasive Imaging and Functional Assessment
Session Type:
Comunicações Orais
FP Number:
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Authors:
Miguel Marques Antunes; Francisco Barbas Albuquerque; Eunice Oliveira; Ana Santana; Pedro Garcia Brás; Tiago Mendonça; Tiago Pereira da Silva; Rúben Ramos; Duarte Cacela; Rui Cruz Ferreira; Sílvia Aguiar Rosa; António Fiarresga
Abstract
<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><strong><span style="font-size:10.5pt">Background:</span></strong><span style="font-size:10.5pt"> Coronary microvascular disfunction (CMD) is related to the affection of the coronary microvasculature, common in hypertrophic cardiomyopathy (HCM). Invasive assessment of CMD through thermodilution methods allows for the calculation of coronary flow reserve (CFR) and index of microvascular resistance (IMR) - categorizing these patients (P) under a functional (low CFR normal IMR) or structural (low CFR high IMR) CMD phenotype. A structural disease phenotype is expected to be associated to myocardial fibrosis - however, this has never been demonstrated.</span></span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><strong><span style="font-size:10.5pt">Objectives:</span></strong><span style="font-size:10.5pt"> To correlate findings of a structural invasively assessed CMD phenotype with myocardial fibrosis evaluated by cardiac magnetic resonance (CMR).</span></span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><strong><span style="font-size:10.5pt">Methods:</span></strong><span style="font-size:10.5pt"> In a prospective single-center study, we opportuniscally recruited consecu</span><span style="font-size:10.0pt">ti</span><span style="font-size:10.5pt">ve adult P with an established diagnosis of HCM that had an indication to pursue elective coronarography (Figure 1). CFR was calculated as the ra</span><span style="font-size:10.0pt">ti</span><span style="font-size:10.5pt">o between res</span><span style="font-size:10.0pt">ti</span><span style="font-size:10.5pt">ng and hyperemia mean transit </span><span style="font-size:10.0pt">ti</span><span style="font-size:10.5pt">mes (T</span><span style="font-size:8.5pt">mn</span><span style="font-size:10.5pt">Rest;T</span><span style="font-size:8.5pt">mn</span><span style="font-size:10.5pt">Hyper). IMR was calculated as the ra</span><span style="font-size:10.0pt">ti</span><span style="font-size:10.5pt">o between distal coronary pressure (Pd) and the inverse of T</span><span style="font-size:8.5pt">mn</span><span style="font-size:10.5pt">Hyper (IMR=Pd/T</span><span style="font-size:8.5pt">mn</span><span style="font-size:10.5pt">Hyper</span><span style="font-size:8.0pt">-1</span><span style="font-size:10.5pt">). A cutoff of ≤22.0 in IMR, and </span>≥<span style="font-size:10.5pt"> 2 in CFR was used. P characteristics, coronary hemodynamic invasive assessment, and CMR data with quantification of late gadolinium enhancement (LGE) were obtained. A logistic regression model was used to test the predictive effect of LGE on CMD phenotype.</span></span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><strong><span style="font-size:10.5pt">Results:</span></strong><span style="font-size:10.5pt"> 34 consecutive P underwent invasive coronary microvascular assessment. Of these 13 P - median age 65 [57-75], 7 (54%) of which female - had a CFR ≤ 2 and CMR with LGE evaluation data available and were therefore included in this analysis (Table 1). Median CFR was 1.5 [1.2-1.5] and median IMR was 19 [14-20]. A total of 3 P (23%) had a phenotype compatible with structural CMD, with the remaining P presenting a functional CMD phenotype (Table 2). CMR revealed a median 8% [6%-15%] LGE of LV mass quantification. </span></span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><span style="font-size:10.5pt">P with a structural CMD phenotype had a statistically significant higher LGE % – median 17% [14-19] vs 6% [6-8] (Table 3). In a logistical regression model, the LGE % correlated with the presence of a structural CMD phenotype – OR 1.4 (95% CI 1.00 – 1.96, p=0.047).</span></span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><strong><span style="font-size:10.5pt">Conclusion:</span></strong><span style="font-size:10.5pt"> In a prospective cohort of HCM P, an invasively-assessed structural CMD phenotype was associated with the presence of extensive myocardial fibrosis assessed by CMR. A percentual increase in LGE correlated with higher odds of finding a structural CMD phenotype. </span></span></span></p>
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