Key result
Functional CMD with abnormal CFR and normal IMR links to higher 5-year all-cause mortality.
Why the study?
Coronary microvascular dysfunction endotypes identified by combined CFR and IMR assessment have not been fully established regarding long-term prognosis.
Does functional coronary microvascular dysfunction increase the risk of all-cause mortality in patients with non-obstructive coronary artery disease?
Observational (n=243)
Does functional coronary microvascular dysfunction increase the risk of all-cause mortality in patients with non-obstructive coronary artery disease?
p-value: p=<0.0001
Functional coronary microvascular dysfunction (abnormal CFR with normal IMR) is a significant predictor of 5-year all-cause mortality in patients with non-obstructive coronary artery disease.
May aid risk stratification in non-obstructive CAD; extends prior associations but leaves open need for prospective trials.
Background Coronary microvascular dysfunction (CMD) has been reported to be associated with adverse cardiovascular events. However, CMD endotypes, which were identified using a combined assessment of coronary flow reserve (CFR) and the index of microvascular resistance (IMR) have not been fully established. Purpose This study aimed to investigate the long-term prognosis of CMD endotypes. Methods We included 378 patients (384 vessels), of whom 243 patients (248 vessels) had non-obstructive coronary artery disease (fractional flow reserve [FFR] >0.80) and were analyzed. The primary endpoint was all-cause mortality at 5 years. Functional CMD was defined as abnormal CFR (<2.5) with normal IMR (<25), while structural CMD was defined as abnormal CFR with abnormal IMR. Results In non-obstructive coronary arteries, the median FFR and CFR (Q1, Q3) were 0.88 (0.85, 0.92) and 2.4 (1.8, 3.2), respectively. The median follow-up was 1,829 days. Abnormal CFR was significantly associated with higher long-term mortality (log-rank P = 0.0007), whereas abnormal IMR was not (log-rank P = 0.34). Kaplan-Meier analysis showed significantly higher mortality in the functional CMD group (log-rank P <0.0001). Conclusions Functional CMD, defined as abnormal CFR (<2.5) with normal IMR (<25), was associated with increased mortality at 5 years.
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Yamanaka et al. (2025) conducted an observational in Non-obstructive coronary artery disease (n=243). Functional coronary microvascular dysfunction vs. Other CMD endotypes was evaluated on All-cause mortality at 5 years (p=<0.0001). Functional coronary microvascular dysfunction, defined as abnormal CFR (<2.5) with normal IMR (<25), was significantly associated with higher all-cause mortality at 5 years (log-rank P <0.0001).
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