Higher angiography-derived microcirculatory resistance was independently associated with increased 5-year MACE risk in DCMrEF patients, with LAD-AMR yielding an AUC of 0.776 (P<0.001).
Cohort (n=531)
Yes
Does Angiography-derived microcirculatory resistance (AMR) predict 5-year MACE and identify patients who benefit from vericiguat in patients with dilated cardiomyopathy with reduced ejection fraction?
Angiography-derived microcirculatory resistance is an independent predictor of 5-year MACE in patients with DCMrEF and may identify a high-risk subgroup that specifically benefits from vericiguat therapy.
p-value: p=<0.001
BACKGROUND Coronary microvascular dysfunction (CMD) is associated with poor prognosis in patients with dilated cardiomyopathy with reduced ejection fraction (DCMrEF). However, its assessment remains challenging in routine clinical practice. This study aims to explore the potential value of Angiography-derived microcirculatory resistance (AMR) in predicting clinical outcomes in DCMrEF patients. METHODS This multicenter retrospective study included DCMrEF patients (2019-2024) with a 5-year MACE endpoint. AMR was calculated for all major arteries. Its prognostic value was assessed by Kaplan-Meier and multivariate Cox regression. A subgroup analysis was conducted to evaluate the impact of vericiguat treatment on clinical outcomes according to patients' baseline AMR levels. RESULTS A total of 531 eligible patients with DCMrEF were enrolled in the study, 204 of whom had endpoint events. The optimal AMR cutoffs were >2.295 for the left anterior descending (LAD) artery (AUC=0.776) and left circumflex (LCX) artery, (AUC=0.761), and >2.5 for the right coronary artery (RCA) (AUC=0.745), all with P < 0.001. Patients were then classified into the higher AMR group and the lower AMR group. Kaplan-Meier and multivariate Cox analyses confirmed higher AMR was independently associated with increased MACE risk. LAD-AMR significantly improved risk reclassification over traditional factors (NRI=0.015, IDI=0.051; both P<0.001). Subgroup analysis revealed vericiguat benefitted only patients with elevated AMR. CONCLUSIONS AMR may be a powerful independent predictor of poor prognosis in DCMrEF patients, with LAD-AMR showing potential for greater predictive value. Vericiguat may represent a potential precision-targeted agent for the high risk of heart failure mediated by microcirculatory dysfunction.
Wang et al. (Thu,) conducted a cohort in Dilated cardiomyopathy with reduced ejection fraction (DCMrEF) (n=531). Angiography-derived microcirculatory resistance (AMR) assessment and vericiguat therapy vs. Lower AMR group was evaluated on 5-year MACE (p=<0.001). Higher angiography-derived microcirculatory resistance was independently associated with increased 5-year MACE risk in DCMrEF patients, with LAD-AMR yielding an AUC of 0.776 (P<0.001).