Differential Interaction of High Microvascular Resistance With Coronary Flow Reserve Across Coronary Microvascular Dysfunction Endotypes

Figures

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  Figure 1. Methodology of the Study Study methodology flow chart and signal analysis with illustration of arterial reservoir pressure and excess pressure. bAPV = baseline average peak velocity; bMR = baseline microvascular resistance; CAD = coronary artery disease; CFR = coronary flow reserve; CMD = coronary microvascular dysfunction; FFR = fractional flow reserve; hAPV = hyperemic average peak velocity; hMR = hyperemic microvascular resistance.

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  Figure 2. Comparison of bMR, hMR, and RRR Among CMD and No CMD Endotypes The P values and EMMs [95% CI] are provided in Table 2. bMR = baseline microvascular resistance; CMD = coronary microvascular dysfunction; EMM = estimated marginal means; hMR = hyperemic microvascular resistance; RRR = resistive reserve ratio.

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  Figure 3. Multivariable GLMM Evaluating the Relationship Between CFR and hMR and Pr/Pxs Ratio, Incorporating Clinical Confounders as well as Adjusting for Patient ID (as Random Effect) Among CMD and no CMD Groups Other information about GLMM (e.g., AIC, BIC, random effect) are provided in the Supplemental Appendix. AIC = Akaike Information Criterion; BIC = Bayesian Information Criterion; GLMM = generalized linear mixed models.

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  Central Illustration. Local and Systemic Hemodynamics in Coronary Microvascular Dysfunction and No-Coronary Microvascular Dysfunction Endotypes With High and Low hMR Independent use of high hMR for the diagnosis of CMD should be avoided, as it may mirror a stronger increment in bMR favoring a preserved CFR, without impairment of hyperemic response. High hMR – preserved CFR endotype exhibits favorable coronary and aortic hemodynamics.