Multiparametric analysis of coronary flow in psoriasis using a coronary flow reserve companion

Figures

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  FIGURE 1. Cartesian and polar coordinates in the flow velocity domain. The coronary flow velocity reserve (CFVR) is defined by the ratio of the maximal coronary diastolic flow velocity during hyperaemia (CFVh) and the maximal coronary diastolic flow velocity at rest (CFVr). Reportedly, coronary microvascular dysfunction (CMD) is present when CFVR ≤2.5 (see green marked triangular area). The graph shows the CFVh (cm/s) versus CFVr (cm/s) for three hypothetical patients: Red dot with Cartesian coordinates {25, 50} and slope CFVR = 50/25 = 2.0. Blue dot with Cartesian coordinates {40, 80} and slope CFVR = 80/40 = 2.0. Purple dot with Cartesian coordinates {25, 80} and slope (not shown) CFVR = 80/25 = 3.2. Clearly, the CFVR values for the red and blue dots are identical, although the flow velocity levels both at rest and during hyperaemia are substantially different. This discrepancy indicates that CFVR alone cannot adequately define (normal nor impaired) myocardial perfusion conditions. The CFVh level for the blue dot is similar to that for the purple dot, which is located outside the CMD zone, with a “healthy” CFVR =3.2. The difference between various (patho)physiological states can be…

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  FIGURE 2. Scatter plot of the coronary flow velocity reserve and hyperemic diastolic coronary flow velocity. Concordant and discordant impairment of the coronary flow velocity reserve (CFVR) and hyperemic diastolic coronary flow velocity (CFVh) identified four endotypes of patients. CFVR ≤ 2.5 and CFVh ≤65 cm/s were defined as abnormal. The PASI of the individual endotypes is shown in the smaller boxes (median and interquartile range)

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  FIGURE 3. Haemodynamic and microvascular coronary flow parameters relative to each endotype and in healthy subjects. Coronary flow velocity reserve was preserved (CFVR) (>2.5) in both endotype 1 and 2. However, endotype 1 showed different coronary flow parameters compared to endotype 2, in particular lower CFVR (C, p = 0.01) with lower CFVr (A) and higher BMR (D)

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  FIGURE 4. cCFVR in each endotype and in healthy subjects. cCFVR was lower in endotype 1 than in endotype 2 (p < 0.001) and healthy subjects (p < 0.0001)

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  FIGURE 5. Comparison between various endotypes and healthy controls. The table specifies the differences in the baseline (BMR) and hyperemic microvascular resistance (HMR), arteriolar resistance index (ARI) and ARI% between four endotypes (n = 38, 63, 21 and 5, respectively) and healthy controls (n = 52). The lower part visualizes the possible patho‐physiological mechanism underlying the different endotypes, compared with healthy subjects

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  FIGURE 6. Coronary flow velocity reserve was preserved (CFVR) change after therapy across the different endotypes. The CFVR was unchanged in 3 (4%) patients with endotype 2 and worsened after 6 months of therapy only in 11 patients (14%), all of which were of endotype 1 (endotype 1, n = 25; endotype 2, n = 30; endotype 3, n = 19; endotype 4, n = 4). Groups were compared by Kruskal‐Wallis with the Dunn multiple comparisons test

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  FIGURE 7. Ability of Coronary flow velocity reserve was preserved (CFVR) and cCFVR to predict depressed CFVR by receiver operating characteristic (ROC) curve analysis. (A) A lower CFVR at baseline is not associated with worse CFVR at follow‐up. The area under the curve was 0.582 with a standard error of 0.108, yielding a 95% confidence interval (CI) of 0.371 to 0.793 (p = 0.4). (B) A lower cCFVR was associated with worse CFVR at follow‐up. The area under the curve was 0.809 with a standard error of 0.088, yielding a 95% CI of 0.636–0.982 (p = 0.002)