Key result
Pre-PCI LAD-ECV is linked to ~33% higher odds of post-PCI microvascular dysfunction.
Why the study?
The mechanistic link between pre-procedural structural remodeling, measured by CCTA-derived myocardial extracellular volume fraction, and post-PCI microvascular function, assessed by coronary flow velocity reserve, in chronic coronary syndrome remained to be elucidated.
Does pre-procedural CCTA-derived LAD-ECV predict post-PCI microvascular dysfunction (CFVR <2.5) in patients with chronic coronary syndrome undergoing PCI for de novo LAD lesions?
Cohort (n=43)
Does pre-procedural CCTA-derived LAD-ECV predict post-PCI microvascular dysfunction (CFVR <2.5) in patients with chronic coronary syndrome undergoing PCI for de novo LAD lesions?
Pre-procedural CCTA-derived myocardial extracellular volume fraction in the LAD territory independently predicts post-PCI coronary microvascular dysfunction in patients with chronic coronary syndrome.
Background Myocardial extracellular volume fraction (ECV) derived from coronary computed tomography angiography (CCTA) is an established surrogate for myocardial interstitial characterization, including fibrosis, inflammation, and edema. While post-percutaneous coronary intervention (PCI) coronary flow velocity reserve (CFVR)—measured via stress transthoracic Doppler echocardiography (S-TDE)—is a pivotal prognostic indicator of microvascular integrity in chronic coronary syndrome (CCS), the mechanistic link between pre-procedural structural remodeling (ECV) and post-procedural functional outcomes (CFVR) remains to be elucidated. Methods We prospectively evaluated CCS patients undergoing CCTA prior to PCI for de novo left anterior descending artery (LAD) lesions, followed by post-PCI S-TDE. The primary objective was to determine the association between pre-PCI ECV within the LAD territory (LAD-ECV) and post-PCI microvascular dysfunction, defined as a CFVR <2.5. Results Of the 43 patients enrolled (mean age 67.6±11.3 years), 52.8% exhibited impaired post-PCI CFVR. Pre-PCI LAD-ECV demonstrated a robust inverse correlation with post-PCI CFVR (R = -0.460, P = 0.002). Multivariable linear regression identified LAD-ECV (β = -0.079, P < 0.001) and estimated glomerular filtration rate (β = 0.014, P = 0.009) as independent predictors of post-PCI CFVR. Notably, LAD-ECV was the sole significant predictor for impaired CFVR in logistic regression analysis (OR: 1.33, P = 0.002). Receiver operating characteristic analysis revealed a superior diagnostic performance for LAD-ECV (AUC 0.854), with an optimal threshold of 31.8%. Patients with LAD-ECV >31.8% had a strikingly higher prevalence of microvascular impairment compared to those below the threshold (80.8% vs. 6.2%, P < 0.001). Conclusion Pre-procedural CCTA-derived ECV serves as a novel and potent predictor of post-PCI microvascular function. This non-invasive structural assessment offers critical insights into the functional recovery of the coronary microvasculature following revascularization in patients with CCS.
No takes yet. Share an insight, caveat, or question.
Sayama et al. (2026) conducted a cohort in Chronic coronary syndrome (n=43). Pre-PCI CCTA-derived extracellular volume fraction within the LAD territory (LAD-ECV >31.8%) vs. LAD-ECV ≤31.8% was evaluated on Post-PCI microvascular dysfunction, defined as a coronary flow velocity reserve (CFVR) <2.5 (OR 1.33, p=0.002). Pre-PCI CCTA-derived LAD-ECV independently predicted post-PCI microvascular dysfunction (OR 1.33, P=0.002), with rates of 80.8% vs 6.2% (P<0.001) using a 31.8% threshold.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: