Epicardial atherosclerosis is associated with a higher mean index of myocardial resistance compared to controls (25 vs 19; P<0.01), although there is large overlap between the groups.
Observational (n=116)
Does the presence of epicardial atherosclerosis influence coronary microvascular function as measured by the index of myocardial resistance (IMR)?
Patients with epicardial atherosclerosis have a higher mean index of myocardial resistance (IMR) compared to those without, indicating impaired microvascular function, though there is significant overlap between the groups.
Absolute Event Rate: 25% vs 19%
p-value: p=<0.01
AIMS: The influence of atherosclerosis and its risk factors on coronary microvascular function remain unclear as current methods of assessing microvascular function do not specifically test the microcirculation in isolation. We examined the influence of epicardial vessel atherosclerosis on coronary microvascular function using the index of myocardial resistance (IMR). METHODS AND RESULTS: IMR (a measure of microvascular function) and fractional flow reserve (FFR, a measure of the epicardial compartment) were measured in 143 coronary arteries (116 patients). Fifteen patients (22 arteries, mean age 48+/-16 years) had no clinical evidence of atherosclerosis (control group). One hundred and one patients (121 arteries, mean age 63+/-11 years) had established atherosclerosis and multiple cardiovascular risk factors (atheroma group). Mean IMR in the control group (19+/-5, range 8-28) was significantly lower than in the atheroma group (25+/-13, range 6-75) (P<0.01). However, there was large overlap between IMR in both groups, with 69% of IMR values in patients with atheroma being within the control range. Mean FFR was also higher in the control group (0.96+/-0.02, range 0.93-1.00) than in the atheroma group (0.85+/-0.14, range 0.19-1.00) (P<0.01). There was no correlation between IMR and FFR (r=0.09; P=0.24), even when results in the control (r=0.02; P=0.92) and atheroma (r=0.15; P=0.10) groups were analysed in isolation. Using stepwise multiple regression analysis presence/absence of atheroma (ss=0.42; P=0.02) was the only independent determinant of IMR. CONCLUSIONS: Mean IMR is higher in patients with epicardial atherosclerosis. However, there is a large overlap between IMR in patients with and without epicardial atherosclerosis.
Melikian et al. (2010) conducted an observational in Epicardial atherosclerosis (n=116). Epicardial atherosclerosis vs. No clinical evidence of atherosclerosis was evaluated on Index of myocardial resistance (IMR) (p=<0.01). Epicardial atherosclerosis is associated with a higher mean index of myocardial resistance compared to controls (25 vs 19; P<0.01), although there is large overlap between the groups.