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Physiological changes associated to ageing in the coronary circulation and its relevance for hyperaemic and non-hyperaemic indices of stenosis relevance
Session:
CO 14 - Doença coronária
Speaker:
Daniel Faria
Congress:
CPC 2021
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.3 Coronary Artery Disease – Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Daniel Candeias Faria
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">BACKGROUND: The clinical impact of age-dependent coronary physiology changes regarding FFR, resting Pd/Pa and microcirculatory function in patients with coronary artery disease remains unclear.</span></span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">OBJECTIVES: We aimed to investigate the modifications in coronary physiology associated to ageing, paying attention to its impact on hyperemic and non-hyperaemic indices of stenosis relevance. </span></span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">METHODS: We performed a pooled patient-level analysis of three prospective international studies, including 1134 patients (1328 vessels) with coronary stenoses interrogated with pressure and flow (thermodilution) guidewires. The age dependent correlations of hyperemic- and non-hyperemic translesional pressure ratio (fractional flow reserve [FFR]and Pd/Pa, respectively) and microcirculation function indices (coronary flow reserve [CFR] and microcirculatory resistance [IMR]) were calculated. Patients were stratified into age related groups, and the respective prevalences of FFR and basal Pd/Pa concordance and discordance were calculated and compared. Patient evolution over a 5 year period was assessed in different age groups, paying attention to vessel oriented patient ocutomes [VOCO], comprised of cardiac death, target vessel related myocardial infarction and target vessel revascularization.</span></span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">RESULTS: Age correlated positively with FFR (</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">r = 0.08, 95% CI: 0.03 to 0.13, p = 0.005</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">), but not with Pd/Pa (</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">r = -0.03, 95% CI:-0.09 to 0.02, p = 0.242</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">). CFR correlated negatively with age (</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">r = -0.15, 95% CI: -0.21 to -0.10, p <0.001</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">) due to a significant decrease in maximal hyperaemic flow in older patients, </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">without a significant increase in baseline flow or resistance - Figure A. Older patients with FFR-guided deferred-PCI with abnormal resting Pd/Pa (≤ 0.92) had significantly more VOCO (HR 2.10, 95% CI: 1.15 to 4.36, p=0.048) - Figure B. This finding was in line with the impact of microvascular dysfunction as assessed by CFR ≤ 2.00 (HR 2.46, 95% CI: 1.23 to 4.96, p = 0.011). </span></span></span></span></span></span></p> <p style="text-align:justify"> </p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">CONLUSIONS: Ageing is associated with marked decrease in microcirculatory function, as assessed with CFR and other indices. In older patients in whom PCI is deferred on the grounds of FFR values, both CFR and Pd/Pa have an incremental value in predicting future VOCO.</span></span></span></p>
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