Journal of cardiac failure · 2026
Invasive Assessment of Coronary Microvascular Dysfunction in Patients With Wild-Type Transthyretin Amyloid Cardiomyopathy.
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Sunohara Daisuke, Ueki Yasushi, Minamisawa Masatoshi, Sato Mitsuto, Fujimori Koki, Nagae Ayumu, Aoki Takenori, Nishikawa Ken, Suzuki Sho, Itagaki Tadashi, Yamamoto Yuki, Okina Yoshiteru, Nomi Hidetomo, Yoshie Koji, Kato Tamon, Saigusa Tatsuya, Ebisawa Soichiro, Sekijima Yoshiki, Kuwahara Koichiro
Аннотация
BACKGROUND: Coronary microvascular dysfunction (CMD) is frequently observed in patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM). We aimed to investigate the prevalence of CMD and identify factors associated with CMD in patients with ATTRwt-CM by using an intracoronary pressure-temperature wire.
METHODS: Patients with cardiac hypertrophy, defined as an interventricular septum ≥12 mm, who were undergoing invasive CMD assessment by the use of a pressure wire, were evaluated in a prospective, multicenter study conducted between August 2022 and April 2025. CMD was defined as coronary flow reserve (CFR) <2.0 or index of microvascular resistance (IMR) ≥25.
RESULTS: A total of 64 patients (ATTRwt-CM, n = 32; left ventricular hypertrophy (LVH), n = 32) were analyzed. A similar prevalence was observed in the 2 groups (ATTRwt-CM: 68.8%; LVH: 59.4%; P = 0.434). In patients with ATTRwt-CM, CFR and IMR were significantly correlated with troponin T (r = -0.503; P = 0.004, and r = 0.483; P = 0.006, respectively), while such correlations were not observed in the LVH group (r = -0.128; P = 0.501; r = 0.130; P = 0.493, respectively). Multivariable linear regression analysis demonstrated that troponin T was significantly associated with CFR (β = -0.011; P = 0.007); and IMR (β = 0.177; P = 0.010) in patients with ATTRwt-CM.
CONCLUSIONS: CMD was highly prevalent in patients with ATTRwt-CM. The modest association among CFR, IMR, and cardiac biomarkers was observed only in patients with ATTRwt-CM compared with those with LVH. This may suggest the pathophysiological role of CMD in myocardial injury among patients with ATTRwt-CM.
METHODS: Patients with cardiac hypertrophy, defined as an interventricular septum ≥12 mm, who were undergoing invasive CMD assessment by the use of a pressure wire, were evaluated in a prospective, multicenter study conducted between August 2022 and April 2025. CMD was defined as coronary flow reserve (CFR) <2.0 or index of microvascular resistance (IMR) ≥25.
RESULTS: A total of 64 patients (ATTRwt-CM, n = 32; left ventricular hypertrophy (LVH), n = 32) were analyzed. A similar prevalence was observed in the 2 groups (ATTRwt-CM: 68.8%; LVH: 59.4%; P = 0.434). In patients with ATTRwt-CM, CFR and IMR were significantly correlated with troponin T (r = -0.503; P = 0.004, and r = 0.483; P = 0.006, respectively), while such correlations were not observed in the LVH group (r = -0.128; P = 0.501; r = 0.130; P = 0.493, respectively). Multivariable linear regression analysis demonstrated that troponin T was significantly associated with CFR (β = -0.011; P = 0.007); and IMR (β = 0.177; P = 0.010) in patients with ATTRwt-CM.
CONCLUSIONS: CMD was highly prevalent in patients with ATTRwt-CM. The modest association among CFR, IMR, and cardiac biomarkers was observed only in patients with ATTRwt-CM compared with those with LVH. This may suggest the pathophysiological role of CMD in myocardial injury among patients with ATTRwt-CM.