International journal of cardiology. Heart & vasculature · 2026
Inter-vessel heterogeneity in coronary microvascular dysfunction: A three-vessel physiological assessment.
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Kunieda Mitsuhito, Shimizu Tomohiro, Uzui Hiroyasu, Kataoka Tatsuhiro, Miyoshi Machiko, Sato Yusuke, Yamaguchi Junya, Hasegawa Kanae, Tama Naoto, Ikeda Hiroyuki, Ishida Kentaro, Tada Hiroshi
Аннотация
BACKGROUND: Coronary microvascular dysfunction (CMD) is typically assessed in the left anterior descending artery (LAD); however, inter-vessel differences involving the left circumflex (LCX) and right coronary arteries (RCA) remain unclear. We investigated inter-vessel variations in CMD and their associations with patient characteristics.
METHODS AND RESULTS: We retrospectively analyzed 91 patients (overall cohort) to evaluate patient characteristics across different coronary microvascular dysfunction (CMD) phenotypes based on physiological cutoffs: isolated CFR impairment, isolated IMR impairment, and combined impairment. Additionally, in a subgroup of 34 patients who successfully underwent physiological assessments in all three major coronary arteries (three-vessel cohort), we compared the CMD diagnostic rates between LAD-only and three-vessel assessments and evaluated vessel-specific correlations between CFR and IMR. In the Overall cohort, analysis of vessel-specific phenotypes revealed that patients with isolated IMR impairment in the LAD had a significantly higher body mass index (26.4 ± 4.90 kg/m2, p = 0.038). In the RCA, patients with isolated CFR impairment were significantly older (77.0 ± 9.18 years, p = 0.044). In the three-vessel cohort, the CMD diagnostic rate was significantly higher with a three-vessel assessment than with an LAD-only assessment (52.9% vs. 23.5%, p = 0.044). Furthermore, a significant inverse correlation between CFR and IMR was observed only in the LCX (r = -0.326, p = 0.033).
CONCLUSIONS: Coronary microvascular physiology varies across the LAD, LCX, and RCA, indicating that conventional LAD-only assessments may underestimate CMD burden. These preliminary retrospective findings require validation in prospective, multicenter studies before routine clinical adoption.
METHODS AND RESULTS: We retrospectively analyzed 91 patients (overall cohort) to evaluate patient characteristics across different coronary microvascular dysfunction (CMD) phenotypes based on physiological cutoffs: isolated CFR impairment, isolated IMR impairment, and combined impairment. Additionally, in a subgroup of 34 patients who successfully underwent physiological assessments in all three major coronary arteries (three-vessel cohort), we compared the CMD diagnostic rates between LAD-only and three-vessel assessments and evaluated vessel-specific correlations between CFR and IMR. In the Overall cohort, analysis of vessel-specific phenotypes revealed that patients with isolated IMR impairment in the LAD had a significantly higher body mass index (26.4 ± 4.90 kg/m2, p = 0.038). In the RCA, patients with isolated CFR impairment were significantly older (77.0 ± 9.18 years, p = 0.044). In the three-vessel cohort, the CMD diagnostic rate was significantly higher with a three-vessel assessment than with an LAD-only assessment (52.9% vs. 23.5%, p = 0.044). Furthermore, a significant inverse correlation between CFR and IMR was observed only in the LCX (r = -0.326, p = 0.033).
CONCLUSIONS: Coronary microvascular physiology varies across the LAD, LCX, and RCA, indicating that conventional LAD-only assessments may underestimate CMD burden. These preliminary retrospective findings require validation in prospective, multicenter studies before routine clinical adoption.