Particularities of coronary physiology in patients with atrial fibrillation: insights from combined pressure and flow indices measurements

Frontiers in Cardiovascular Medicine

Cardiovascular Medicine

Sophie Samyn¹  Marielle Morissens¹  Jose Castro Rodriguez¹  Georgiana Pintea Bentea¹  Brahim Berdaoui¹  Philippe van de Borne² 

[1] Department of Cardiology, CHU Brugmann, Brussels, Belgium;Department of Cardiology, CHU Erasme, Brussels, Belgium;

关键词: atrial fibrillation;    CFR;    FFR;    HMR;    microvascular dysfunction;   

DOI  :  10.3389/fcvm.2023.1206743

 received in 2023-04-16, accepted in 2023-07-31,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundSymptoms suggestive of myocardial ischemia are frequently encountered in patients with atrial fibrillation (AF) even in the absence of obstructive coronary artery disease. Nevertheless, an in-depth characterisation of coronary physiology in patients with AF is currently lacking.ObjectivesWe aim to provide an insight into the characteristics of coronary physiology in AF, by performing simultaneous invasive measurements of coronary flow- and pressure- indices in a real-life population of patients with AF and indication of coronary angiography.MethodsThis is a prospective open label study including patients with permanent or persistent AF and indication of coronary angiography showing intermediate coronary stenosis requiring routine physiological assessment (n = 18 vessels from 14 patients). We measured FFR (fractional flow reserve), and Doppler-derived coronary flow indices, including CFR (coronary flow reserve) and HMR (hyperaemic microvascular resistance).ResultsFrom the analysed vessels, 18/18 vessels (100%) presented a pathological CFR (<2.5), indicative of coronary microvascular dysfunction (CMD), and 3/18 (17%) demonstrated obstructive epicardial coronary disease (FFR ≤ 0.8). A large proportion of vessels (15/18; 83%) showed discordant FFR/CFR with preserved FFR and low CFR. 47% of the coronary arteries in patients with AF and non-obstructive epicardial coronary disease presented structural CMD (HMR ≥ 2.5 mmHg/cm/s), and were associated with high BMR and an impaired response to adenosine. Conversely, vessels from patients with AF and non-obstructive epicardial coronary disease with functional CMD (HMR < 2.5 mmHg/cm/s) showed higher bAPV. The permanent AF subpopulation presented increased values of HMR and BMR compared to persistent AF, while structural CMD was more often associated with persistent symptoms at 3 months, taking into account the limited sample size of our study.ConclusionOur findings highlight a systematically impaired CFR in patients with AF even in the absence of obstructive epicardial coronary disease, indicative of CMD. In addition, patients with AF presented more prevalent structural CMD (HMR ≥ 2.5 mmHg/cm/s), characterized by reduced hyperaemic responses to adenosine, possibly interfering with the FFR assessment.

【 授权许可】

Unknown   
© 2023 Pintea Bentea, Berdaoui, Samyn, Morissens, van de Borne and Castro Rodriguez.