Quantitative assessment of coronary microvascular function in patients with and without epicardial atherosclerosis

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 (B=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 I MR in patients with and without epicardial atherosclerosis.