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    Homogeneity of the coronary microcirculation in angina with non-obstructive coronary artery disease
    (Oxford University Press (OUP), 2025-03-24)
    Masahiro Hoshino
    ;
    Roel Hoek
    ;
    Ruurt A Jukema
    ;
    Jorge Dahdal
    ;
    Pepijn van Diemen
    The homogeneity of coronary microvascular dysfunction (CMD) across different myocardial territories in angina with nonobstructive coronary artery disease (ANOCA) patients is scarcely explored. This study investigates the variability in microvascular resistance reserve (MRR) across the 3 main perfusion territories of the coronary circulation to investigate the homogeneity or dishomogeneity of microcirculatory function
    Scopus© Citations 1  2
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    Impact of myocardial scar burden on microvascular resistance reserve in patients with coronary artery disease
    (Springer Science and Business Media LLC, 2025-02-20)
    Masahiro Hoshino
    ;
    Roel Hoek
    ;
    Ruurt. A. Jukema
    ;
    Jorge Dahdal
    ;
    Pepijn van Diemen
    Purpose The impact of myocardial scar on coronary microcirculation is not well understood. This study aims to evaluate the association between microvascular resistance reserve (MRR) and scar tissue. Methods In this post-hoc analysis of the PACIFIC 2 trial, symptomatic patients with prior myocardial infarction (MI) and/or percutaneous coronary intervention (PCI) underwent [15O]H2O positron emission tomography (PET), cardiac magnetic resonance (CMR) imaging, and fractional flow reserve (FFR). MRR was assessed utilizing PET-derived coronary flow reserve and FFR measurements. Scar quantification was assessed by CMR late gadolinium enhancement (LGE). Vessel LGE burden was defined as the scar tissue proportion in each myocardial territory. Total LGE burden was defined as the proportion of overall scar. Results The study included 154 patients with 397 vessels with a mean MRR of 3.56 ± 1.24. Patients with any scar tissues (LGE > 0%) exhibited a lower MRR in every myocardial territory than those without scar tissues. After adjusting for cardiovascular risk factors, either vessel LGE burden (β =-0.013, P = 0.006) or total LGE burden (β =-0.039, P = 0.002) independently predicted a reduced MRR. Compared to myocardial territories without scar tissues (LGE burdens = 0%), MRR was significantly lower in myocardial territories with vessel LGE burden = 0% + total LGE burden > 0%, and in myocardial territories with both LGE burdens > 0%. Conclusion Scar burden was negatively associated with MRR in patients with prior MI and/or PCI. Our findings indicate that both the proportion of myocardial scar in the vascular territory and the overall myocardial scar affect the microcirculation of individual vascular territories.
      1Scopus© Citations 4
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    Microvascular resistance reserve in relation to total and vessel-specific atherosclerotic burden
    (Oxford University Press (OUP), 2024-11-12)
    Masahiro Hoshino
    ;
    Ruurt A Jukema
    ;
    Roel Hoek
    ;
    Jorge Dahdal
    ;
    Pieter Raijmakers
    The relationship between coronary artery atherosclerosis and microvascular resistance remains unclear. This study aims to clarify the relationship between total atherosclerotic and vessel-specific atherosclerotic burden and microvascular resistance reserve (MRR).</jats:p> Methods and results In this post hoc analysis of the PACIFIC 1 trial, symptomatic patients without prior coronary artery disease (CAD) underwent [15O]H2O positron emission tomography, coronary computed tomography angiography (CCTA), and invasive fractional flow reserve (FFR). MRR was assessed across all three coronary branches, utilizing PET-derived coronary flow reserve and invasive FFR measurements. CCTA was used to assess patient and vessel-specific plaque volumes. Percentage atheroma volume (PAV) was defined as total plaque volume divided by vessel volume. The study included 142 patients (55% male, 57.5 ± 8.6 years) with 426 vessels with a mean MRR of 3.77 ± 1.64. While a significantly higher PAV was observed in the left anterior descending artery territory, MRR was similar across the three coronary branches. Generalized estimating equations without correction for cardiovascular risk factors identified that patient-specific PAV tertiles but not vessel-specific PAV tertiles were related to vessel-specific MRR. After correction for cardiovascular risk factors, compared with the first tertile of patient-specific PAV, the second tertile showed a vessel-specific MRR decrease of β = −0.362, P = 0.018, and the third tertile showed a decrease of β = −0.347, P = 0.024.</jats:p> Conclusion In patients without prior CAD, patient-specific plaque burden was negatively associated to vessel-specific MRR; however, vessel-specific plaque burden was not related to vessel-specific MRR. Our findings suggest that the relation between atherosclerotic burden and an impaired microcirculatory function is of systemic origin.
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