Relation Between Microvascular and Macrovascular Hemodynamics in Normal Epicardial Coronary Arteries

Authors : Cafer PANÇ, Onur ERDOĞAN, Remzi SARIKAYA, Mehmet KOCAAĞA, Pelin ÖZER, Berrin UMMAN

Pages : 147-155

Doi:10.46310/tjim.871224

View : 49 | Download : 13

Publication Date : 2021-10-29

Article Type : Research Paper

Abstract :Introduction: Cardiovascular risk factors both affect macrovascular and microvascular systems, resulting in negative results on the entire vascular tree. Aortic stiffness causes augmented systolic pressure, increased pulse pressure, increased myocardial oxygen demand, and consequently, coronary blood flow diminishes because of decreased diastolic augmentation. The aim of our study is to investigate the relation between macrovascular and microvascular hemodynamics. Methods: We have included 58 consecutive patients insert ignore into journalissuearticles values(29 male, age 54[34-71]); without any epicardial coronary stenosis in coronary angiography. Macrovascular and microvascular parameters were calculated with the measurements of tonometry, coronary flow reserve, and microvascular resistance. Results:Carotid-femoral pulse wave velocity insert ignore into journalissuearticles values(PWV); and subendocardial viability ratio insert ignore into journalissuearticles values(SEVR); had an inverse correlation insert ignore into journalissuearticles values(r=-0.328,p=0.007);.The main reason of this correlation was priorly positive correlation between PWV and systolic pressure-time integral insert ignore into journalissuearticles values(SPTI); insert ignore into journalissuearticles values(r=0.465, p<0.001);.A positive correlation was noted between augmentation index insert ignore into journalissuearticles values(AI); and PWV insert ignore into journalissuearticles values(r=0.352,p=0.010);; and an inverse significant correlation was noted between AI and SEVR insert ignore into journalissuearticles values(r=-0.383,p=0.003);.PWV had a positive correlation with diastolic/systolic coronary flow velocity insert ignore into journalissuearticles values(r=0.42,p=0.04); and microvascular resistance insert ignore into journalissuearticles values(MR); insert ignore into journalissuearticles values(r=0.44,p=0.03); and a negative correlation with hyperemic mean coronary flow velocity insert ignore into journalissuearticles values(r=-0.416,p=0.043); and coronary flow reserve insert ignore into journalissuearticles values(CFR); insert ignore into journalissuearticles values(r=-0.419,p=0.04); in diabetic patient group insert ignore into journalissuearticles values(n=27);.AI was inversely related to CFR insert ignore into journalissuearticles values(r=-0.41,p=0.04); in diabetic patient group.SEVR and CFR were well correlated in the same direction insert ignore into journalissuearticles values(r=0.569, p<0.001);.SEVR was significantly lower in the patients with lower CFR insert ignore into journalissuearticles values(1.41±0.23/1.58±0.24,p=0.01);.SEVR had a significant negative correlation with MR insert ignore into journalissuearticles values(r=-0.321,p=0.016);. SEVR was associated with arteriolar resistance index insert ignore into journalissuearticles values(r=0.413,p=0.002);. Conclusion: Cardiovascular events appear as a combined result of the pathologies of the macro and microvascular levels. Aortic wall pathologies, which affect central hemodynamic properties, change subendocardial perfusion and coronary microcirculation.
Keywords : pulse wave velocity, augmentation index, subendocardial viability ratio, index of microvascular resistance, coronary flow reserve, normal coronary arteries, microvascular dysfunction

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