title: Impact of smoking on coronary microcirculatory resistance in patients with coronary artery disease.
abstract: The aim of this study was to investigate the relationship between coronary microvascular function and smoking using the 3 parameters fractional flow reserve (FFR), coronary flow reserve (CFR(thermo)), and index of microcirculatory resistance (IMR) in patients with coronary artery disease (CAD). A total of 97 CAD patients with 148 intermediate stenotic lesions were divided into two groups: current and former smokers (Smokers: n = 54), and those who had never smoked (Non-smokers: n = 43). Coronary physiology measurements were made following coronary angiography at rest and during hyperemia induced with intravenous adenosine triphosphate. If a patient had several intermediate lesions, the lesion producing the largest IMR value and minimum FFR(myo) and CFR(thermo) value was selected. Averaged over all patients, the FFR(myo), CFR(thermo), and IMR values were 0.86 ± 0.10, 2.66 ± 1.50, and 20.8 ± 10.7, respectively. There was no significant correlation between FFR(myo) and IMR. There were no significant differences between smokers and non-smokers in FFR(myo) value (median: 0.85 [IQR: 0.74-0.90] versus 0.87 [IQR: 0.83-0.90], P = 0.15) and CFR(thermo) value (median: 1.90 [IQR: 1.56-3.16] versus 2.10 [IQR: 1.50-2.67] U, P = 0.95). The IMR value was significantly greater in smokers (median: 24.2 [IQR: 16.8-32.5] U versus 18.5 [IQR: 15.4-27.0] U, P = 0.04). In multivariate analysis, smoking was an independent predictor of increased IMR. Smoking appears to have a detrimental effect on coronary microvascular function as measured by IMR.
authors.affiliation: Department of Cardiovascular Medicine, Kashiwa Municipal, Chiba; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Miyazaki
authors.forename: Takashi
authors.initials: T
authors.lastname: Ashikaga
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Ohigashi
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Komura
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D003326:Coronary Circulation / Q000502:physiology*; D003331:Coronary Vessels / Q000473:pathology / Q000503:physiopathology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D007564:Japan; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D055806:Microvessels / Q000473:pathology / Q000503:physiopathology; D008875:Middle Aged; D012189:Retrospective Studies; D012907:Smoking / Q000503:physiopathology*; D013223:Statistics as Topic; D014655:Vascular Resistance