title: Clinical role of post-angioplasty hyperemic microvascular resistances in chronic ischemic left ventricular dysfunction.
abstract: OBJECTIVE
  To investigate the impact of hyperemic microvascular resistances (HMRs) on myocardial perfusion and contractility after percutaneous coronary intervention (PCI) in chronic ischemic left ventricular dysfunction (CILVD).
  
  
  METHODS
  The current retrospective study included 48 patients with CILVD of the left anterior descending territory undergoing HMRs assessment before and after PCI with a dual-sensor intracoronary pressure-flow wire. The severity of resting myocardial underperfusion and contractile dysfunction of the left anterior descending territory was scored as summed rest score (SRS-T) by single photon emission tomography, wall motion score index (WMSI-T) and left ventricular ejection fraction (LVEF) by transthoracic echocardiography before PCI and after 3 months. Patients were divided into two groups according to the mean post-PCI HMRs.
  
  
  RESULTS
  Mean post-PCI HMRs were 2.05 ± 0.43 mmHg/cm/s; increased HMRs (i.e. >2 mmHg/cm/s) were found in 17 patients (35.4%, group B) (3.29 ± 0.77 mmHg/cm/s), whereas 31 patients (64.6%, group A) showed lower values (1.35 ± 0.34 mmHg/cm/s; P < 0.001). Pre-PCI HMRs, WMSI-T and SRS-T were similar among groups.After PCI, a significant improvement of LVEF, WMSI-T and SRS-T was observed only in group A (6.6 ± 7.4%, 0.44 ± 0.42 and 3.9 ± 2.9, respectively) compared with group B (1.3 ± 1.9%, 0.02 ± 0.07 and 1.1 ± 1.9; P = 0.011, P < 0.001 and P = 0.028, respectively).Post-PCI HMRs predicted the absence of improvement of LVEF and WMSI-T at a cutoff value of 1.95 mmHg/cm/s (area under the curve 0.69 and 0.73; P = 0.038 and 0.017, respectively), with a positive predictive value of 96 and 100%, respectively.
  
  
  CONCLUSIONS
  Increased post-PCI HMRs may predict the lack of functional improvement of the revascularized myocardium in CILVD.
authors.affiliation: aDepartment of Cardiology bDepartment of Nuclear Medicine, Ospedale di Circolo and Fondazione Macchi, University of Insubria, Varese, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Gorla
authors.forename: Edoardo
authors.initials: E
authors.lastname: Verna
authors.forename: Simone
authors.initials: S
authors.lastname: Scotti
authors.forename: Sergio
authors.initials: S
authors.lastname: Ghiringhelli
authors.forename: Laura
authors.initials: L
authors.lastname: Zoli
authors.forename: Stefano
authors.initials: S
authors.lastname: Provasoli
authors.forename: Silvana
authors.initials: S
authors.lastname: Garancini
authors.forename: Roberto
authors.initials: R
authors.lastname: De Ponti
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Salerno-Uriarte
mesh_terms: D000368:Aged; D019540:Area Under Curve; D003326:Coronary Circulation; D004452:Echocardiography; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology*; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009200:Myocardial Contraction; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D055414:Myocardial Perfusion Imaging / Q000379:methods; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D012372:ROC Curve; D020127:Recovery of Function; D012189:Retrospective Studies; D013318:Stroke Volume; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D014655:Vascular Resistance; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D016277:Ventricular Function, Left