Physiological Characterization of Coronary Endotypes: Potential Links with Myocardial Ischemia
Background: Comprehensive physiological characterization of coronary endotypes remains limited, especially in epicardial dysfunction. Objectives: To describe hemodynamic profiles across the full spectrum of coronary endotypes and explore potential links with ischemia. Methods: Patients with suspecte...
| Autores: | , , , , , , , , , , , |
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| Formato: | artículo |
| Fecha de publicación: | 2025 |
| País: | España |
| Recursos: | Conselleria de Salut i Consum del Govern de les Illes Balears |
| Repositorio: | Docusalut |
| Idioma: | inglés |
| OAI Identifier: | oai:dnet:docusalut___::b99466f6655129946332e4d810599e7f |
| Acesso em linha: | https://hdl.handle.net/20.500.13003/27496 |
| Access Level: | acceso abierto |
| Palavra-chave: | Coronary Artery Disease Coronary Circulation Myocardial Coronary Artery Disease Myocardial Fractional Flow Reserve |
| Resumo: | Background: Comprehensive physiological characterization of coronary endotypes remains limited, especially in epicardial dysfunction. Objectives: To describe hemodynamic profiles across the full spectrum of coronary endotypes and explore potential links with ischemia. Methods: Patients with suspected chronic coronary syndromes who underwent invasive physiological assessment in the ANFIBIO Project (NCT05374694) were classified according to fractional flow reserve [(FFR)≤0.80] and index of microcirculatory resistance [(IMR)≥25] in the left anterior descending artery into four groups: normal indices, isolated epicardial, isolated microvascular, and combined dysfunction. Coronary pressure, flow, and resistance indices were compared between groups. Results: A total of 130 patients were finally included. A gradual decrease in hyperemic coronary flow [(Qcor) in mL/min; normal indices: 387±192, isolated epicardial: 278±153, isolated microvascular: 130±41, combined: 96±33; p<0.001] and a progressive increase in total coronary resistance [(RTotal) in Wood units (WU); normal indices: 238±139, isolated epicardial: 373±167, isolated microvascular: 694±210, combined: 999±342; p<0.001] were observed as more compartments were involved. Also, epicardial dysfunction was primarily associated with reduced distal coronary pressure (Pd) and elevated epicardial resistance [(REpi) in WU; normal indices: 25±18, isolated epicardial: 145±113, isolated microvascular: 66±34, combined: 389±282; p<0.001], whereas microvascular dysfunction was characterized by preserved Pd but markedly decreased Qcor and increased microvascular resistance [(RMicro) in WU; normal indices: 213±124, isolated epicardial: 228±73, isolated microvascular: 628±195, combined: 610±137; p<0.001]. Combined dysfunction shares mechanisms of both epicardial and microvascular dysfunction. Conclusions: Coronary endotypes exhibit distinct hemodynamic patterns with specific pressure- and flow-related ischemic mechanisms. Integrated physiological assessment is essential for accurate endotype characterization and personalized therapeutic strategies. |
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