In patients with coronary artery disease, the microcirculation impairment, related to the increase of left ventricular end-diastolic pressure (LVEDP), is one of the most important factors that should be considered in addition to the functional significance evaluation of lesions in the epicardial vessels. This impairment results in a markedly reduced myocardial perfusion, and ischemia.
In our hypothesis, the morphological alterations of microcirculation hide a functional underestimation of the stenosis, due to the elevated distal stenosis pressures (Pd).
This alteration, consequently, may increase the value of FFR and IFR, which may appear less significant, underlining the hemodynamic dependence of microcirculatory status on FFR and IFR.
The increase of micro vascular resistance reflects the vessels calibre reduction of the intra-myocardial coronary microcirculation, thus altering the physiological function of "intra-myocardial pump". Therefore, LVEDP hinders the perfusion by passive compression in sub-endocardium tissue, leading to ischemia.
The aim of the study is to analyse a quantitatively assessment of coronary microcirculation by Doppler-pressure wire guide of coronary flow reserve (CFR) and hyperaemic micro vascular resistance (HMR) and, consequently, to investigate how these parameters are affected by a high LVEDP and, on the other hand, how these parameters affect the functional value of FFR and IFR.
Furthermore, comparing the HMR and CFR with the information obtained from echocardiographic study, we want to assess how these parameters may be predictive in terms of systolic and diastolic ventricular dysfunction and in term of Major adverse cardiovascular events (MACE) at 12 months follow-up.
Although FFR and is recommended by international guidelines to identify hemodynamically relevant coronary lesion(s) when evidence of ischaemia is not available with class of evidence IA and emerging data suggest that iFR may be a superior prognostic tool in comparison with FFR for deferring nonculprit lesions in patients with acute coronary syndrome evaluation, it should be noted that these methods, based on pressure-derived index, should be altered in ventricular diastolic dysfunction.
In patients with coronary artery disease, the microcirculation impairment, related to the increase of left ventricular end-diastolic pressure (LVEDP), is one of the most important factors that should be considered in addition to the functional significance evaluation of lesions in the epicardial vessels. This impairment results in a markedly reduced myocardial perfusion, and ischemia.
In our hypothesis, the morphological alterations of microcirculation hide a functional underestimation of the stenosis, due to the elevated distal stenosis pressures (Pd). This alteration, consequently, may increase the value of FFR and IFR, which may appear less significant, underlining the hemodynamic dependence of microcirculatory status on FFR and IFR.
The increase of micro vascular resistance reflects the vessels calibre reduction of the intra-myocardial coronary microcirculation, thus altering the physiological function of "intra-myocardial pump". Therefore, LVEDP hinders the perfusion by passive compression in sub-endocardium tissue, leading to ischemia.
In this setting, our registry, will potentially demonstrate in real-world clinical practice, if an association exists between the LVEDP and FFR, IFR, coronary flow reserve in patients with angiographic stenosis. The results will potentially impact on the patient selection for the use of coronary physiology to guide revascularization, that it has been found to improve patient outcomes and defer stenting of nonischemic lesions compared with angiographic assessment. The results of our study will, also, potentially contribute to choose the most cost-effective use of FFR and IFR in these patients.