Ricerc@Sapienza

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.