Author + information
- Michael Thomas Osbornea,b,
- Navkaranbir Bajaja,b,
- Viviany Taquetia,b,
- Paco Bravoa,b,
- Tomas Vitaa,b,
- Ankur Guptaa,b,
- Courtney Fostera,b,
- Meagan Harringtona,b,
- Victoria Morgana,b,
- Jon Hainera,b,
- Sharmila Dorbalaa,b,
- Ron Blanksteina,b and
- Marcelo Di Carlia,b
Background: Metabolic syndrome (MS) and diabetes (DM) are associated with microvascular dysfunction. Impaired coronary flow reserve (CFR) in the presence of normal myocardial perfusion is a marker of microvascular dysfunction and may be associated with adverse events along a continuum of metabolic disease.
Methods: 959 consecutive patients undergoing cardiac positron emission tomography showing normal perfusion and preserved ejection fraction (EF > 40%) were evaluated over a median follow up of 5.4 years for adverse events (composite of myocardial infarction, heart failure admission & death). Patients were divided into groups of no MS or DM, MS with no DM and DM. The association of CFR with events was assessed with Cox and Poisson regression.
Results: Overall, a unit decrease in CFR was associated with an adjusted hazard ratio of 2.04 for adverse events (95% confidence interval 1.42-2.86, p<0.001). There was a significant association between abnormal CFR (< 2.0) and adjusted annualized endpoint rate (AAER) for all groups (p=0.0008, multivariate restricted cubic spline). The rate of abnormal CFR increased from 40% in no MS or DM to 43% in MS with no DM to 59% in DM. The AAER was higher in all groups with abnormal CFR (Figure) and was significantly higher than with normal CFR in the no MS or DM and MS with no DM groups (p=0.048 & 0.007).
Conclusions: Microvascular dysfunction is associated with increased risk of adverse events in patients with normal perfusion and preserved EF along a continuum of metabolic disease.
Moderated Poster Contributions
Non Invasive Imaging Moderated Poster Theater, Poster Hall, Hall C
Friday, March 17, 2017, 11:45 a.m.-11:55 a.m.
Session Title: Noninvasive Assessment of Coronary Flow Reserve: Clinical Implications
Abstract Category: 30. Non Invasive Imaging: Nuclear
Presentation Number: 1136M-17
- 2017 American College of Cardiology Foundation