Contribution of Age-Related Microvascular Dysfunction to Abnormal Coronary: Hemodynamics in Patients With Ischemic Heart Disease

Tim P van de Hoef, Mauro Echavarria-Pinto, Martijn Meuwissen, Valerie E Stegehuis, Javier Escaned, Jan J Piek

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVES: This study sought to investigate the contribution of age-related microcirculatory dysfunction to abnormal coronary hemodynamics in patients with coronary atherosclerosis.

BACKGROUND: Impairment in myocardial blood supply in patients with coronary atherosclerosis can be accentuated due to age-related changes in microcirculatory function.

METHODS: Intracoronary pressure and flow were measured with the Doppler technique in 299 vessels (228 patients), and the thermodilution technique in 120 vessels (99 patients). In 172 patients, Doppler measurements were also performed in unobstructed vessels. Associations of coronary hemodynamics with aging were studied in both the stenosed and unobstructed arteries.

RESULTS: Aging was associated with a progressive increase in minimal microvascular resistance and a progressive decrease in hyperemic flow in both obstructed and nonobstructed coronary arteries. As such, coronary flow reserve decreased with advancing age. Epicardial stenosis severity assessed by resting Pd/Pa, basal stenosis resistance index, and hyperemic stenosis resistance index was equivalent across age groups. By contrast, fractional flow reserve increased with advancing age. Consequently, the adjusted risk of a fractional flow reserve/coronary flow reserve pattern reflective of concomitant focal epicardial and diffuse or microvascular disease (relative risk: 1.6; 95% confidence interval: 1.1 to 2.3; p = 0.017) increased with advancing age, whilst the adjusted risk of a fractional flow reserve/coronary flow reserve pattern reflective of non-flow-limiting stenosis with a healthy microcirculation decreased (relative risk: 0.7; 95% CI: 0.5 to 1.0; p = 0.022).

CONCLUSIONS: Aging is associated with progressive pan-myocardial impairment of coronary vasodilatory capacity due to an increase in minimal microvascular resistance. Concomitant aging-related impairment in microvascular function impacts the pathophysiology of ischemic heart disease in the individual patient and is not adequately identified by hyperemic coronary pressure measurements alone.

Original languageEnglish
Pages (from-to)20-29
Number of pages10
JournalJACC. Cardiovascular Interventions
Volume13
Issue number1
DOIs
Publication statusPublished - 13 Jan 2020
Externally publishedYes

Keywords

  • Age Factors
  • Aged
  • Aging
  • Cardiac Catheterization
  • Coronary Angiography
  • Coronary Circulation
  • Coronary Stenosis/diagnosis
  • Coronary Vessels/diagnostic imaging
  • Echocardiography, Doppler
  • Female
  • Hemodynamics
  • Humans
  • Male
  • Microcirculation
  • Middle Aged
  • Netherlands
  • Predictive Value of Tests
  • Prognosis
  • Risk Factors
  • Severity of Illness Index
  • Spain
  • Thermodilution
  • Vascular Resistance
  • Vasodilation

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