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1 Coronary microvascular dysfunction in stable coronary artery disease: the CE-MARC 2 coronary physiology sub-study
  1. David S Corcoran1,2,
  2. Robin Young3,
  3. David Adlam4,
  4. Alex McConnachie3,
  5. Kenneth Mangion1,2,
  6. David Ripley4,
  7. David Cairns5,
  8. Julia Brown5,
  9. Chiara Bucciarelli-Ducci6,
  10. Rajesh Kharbanda7,
  11. Keith G Oldroyd2,
  12. Gerry P McCann4,
  13. John P Greenwood8,
  14. Colin Berry1,2
  1. 1British Heart Foundation (BHF) Glasgow Cardiovascular Research Centre, University of Glasgow
  2. 2West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow
  3. 3Robertson Centre for Biostatistics, University of Glasgow
  4. 4Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester
  5. 5Leeds Institute of Clinical Trials Research, University of Leeds
  6. 6Bristol Heart Institute, University of Bristol
  7. 7Oxford Heart Centre, John Radcliffe Hospital
  8. 8Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds


Background In patients with angina undergoing invasive diagnostic management, no obstructive coronary artery disease (CAD) is a common finding. Coronary microvascular dysfunction may be relevant. We aimed to assess the prevalence of abnormal coronary microvascular function in patients with suspected CAD.

Methods CE-MARC 2 was a prospective multicentre randomised trial of functional imaging vs guideline-based management in patients with suspected CAD. Invasive angiography was protocol-directed based on the presence of inducible ischaemia on non-invasive stress testing, or directly as per NICE guideline care. Fractional flow reserve (FFR) and microvascular function (coronary flow reserve (CFR), index of microcirculatory resistance (IMR), resistance reserve ratio (RRR)) were measured in major epicardial vessels with stenosis ≥40-≤90%.

Results 267/1202 (22.2%) patients underwent angiography and 81 (30%) patients had FFR measured. 63 (78%) of these patients had microvascular function assessed in 85 arteries (age 58.5±8.2 years; 47 (75%) male). 25/63 (40%) patients had no obstructive CAD, and of these 17 (68%) had an abnormality in at least one parameter of microvascular function (figure).

Conclusions Coronary microvascular dysfunction is common in patients with angina and no obstructive CAD. Invasive microvascular function assessment may be relevant for clinical decision-making.

Abstract 1 Figure 1

Abnormal invasive coronary microvascular function test results on a per-patient and per-vessel basis. An FFR ≤0.80 indicated obstructive epicardial CAD

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