Haartsen, M (2018) Impact of risk factors for coronary heart disease on coronary microvascular resistance. thesis, Medicine.
Full text available on request.Abstract
Background: Coronary flow reserve (CFR) and fractional flow reserve (FFR) are invasive physiological parameters used for quantifying inducible myocardial ischemia and subsequently clinical decision making for treatment. However, an increase in microvascular resistance (which is determined by the ratio of distal coronary pressure to flow velocity) might change these values. This can result in underestimation of the severity of the stenosis. Therefore it is valuable to investigate which individual factors, such as risk factors for CHD have a potential effect on the microvascular resistance. This might help to identify patients with an increased microvascular resistance. Methods: In 338 patients, 435 coronary vessels were evaluated, of which 415 vessels with an intermediate stenosis and 20 reference vessels. Using sensor-equipped guidewires during catheterization, intracoronary pressure and flow measurements were obtained to determine hyperemic microvascular resistance (HMR) and basal microvascular resistance (BMR). Patients characteristics and risk factors for CHD were obtained retrospectively, using the electronic patient file. A multiple linear regression analysis was performed to calculate the impact of risk factors for CHD on HMR and BMR. Results: Adjusted for the other risk factors for CHD, cigarette smoking was a significant predictor for HMR. Cigarette smoking is associated with a decrease in HMR with a mean of -0.387 (95% CI: -0.626 - -0.149, p = 0.02). There was not a significant relationship between one of the risk factors and BMR. In patients with a greater number of risk factors, the HMR was significantly reduced (B = -0.110, 95% CI -0.180 - - 0.041, p = 0.002). Conclusion: Our findings demonstrate that cigarette smoking is associated with a reduction in the HMR. The other selected risk factors for CHD do not have a significant relationship with HMR or BMR. In patients with a greater number of risk factors for CHD, the mean HMR is lower as compared with patients with a lower number of risk factors. We cannot explain these results based on other studies concerning coronary physiology, and thus cannot draw any well-founded conclusions based on our results.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Affiliation coordinator: and Nieuwland, W. MD |
| Supervisor name: | External supervisors: and Stegehuis V.E. MD and Wijntjens G.W.M.MD and Murai T. MD PhD and Piek J.J.MD PhD |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:40 |
| Last Modified: | 25 Jun 2020 10:40 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/142 |
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