The change of angina levels in patients with chronic coronary syndromes and coronary microcirculatory dysfunction – a prospective study with 24 months follow-up

Łukasz Niewiara; Paweł Kleczyński; Piotr Szolc; Bartłomiej Guzik; Marta Diachyshyn; Michalina Jelonek; Joanna Handzlik; Krzysztof Żmudka; Jacek Legutko

doi:10.5114/aic.2023.133806

eISSN: 1897-4295
ISSN: 1734-9338

Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej

Current issue Archive Manuscripts accepted About the journal Editorial board Abstracting and indexing Subscription Contact Instructions for authors Publication charge Ethical standards and procedures

Editorial System

Submit your Manuscript

Editorial Policies

Sarajevo Declaration on Integrity and Visibility of Scholarly Publications

4/2023
vol. 19

Send email

Copy url:

abstract:

Original paper

The change of angina levels in patients with chronic coronary syndromes and coronary microcirculatory dysfunction – a prospective study with 24 months follow-up

Łukasz Niewiara

^{1, 2}

,

Paweł Kleczyński

^{1, 2}

,

Piotr Szolc

^{2, 3}

,

Bartłomiej Guzik

^{1, 2}

,

Marta Diachyshyn

^{1, 2}

,

Michalina Jelonek

⁴

,

Joanna Handzlik

⁴

,

Krzysztof Żmudka

^{1, 2}

,

Jacek Legutko

^{1, 2}

Department of Interventional Cardiology, Jagiellonian University Medical College, Institute of Cardiology, St. John Paul II Hospital, Krakow, Poland
Clinical Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
Department of Emergency Medicine, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
Student Scientific Group of Modern Cardiac Therapy at the Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland

Adv Interv Cardiol 2023; 19, 4 (74): 318–325

DOI: https://doi.org/10.5114/aic.2023.133806

Online publish date: 2023/12/22

View full text Get citation

EndNote

Papers, Reference Manager, RefWorks, Zotero

AMA

Niewiara Ł, Kleczyński P, Szolc P, et al. The change of angina levels in patients with chronic coronary syndromes and coronary microcirculatory dysfunction – a prospective study with 24 months follow-up. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2023;19(4):318-325. doi:10.5114/aic.2023.133806.

APA

Niewiara, Ł., Kleczyński, P., Szolc, P., Guzik, B., Diachyshyn, M.,  & Jelonek, M. et al. (2023). The change of angina levels in patients with chronic coronary syndromes and coronary microcirculatory dysfunction – a prospective study with 24 months follow-up. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 19(4), 318-325. https://doi.org/10.5114/aic.2023.133806

Chicago

Niewiara, Łukasz, Paweł Kleczyński, Piotr Szolc, Bartłomiej Guzik, Marta Diachyshyn, Michalina Jelonek,  and Joanna Handzlik et al. 2023. "The change of angina levels in patients with chronic coronary syndromes and coronary microcirculatory dysfunction – a prospective study with 24 months follow-up". Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej 19 (4): 318-325. doi:10.5114/aic.2023.133806.

Harvard

Niewiara, Ł., Kleczyński, P., Szolc, P., Guzik, B., Diachyshyn, M., Jelonek, M., Handzlik, J., Żmudka, K.,  and Legutko, J. (2023). The change of angina levels in patients with chronic coronary syndromes and coronary microcirculatory dysfunction – a prospective study with 24 months follow-up. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 19(4), pp.318-325. https://doi.org/10.5114/aic.2023.133806

MLA

Niewiara, Łukasz et al. "The change of angina levels in patients with chronic coronary syndromes and coronary microcirculatory dysfunction – a prospective study with 24 months follow-up." Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, vol. 19, no. 4, 2023, pp. 318-325. doi:10.5114/aic.2023.133806.

Vancouver

Niewiara Ł, Kleczyński P, Szolc P, Guzik B, Diachyshyn M, Jelonek M et al. The change of angina levels in patients with chronic coronary syndromes and coronary microcirculatory dysfunction – a prospective study with 24 months follow-up. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2023;19(4):318-325. doi:10.5114/aic.2023.133806.

Introduction:
A substantial proportion of patients with chronic coronary syndromes suffer from angina even after medical treatment and revascularization. Coronary microvascular dysfunction (CMD) is discussed as a potential mechanism.

Aim:
To assess angina status in patients with chronic coronary syndromes undergoing functional assessment of coronary circulation regarding the presence of coronary microcirculatory dysfunction.

Material and methods:
The study included 101 consecutive patients referred for coronary angiography requiring functional stenosis assessment, with median age of 66 years, 74% male, diagnosed or treated for dyslipidemia (91%) and diabetes type 2 (42%), 20% with a history of prior non-ST myocardial infarction. Fractional flow reserve (FFR), coronary flow reserve (CFR), resistive reserve ratio (RRR), and index of microcirculatory resistance (IMR) were measured. The diagnosis of CMD was defined by either IMR ≥ 25 units or CFR ≤ 2.0 in case of no significant stenosis. A change of one CCS class over 24 months follow-up was considered clinically significant.

Results:
In patients without CMD diagnosis, there was a significant decrease in angina intensity (p < 0.001). Lack of angina improvement was associated with lower median RRR (2.30 (1.70, 3.30) vs. 3.05 (2.08, 4.10), p = 0.004) and lower median CFR (1.90 (1.40, 2.50) vs. 2.30 (IQR: 1.60, 3.00), p = 0.021), as compared to patients with angina improvement.

Conclusions:
The presence of CMD is a risk factor for no angina improvement. Impaired coronary resistive reserve ratio and lower microvascular reactivity may be one of the pathomechanisms leading to the lack of angina improvement in patients with chronic coronary syndromes.

keywords:

The change of angina levels in patients with chronic coronary syndromes and coronary microcirculatory dysfunction – a prospective study with 24 months follow-up

Łukasz Niewiara 1, 2 , Paweł Kleczyński 1, 2 , Piotr Szolc 2, 3 , Bartłomiej Guzik 1, 2 , Marta Diachyshyn 1, 2 , Michalina Jelonek 4 , Joanna Handzlik 4 , Krzysztof Żmudka 1, 2 , Jacek Legutko 1, 2

coronary flow reserve, chronic coronary syndromes, coronary microcirculatory dysfunction, angina symptoms, resistive reserve ratio

Łukasz Niewiara

^{1, 2}

,

Paweł Kleczyński

^{1, 2}

,

Piotr Szolc

^{2, 3}

,

Bartłomiej Guzik

^{1, 2}

,

Marta Diachyshyn

^{1, 2}

,

Michalina Jelonek

⁴

,

Joanna Handzlik

⁴

,

Krzysztof Żmudka

^{1, 2}

,

Jacek Legutko

^{1, 2}