Impact of Coronary Microvascular Dysfunction on Left Ventricular Function After Percutaneous Coronary Intervention: Assessment With Combined Dipyridamole-Exercise Stress and Myocardial Strain/Work.

Patients with CMD (CFVR < 2.5) showed impaired LV functional reserve compared to those with CFVR ≥ 2.5 after PCI.

• 84 CAD individuals who underwent left anterior descending artery PCI were enrolled (54 ± 10 years, 17.9% female).
• Participants were stratified into CFVR ≥ 2.5 group (n = 63) and CFVR < 2.5 group (n = 21).
• The CFVR < 2.5 group showed lower GLS, GWI, and GWE at peak exercise and recovery (all p < 0.05).
• The CFVR < 2.5 group showed lower peak exercise GCW and higher recovery GWW (all p < 0.05).
• Smaller absolute changes ΔE-R in GLS, GWI, and GCW were observed in the CFVR < 2.5 group (all p < 0.05).

Peak exercise GCW, recovery GWW, and ΔGCW (E-R) were independent predictors of CMD in multivariable analysis.

• Multivariable analysis identified three independent predictors of CMD: peak exercise global constructive work (GCW), recovery global wasted work (GWW), and ΔGCW (E-R).
• These parameters reflect differences before versus after exercise stress.
• All predictors were derived from the combined dipyridamole-exercise stress echocardiography assessment at 3 months post-PCI.

At 1-year follow-up, the CFVR ≥ 2.5 group had significantly better quality of life outcomes on the Seattle Angina Questionnaire compared to the CFVR < 2.5 group.

• SAQ physical limitation score was higher in the CFVR ≥ 2.5 group (92.86 ± 11.38 vs. 82.14 ± 17.93, p < 0.05).
• SAQ quality of life score was higher in the CFVR ≥ 2.5 group (95.63 ± 10.57 vs. 83.33 ± 19.90, p < 0.05).
• SAQ summary score was higher in the CFVR ≥ 2.5 group (94.05 ± 8.51 vs. 85.71 ± 15.71, p < 0.05).
• No adverse clinical events occurred in either group at 1-year follow-up.

Combined dipyridamole-exercise stress echocardiography (DExE) with myocardial strain/work analysis was used to assess CMD and LV function at 3 months post-PCI.

• This was a prospective study enrolling CAD individuals who underwent left anterior descending artery PCI.
• DExE assessment was performed at 3 months post-PCI to evaluate myocardial strain/work parameters at rest and stress.
• The primary endpoint was adverse clinical events and the secondary endpoint was SAQ health status at 1 year.
• CMD was defined by coronary flow velocity reserve (CFVR) < 2.5.

CMD persists after PCI in individuals with coronary artery disease and is associated with impaired LV functional reserve detectable by stress echocardiography.

• 21 of 84 participants (25%) had CFVR < 2.5 at 3 months post-PCI, indicating persistent CMD.
• The study underscores the need for close cardiac function monitoring in post-PCI CMD individuals.
• Myocardial strain and work parameters captured differences in LV function that were not apparent at rest alone.