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Background <p>Coronary microvascular dysfunction (CMD) contributes to myocardial ischemia in patients with angina and non-obstructive coronary artery disease. Quantitative positron emission tomography (PET) allows noninvasive assessment of myocardial blood flow and identification of CMD.</p> Objectives <p>To investigate the association between PET-assessed coronary microvascular dysfunction (CMD), coronary plaque burden, and vascular remodeling, integrating microvascular resistance reserve (MRR).</p> Methods <p>This post hoc analysis of the PACIFIC-1 trial included coronary arteries from symptomatic patients with suspected stable CAD who underwent [<sup>15</sup>O]water PET, coronary CT angiography (CTA), and invasive fractional flow reserve (FFR). Coronary arteries were categorized into three groups: non-ischemic vessels (normal FFR and hyperemic myocardial blood flow [hMBF], <i>n</i> = 352), CMD vessels (normal FFR but impaired hMBF, <i>n</i> = 88), and epicardial flow-limiting vessels (abnormal FFR, <i>n</i> = 159). MRR was calculated by integrating PET-derived coronary flow reserve with invasive FFR. AI-based CTA quantified plaque burden and remodeling.</p> Results <p>Diameter stenosis and plaque burden increased progressively from non-ischemic to CMD to epicardial flow-limiting vessels (all <i>P</i> &lt; 0.05). CMD vessels demonstrated the largest lumen volume (583.75 mm<sup>3</sup> [IQR 337.02–754.30]) and lumen area (4.63 mm<sup>2</sup> [IQR 3.77–6.67]) among the three groups (both <i>P</i> &lt; 0.05). In non-ischemic vessels, noncalcified plaque burden was associated with worse microvascular function detected by MRR (B = -0.12, 95%CI [-0.21, -0.04], <i>P</i> = 0.006). In CMD vessels, remodeling index was independently associated with higher MRR after adjustment (B = 0.10, 95%CI [0.05, 0.15], <i>P</i> &lt; 0.001).</p> Conclusions <p>CMD is associated with an intermediate atherosclerotic burden and paradoxical lumen enlargement, representing a distinct functional-structural phenotype defined by PET-derived microvascular dysfunction and CT-based plaque characteristics.</p> <p><b>Clinical Trial Registration:</b></p> <p>URL: <a href="https://www.clinicaltrials.gov">https://www.clinicaltrials.gov</a>; Unique identifier: NCT01521468.</p> Graphical Abstract <p>Abbreviations: CMD, coronary microvascular dysfunction; FFR, fractional flow reserve; MBF, myocardial blood flow; MRR, microvascular resistance reserve; PET, positron emission tomography-computed tomography.</p> <p></p>

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PET-based assessment of coronary microvascular dysfunction and its relation to plaque burden and vascular remodeling: integration with microvascular resistance reserve

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月6日

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  • Yipu Ding,
  • Roel Hoek,
  • Putri Annisa Kamila,
  • Ibrahim Danad,
  • Nick S. Nurmohamed,
  • Ruurt A. Jukema,
  • Pieter G. Raijmakers,
  • Roel S. Driessen,
  • Pepijn A. van Diemen,
  • Andrew D. Choi,
  • Juhani Knuuti,
  • Paul Knaapen,
  • Hongbin Liu,
  • Jeroen J. Bax,
  • Alexander van Rosendael,
  • Roel S. Driessen,
  • Pepijn van Diemen,
  • Ruurt Jukema,
  • Lilian Meijboom,
  • Juhani Knuuti,
  • Antti Saraste,
  • Pieter G. Raijmakers,
  • Paul Knaapen,
  • Ibrahim Danad

摘要

Background

Coronary microvascular dysfunction (CMD) contributes to myocardial ischemia in patients with angina and non-obstructive coronary artery disease. Quantitative positron emission tomography (PET) allows noninvasive assessment of myocardial blood flow and identification of CMD.

Objectives

To investigate the association between PET-assessed coronary microvascular dysfunction (CMD), coronary plaque burden, and vascular remodeling, integrating microvascular resistance reserve (MRR).

Methods

This post hoc analysis of the PACIFIC-1 trial included coronary arteries from symptomatic patients with suspected stable CAD who underwent [15O]water PET, coronary CT angiography (CTA), and invasive fractional flow reserve (FFR). Coronary arteries were categorized into three groups: non-ischemic vessels (normal FFR and hyperemic myocardial blood flow [hMBF], n = 352), CMD vessels (normal FFR but impaired hMBF, n = 88), and epicardial flow-limiting vessels (abnormal FFR, n = 159). MRR was calculated by integrating PET-derived coronary flow reserve with invasive FFR. AI-based CTA quantified plaque burden and remodeling.

Results

Diameter stenosis and plaque burden increased progressively from non-ischemic to CMD to epicardial flow-limiting vessels (all P < 0.05). CMD vessels demonstrated the largest lumen volume (583.75 mm3 [IQR 337.02–754.30]) and lumen area (4.63 mm2 [IQR 3.77–6.67]) among the three groups (both P < 0.05). In non-ischemic vessels, noncalcified plaque burden was associated with worse microvascular function detected by MRR (B = -0.12, 95%CI [-0.21, -0.04], P = 0.006). In CMD vessels, remodeling index was independently associated with higher MRR after adjustment (B = 0.10, 95%CI [0.05, 0.15], P < 0.001).

Conclusions

CMD is associated with an intermediate atherosclerotic burden and paradoxical lumen enlargement, representing a distinct functional-structural phenotype defined by PET-derived microvascular dysfunction and CT-based plaque characteristics.

Clinical Trial Registration:

URL: https://www.clinicaltrials.gov; Unique identifier: NCT01521468.

Graphical Abstract

Abbreviations: CMD, coronary microvascular dysfunction; FFR, fractional flow reserve; MBF, myocardial blood flow; MRR, microvascular resistance reserve; PET, positron emission tomography-computed tomography.