{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T06:52:27Z","timestamp":1789627947165,"version":"build-2803163510"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Resistive reserve ratio (RRR), or the ratio of baseline to hyperemic microvascular resistance, has prognostic implications in predicting clinical outcomes in patients with obstructive coronary artery disease. However, its value in patients with angina or ischemia with nonobstructive coronary artery disease is unknown.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We included 1692 patients with nonobstructive coronary artery disease who underwent invasive coronary vasoreactivity testing. Abnormal coronary flow reserve (CFR, the ratio of hyperemic and baseline resting flow velocities) and RRR were defined as &lt;2.5 and &lt;2.62, respectively. The mortality rate was marginally higher in patients with abnormal CFR (428 patients [25%]) than those with normal CFR (38 [9%] versus 81 [6%];\n              <jats:italic>P<\/jats:italic>\n              =0.08), and was significantly higher in patients with abnormal RRR (716 patients [42%]) than those with normal RRR (70 [10%] versus 49 [5%],\n              <jats:italic>P<\/jats:italic>\n              =0.0002) over the median follow\u2010up of 11.3\u00a0years. Patients with abnormal CFR had marginally lower survival than those with normal CFR (log\u2010rank\n              <jats:italic>P<\/jats:italic>\n              =0.08). In contrast, patients with abnormal RRR had significantly lower survival than those with normal RRR (log\u2010rank\n              <jats:italic>P<\/jats:italic>\n              =0.001). Abnormal RRR was associated with shorter time to death even after adjustment for other covariates (adjusted hazard ratio, 1.63; 95% CI, 1.11\u20132.38;\n              <jats:italic>P<\/jats:italic>\n              =0.01).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">In patients with no obstructive coronary artery disease, RRR was superior to CFR in predicting long\u2010term survival. An RRR &lt;2.62 was associated with 1.6 times increased risk of death in patients with nonobstructive coronary artery disease. Indices of coronary microcirculatory resistive reserve comprising flow\u2010 and pressure\u2010derived values may reflect underlying microvascular pathology more faithfully than flow\u2010alone indices like CFR.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.020464","type":"journal-article","created":{"date-parts":[[2021,5,15]],"date-time":"2021-05-15T09:24:30Z","timestamp":1621070670000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":44,"title":["Risk Stratification of Patients With NonObstructive Coronary Artery Disease Using Resistive Reserve Ratio"],"prefix":"10.1161","volume":"10","author":[{"given":"Takumi","family":"Toya","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"},{"name":"Division of Cardiology National Defense Medical College Tokorozawa Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel T.","family":"Corban","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilke","family":"\u04e6zcan","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaskanwal D.","family":"Sara","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faten","family":"Sebaali","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4932-0112","authenticated-orcid":false,"given":"Javier","family":"Escaned","sequence":"additional","affiliation":[{"name":"Department of Cardiology Hospital Cl\u00ednico San Carlos Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3271-3887","authenticated-orcid":false,"given":"Lilach O.","family":"Lerman","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9446-5313","authenticated-orcid":false,"given":"Amir","family":"Lerman","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.01.054"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.008507"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2013.86"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.carrev.2019.01.022"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.119.008505"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.015846"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.041595"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.03.051"},{"key":"e_1_3_1_10_2","article-title":"Prognostic impact and clinical outcomes of coronary flow reserve and hyperemic microvascular resistance","author":"Toya T","year":"2020","unstructured":"Toya T, Corban MT, Park JY, Ahmad A, Ozcan I, Sebaali F, Sara J, Gulati R, Lerman LO, Lerman A. 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