Thermodilution-Based Invasive Assessment of Absolute Coronary Blood Flow and Microvascular Resistance: Quantification of Microvascular (Dys)Function?

Keulards, Daniëlle C J; Farissi, Mohamed El; Tonino, Pim A.L.; Teeuwen, Koen; Vlaar, Pieter J.; Hagen, Eduard van; Wijnbergen, Inge; Vos, Annemiek de; Brueren, Guus; Veer, Marcel van‘t; Pijls, Nico H.J.

doi:10.1155/2020/5024971

Cited by 12 publications

(5 citation statements)

References 21 publications

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“… Continuous thermodilution technique (absolute values). 14 After waiting at least 2 minutes to ensure that the hyperemic effect of the bolus thermodilution method disappeared, a dedicated rapid exchange coronary infusion microcatheter, Rayflow (Hexacath, France), was positioned in the proximal segment of the vessel. The pressure–temperature sensor was located at the same position as with bolus thermodilution, 3 to 6 cm distal from the tip of the RayFlow catheter.…”

Section: Methodsmentioning

confidence: 99%

Continuous Versus Bolus Thermodilution‐Derived Coronary Flow Reserve and Microvascular Resistance Reserve and Their Association With Angina and Quality of Life in Patients With Angina and Nonobstructive Coronaries: A Head‐to‐Head Comparison

Jansen

Vos

Paradies

et al. 2023

JAHA

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Background Coronary flow reserve (CFR) and microvascular resistance reserve (MRR) are physiological parameters to assess coronary microvascular dysfunction. CFR and MRR can be assessed using bolus or continuous thermodilution, and the correlation between these methods has not been clarified. Furthermore, their association with angina and quality of life is unknown. Methods and Results In total, 246 consecutive patients with angina and nonobstructive coronary arteries from the multicenter Netherlands Registry of Invasive Coronary Vasomotor Function Testing (NL‐CFT) were investigated. The 36‐item Short Form Health Survey Quality of Life and Seattle Angina questionnaires were completed by 153 patients before the invasive measurements. CFR and MRR were measured consecutively with bolus and continuous thermodilution. Mean continuous thermodilution‐derived coronary flow reserve (CFR abs ) was significantly lower than mean bolus thermodilution‐derived coronary flow reserve (CFR bolus ) (2.6±1.0 versus 3.5±1.8; P <0.001), with a modest correlation ( ρ =0.305; P <0.001). Mean continuous thermodilution‐derived microvascular resistance reserve (MRR abs ) was also significantly lower than mean bolus thermodilution‐derived MRR (MRR bolus ) (3.1±1.1 versus 4.2±2.5; P <0.001), with a weak correlation ( ρ =0.280; P <0.001). CFR bolus and MRR bolus showed no correlation with any of the angina and quality of life domains, whereas CFR abs and MRR abs showed a significant correlation with physical limitation ( P =0.005, P =0.009, respectively) and health ( P =0.026, P =0.012). In a subanalysis in patients in whom spasm was excluded, the correlation further improved (MRR abs versus physical limitation: ρ =0.363; P =0.041, MRR abs versus physical health: ρ =0.482; P =0.004). No association with angina frequency and stability was found. Conclusions Absolute flow measurements using continuous thermodilution to calculate CFR abs and MRR abs weakly correlate with, and are lower than, the surrogates CFR bolus and MRR bolus . Absolute flow parameters showed a relationship with physical complaints. No relationship with angina frequency and stability was found.

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Section: Methodsmentioning

confidence: 99%

Continuous Versus Bolus Thermodilution‐Derived Coronary Flow Reserve and Microvascular Resistance Reserve and Their Association With Angina and Quality of Life in Patients With Angina and Nonobstructive Coronaries: A Head‐to‐Head Comparison

Jansen

Vos

Paradies

et al. 2023

JAHA

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“…The invasive methods presently used to assess microvascular function, CFR and Index of Microvascular Resistance (IMR), are operator dependent and are based on adenosine to induce hyperemia. In the current issue, Keullards et al reviewed the new thermodilution-based method for the measurement of absolute coronary blood flow and microvascular resistance [ 33 ]. The measurements are easy to perform using the Rayflow® infusion catheter and Coroventis® software.…”

Section: Diagnosis and Methodsmentioning

confidence: 99%

Myocardial Microvascular Physiology in Acute and Chronic Coronary Syndromes, Aortic Stenosis, and Heart Failure

Larsen

Fearon

Anderson

et al. 2022

Journal of Interventional Cardiology

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“…Nonhyperemic resting indices were measured using a physiological pressure wire (PressureWire™ X Guidewire, Abbott Laboratories) 9 . Additionally, indices such as coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR) have been evaluated using thermodilution technology 10,11 . The outcomes of these measurements were methodically recorded and integrated into the CMDR along with the corresponding findings from coronary angiography.…”

Section: Assessment Of Microvascular Physiologymentioning

confidence: 99%

Investigating Electrocardiographic Abnormalities in Patients with Coronary Microvascular Dysfunction

Merdler,

Hill,

Ozturk

et al. 2024

Preprint

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BACKGROUND: Coronary microvascular dysfunction (CMD) is a frequently overlooked and underdiagnosed mechanism of cardiac ischemia despite its heightened risk of major adverse cardiovascular events. The potential impact of CMD on the conduction system and occurrence of arrhythmias has received limited attention. This study aimed to examine the link between CMD and surface electrocardiography (ECG). METHODS: We harnessed the Coronary Microvascular Disease registry (CMDR), utilizing the CoroVentis CoroFlow System (Abbott) to invasively assess patients presenting with symptomatic chest pain. All patients underwent microvascular assessment of the left anterior descending artery territory. Our cohort was stratified into two groups, CMD-positive and CMD-negative, with an analysis of the most recent ECG performed prior to the invasive evaluation for each patient. RESULTS: Our cohort comprised 230 patients, of which 60 were classified as CMD-positive and 170 as CMD-negative. T-wave inversion was observed in 30.5% of CMD-positive patients compared to 20% in the CMD-negative group (P=0.09), and ST depression was identified in 6.7% of CMD-positive patients compared to 2.4% of CMD-negative patients (P=0.12). There were no differences in conduction disorders, such as left bundle branch block (LBBB), left anterior hemiblock (LAHB), left posterior hemiblock (LPHB), right bundle branch block (RBBB), incomplete right bundle branch block (ICRBBB), and bifascicular block, between the two groups. There were no discernible distinctions in the ECG intervals, including the PR, QRS, and QT. There was a trend of increased left ventricular hypertrophy (LVH) according to the ECG criteria in patients with CMD (11.7% vs. 5.3%; P=0.09). CONCLUSION: Our study revealed a tendency toward ischemic and hypertrophic ECG changes among CMD-positive patients, but no differences in the occurrence of conduction disorders in patients with and without CMD. REGISTRATION: URL: https://clinicaltrials.gov; Unique Identifier:NCT05960474GRAPHIC ABSTRACT: A graphic abstract is available for this article.

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Thermodilution-Based Invasive Assessment of Absolute Coronary Blood Flow and Microvascular Resistance: Quantification of Microvascular (Dys)Function?

Cited by 12 publications

References 21 publications

Continuous Versus Bolus Thermodilution‐Derived Coronary Flow Reserve and Microvascular Resistance Reserve and Their Association With Angina and Quality of Life in Patients With Angina and Nonobstructive Coronaries: A Head‐to‐Head Comparison

Continuous Versus Bolus Thermodilution‐Derived Coronary Flow Reserve and Microvascular Resistance Reserve and Their Association With Angina and Quality of Life in Patients With Angina and Nonobstructive Coronaries: A Head‐to‐Head Comparison

Myocardial Microvascular Physiology in Acute and Chronic Coronary Syndromes, Aortic Stenosis, and Heart Failure

Investigating Electrocardiographic Abnormalities in Patients with Coronary Microvascular Dysfunction

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