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Quantification of Absolute Myocardial Flow and Resistance by Continuous Thermodilution in Patients with Ischemia and
Regina E Konst1, Daniëlle C J Keulards2, Niels van Royen1
1Radboud University Medical Center.
Insights
Many patients with angina have no obstructive coronary artery disease (INOCA). Coronary vasomotor dysfunction is common, and invasive coronary vasomotor function testing (CFT) is recommended. Continuous thermodilution offers improved assessment of coronary blood flow and resistance.
Area of Science:
- Cardiology
- Vascular Physiology
- Diagnostic Imaging
Background:
- Coronary angiography reveals no obstructive coronary artery disease in about half of patients with angina or ischemia.
- Angina or ischemia and no obstructive coronary artery disease (INOCA) often stems from underlying coronary vasomotor dysfunction.
- Current guidelines recommend invasive coronary vasomotor function testing (CFT) for diagnosing INOCA.
Purpose of the Study:
- To provide an overview of the continuous thermodilution method for assessing coronary vasomotor function.
- To highlight the potential of continuous thermodilution for quantifying absolute coronary blood flow and resistance.
- To discuss the advantages of continuous thermodilution over standard physiological measures in CFT.
Main Methods:
- Invasive coronary vasomotor function testing (CFT) using various diagnostic modalities.
- Assessment of different vasomotor dysfunction endotypes, including epicardial and microvascular vasospasm, and microvascular vasodilatory dysfunction.
- Application of continuous thermodilution for quantifying absolute coronary blood flow and resistance.
Main Results:
- Continuous thermodilution allows for the quantification of absolute coronary blood flow.
- This method enables precise measurement of absolute coronary resistance.
- The data suggest continuous thermodilution may offer superior physiological measures compared to current standards.
Conclusions:
- Continuous thermodilution is a promising method for invasive coronary vasomotor function testing.
- It provides more accurate assessments of coronary hemodynamics in patients with INOCA.
- This technique may improve the diagnosis and management of coronary vasomotor dysfunction.
Abstract:
In approximately half of the patients undergoing coronary angiography for angina pectoris or for signs or symptoms suggestive of ischemic heart disease, no obstructive coronary artery disease is angiographically visible. The majority of these patients with angina or ischemia and no obstructive coronary artery disease (INOCA) have an underlying coronary vasomotor dysfunction, and current consensus documents recommend diagnostic invasive coronary vasomotor function testing (CFT). During CFT, a variety of vasomotor dysfunction endotypes can be assessed, including vasospastic coronary dysfunction (epicardial or microvascular vasospasm), and/or microvascular vasodilatory dysfunction, including impaired vasodilatory capacity and increased microvascular resistance. The quantification of the continuous thermodilution derived absolute coronary blood flow and resistance might be a better measure compared to the currently used standard physiologic measures. This article provides an overview of this continuous thermodilution method.
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