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Updated: Jun 19, 2026
Non-invasive Assessment of Microvascular and Endothelial Function
Published on: January 29, 2013
Implementation of Microcirculation Examination in Clinical Practice-Insights from the Nationwide POL-MKW Registry
Rafał Januszek1, Łukasz Kołtowski2, Mariusz Tomaniak2
1Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Cracow University, 30-705 Kraków, Poland.
Insights
Coronary microcirculation assessment is increasing in Poland. Impaired coronary flow reserve (CFR) or index of microcirculatory resistance (IMR) often leads to additional pharmacotherapy, not angina symptoms.
Area of Science:
- Cardiology
- Vascular Biology
- Diagnostic Medicine
Background:
- Coronary microcirculation assessment aids in risk stratification and treatment adjustment for cardiovascular conditions.
- Understanding factors linked to abnormal coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) is crucial for patient management.
Purpose of the Study:
- To evaluate clinical presentation and treatment patterns following coronary microcirculation assessment.
- To identify factors associated with abnormal CFR and IMR values.
Main Methods:
- Retrospective analysis of 223 patients from a national registry of invasive coronary microvascular testing (2018-2023).
- Assessment of coronary flow reserve (CFR) and index of microcirculatory resistance (IMR).
Main Results:
- Coronary microcirculatory assessments increased significantly in Poland from 2018-2023.
- Patients with impaired IMR (≥25) had fewer comorbidities. Normal IMR was associated with more frequent revascularization attempts.
- Patients with coronary microvascular dysfunction (CMD) received additional pharmacotherapy (trimetazidine, CCBs) more frequently. Angina symptoms showed no association with IMR or CFR impairment.
Conclusions:
- Coronary microcirculation assessment frequency is rising in Poland.
- Angina symptoms do not correlate with impaired IMR or CFR.
- Patients diagnosed with coronary microvascular dysfunction (CMD) post-assessment are more likely to receive intensified pharmacotherapy.
Abstract:
Background and Objectives: The assessment of coronary microcirculation may facilitate risk stratification and treatment adjustment. The aim of this study was to evaluate patients' clinical presentation and treatment following coronary microcirculation assessment, as well as factors associated with an abnormal coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) values. Materials and Results: This retrospective analysis included 223 patients gathered from the national registry of invasive coronary microvascular testing collected between 2018 and 2023. Results: The frequency of coronary microcirculatory assessments in Poland has steadily increased since 2018. Patients with impaired IMR (≥25) were less burdened with comorbidities. Patients with normal IMR underwent revascularisation attempts more frequently (11.9% vs. 29.8%, p = 0.003). After microcirculation testing, calcium channel blockers (CCBs) and angiotensin-converting enzyme inhibitors were added more often for patients with IMR and CFR abnormalities, respectively, as compared to control groups. Moreover, patients with coronary microvascular dysfunction (CMD, defined as CFR and/or IMR abnormality), regardless of treatment choice following microcirculation assessment, were provided with trimetazidine (23.2%) and dihydropyridine CCBs (26.4%) more frequently than those without CMD who were treated conservatively (6.8%) and by revascularisation (4.2% with p = 0.002 and 0% with p < 0.001, respectively). Multivariable analysis revealed no association between angina symptoms and IMR or CFR impairment. Conclusions: The frequency of coronary microcirculatory assessments in Poland has steadily increased. Angina symptoms were not associated with either IMR or CFR impairment. After microcirculation assessment, patients with impaired microcirculation, expressed as either low CFR, high IMR or both, received additional pharmacotherapy treatment more often.
