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Updated: Jun 26, 2026

Non-invasive Assessment of Microvascular and Endothelial Function
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Microcirculatory dysfunction in hypertrophic cardiomyopathy with chest pain assessed by angiography-derived

Yahui Lu1,2, Zheng-Kai Xue1,2, Wenqing Gao1,2

  • 1Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.

Scientific Reports
|July 23, 2024
PubMed

Insights

Chest pain in hypertrophic cardiomyopathy (HCM) is linked to microvascular dysfunction. Angiography-derived microcirculatory resistance (AMR) revealed higher resistance in HCM patients, predicting adverse outcomes.

Area of Science:

  • Cardiology
  • Cardiovascular Physiology

Background:

  • Chest pain is a common symptom in hypertrophic cardiomyopathy (HCM), often linked to myocardial ischemia without significant coronary artery stenosis.
  • Microvascular dysfunction is increasingly recognized as a contributor to ischemia in HCM.

Purpose of the Study:

  • To investigate microvascular dysfunction in HCM patients using angiography-derived microcirculatory resistance (AMR).
  • To assess the correlation between AMR and clinical outcomes in HCM patients.

Main Methods:

  • Retrospective analysis of HCM patients with chest pain and control patients.
  • Calculation of AMR using angiography, a wire-free and adenosine-free index.
  • Propensity score matching to balance demographic characteristics.
  • Correlation analysis with echocardiography and follow-up data.

Main Results:

  • No significant difference in epicardial coronary stenosis between 76 HCM patients and 152 controls after matching.
  • Markedly greater AMR in the three epicardial coronary arteries of HCM patients.
  • 65.7% of HCM patients met the criterion (AMR ≥ 250 mmHg*s/m) for coronary microvascular dysfunction (CMD).
  • Increased left ventricular wall thickness was an independent risk factor for CMD (OR=1.209).
  • Higher AMR in the left anterior descending artery (AMR_LAD ≥ 250 mmHg*s/m) predicted increased cumulative risk of adverse endpoints (log-rank p=0.023) and was an independent risk factor (HR=11.64).

Conclusions:

  • Angiography-derived microcirculatory resistance (AMR) is a valuable tool for assessing microvascular dysfunction in HCM.
  • Coronary microvascular dysfunction is prevalent in HCM patients with chest pain.
  • AMR provides significant prognostic insights, with higher values indicating increased risk of adverse clinical outcomes.

Keywords:
Angiography-derived physiologyCoronary microvascular dysfunctionHypertrophic cardiomyopathyIndex of microcirculatory resistancePrognostic assessment

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