A Systematic Approach to the Evaluation of the Coronary Microcirculation Using Bolus Thermodilution: CATH CMD

Area of Science:

• Cardiology
• Vascular Biology
• Diagnostic Imaging

Background:

• Coronary microvascular dysfunction (CMD) is a significant cause of myocardial ischemia in patients with angina without obstructive coronary artery disease (ANOCA).
• Accurate assessment of microvascular function is crucial for diagnosing and managing these patients.
• Current diagnostic methods for CMD can be complex or inaccessible.

Purpose of the Study:

• To review the bolus thermodilution method for assessing coronary microvascular resistance.
• To introduce the CATH CMD algorithm for systematic evaluation of the coronary microcirculation.
• To promote a standardized approach for diagnosing CMD.

Main Methods:

• Utilizing the thermodilution technique to measure coronary flow reserve (CFR) and index of microcirculatory resistance (IMR).
• Detailing the fundamental steps for conducting thermodilution measurements.
• Implementing the CATH CMD algorithmic approach for structured microcirculatory assessment.

Main Results:

• The thermodilution technique provides validated indices (CFR, IMR) for evaluating coronary microcirculation.
• The index of microcirculatory resistance (IMR) specifically quantifies minimum achievable microvascular resistance.
• The CATH CMD algorithm offers a systematic framework for evaluating CMD.

Conclusions:

• The bolus thermodilution technique is an accessible method for assessing microvascular resistance.
• A standardized algorithmic approach, like CATH CMD, can enhance the adoption and streamline the diagnosis of CMD.
• Improved diagnosis of CMD will facilitate better patient management and outcomes.