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

Carlos Collet1, Andy Yong2, Daniel Munhoz1,3

  • 1Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.

Journal of the Society for Cardiovascular Angiography & Interventions
|August 12, 2024
PubMed

Insights

Coronary microvascular dysfunction (CMD) is diagnosed using the thermodilution technique, which measures microvascular resistance. A new algorithm, CATH CMD, standardizes this assessment for better diagnosis of CMD in angina patients.

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.

Keywords:
CATH CMDcoronary flow reservecoronary microvascular dysfunctioncoronary microvascular functionindex of microvascular dysfunction

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