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Updated: Jun 14, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Developments and Controversies in Invasive Diagnosis of Coronary Microvascular Dysfunction in Angina With
Kara J Denby1, Mohammad Zmaili2, Sudarshana Datta3
1Department of Cardiovascular Medicine, Saint Alphonsus Regional Medical Center, Boise, ID.
Abstract:
Approximately half of all coronary angiograms performed for angina do not show obstructive coronary artery disease, and many of these patients have coronary microvascular dysfunction (CMD). Invasive testing for CMD has increased with the advent and wider availability of thermodilution systems. We review CMD pathophysiology and invasive diagnostic testing using the Doppler and thermodilution systems. We report the results of a PubMed search of invasive microvascular testing and discuss limitations of current diagnostic algorithms in the diagnosis of CMD, including controversies regarding the optimal cutoff value for abnormal coronary flow reserve, use of microvascular resistance indices, and options for increasing sensitivity of testing.
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