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A Methodological Approach to Non-invasive Assessments of Vascular Function and Morphology
Published on: February 7, 2015
A Systematic Approach and Practical Guide to Using Bolus Thermodilution for Invasive Coronary Microvascular
Jason Galo1, Abhishek Chaturvedi1, Beni Rai Verma1
1Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA.
Insights
Angina with non-obstructive coronary arteries (ANOCA) is often caused by coronary microvascular dysfunction (CMD). This review details invasive coronary function testing (CFT) for accurate CMD diagnosis using coronary flow reserve (CFR) and index of microcirculatory resistance (IMR).
Area of Science:
- Cardiology
- Vascular Biology
- Diagnostic Imaging
Background:
- Angina with non-obstructive coronary arteries (ANOCA) affects many, particularly women, and is linked to coronary microvascular dysfunction (CMD).
- CMD significantly reduces quality of life and leads to poor clinical outcomes.
- Invasive coronary function testing (CFT) offers precise CMD diagnosis.
Purpose of the Study:
- To provide a systematic approach for evaluating CMD using CFT.
- To emphasize practical steps and troubleshooting for accurate CFR and IMR measurements.
- To discuss CMD phenotypes and their pathophysiological mechanisms.
Main Methods:
- Utilizing bolus thermodilution technique for assessing coronary flow reserve (CFR) and index of microcirculatory resistance (IMR).
- Addressing common challenges in CFT, including guide/wire positioning, waveform artifacts, and injection errors.
- Comparing bolus thermodilution with continuous thermodilution for accuracy and cost-effectiveness.
Main Results:
- CFT enables precise diagnosis of CMD through CFR and IMR.
- Practical solutions are provided for common testing challenges.
- Bolus thermodilution is a cost-effective method for assessing CMD.
Conclusions:
- Accurate diagnosis and management of CMD are essential for improving patient outcomes.
- Proficiency in CFT is crucial for clinicians managing ANOCA patients.
- This review enhances understanding and application of CMD testing.
Abstract:
Angina pectoris with non-obstructive coronary arteries (ANOCA) is a prevalent condition, particularly affecting women, and is often associated with coronary microvascular dysfunction (CMD). CMD, the primary cause of ANOCA, is associated with a diminished quality of life and adverse clinical outcomes. Invasive coronary function testing (CFT) now provides a precise diagnosis of CMD through indices such as coronary flow reserve (CFR) and index of microcirculatory resistance (IMR), assessed using the bolus thermodilution technique. This comprehensive review outlines a systematic approach to evaluating CMD, emphasizing practical steps and troubleshooting strategies to ensure accurate measurements of CFR and IMR. CMD phenotypes, including structural, functional, and compensated CMD, are discussed, along with their distinct pathophysiological mechanisms. Common challenges encountered during CMD testing, such as improper guide or wire positioning, waveform artifacts, and injection errors, are addressed with practical solutions. While continuous thermodilution offers enhanced accuracy, bolus thermodilution remains cost-effective and widely utilized. Proficiency in the intricacies of CMD testing is crucial for accurate diagnosis and management, ultimately enhancing clinical outcomes for this underrecognized patient population.
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