A Systematic Approach and Practical Guide to Using Bolus Thermodilution for Invasive Coronary Microvascular...

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.