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Updated: May 5, 2026
Non-invasive Assessment of Microvascular and Endothelial Function
Published on: January 29, 2013
Angiography-derived index of microcirculatory resistance as a novel tool to assess coronary microvascular dysfunction
Zhan Gao1, Xue Hua Qian2, Jia Yu Ke1
1The Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China.
Insights
Coronary microvascular dysfunction (CMD) is linked to diabetic cardiomyopathy (DbCM). The angiography-derived index of microcirculatory resistance (AMR) shows promise for diagnosing CMD and may be improved by certain medications.
Area of Science:
- Cardiology
- Diabetology
- Vascular Medicine
Background:
- Coronary microvascular dysfunction (CMD) is a proposed mechanism and therapeutic target in diabetic cardiomyopathy (DbCM).
- Clinical investigation of CMD in DbCM is limited.
- Angiography-derived index of microcirculatory resistance (AMR) is a novel, non-invasive measure of CMD with clinical potential.
Purpose of the Study:
- To investigate the clinical utility of AMR in diagnosing CMD in patients with DbCM.
- To identify risk factors for abnormal AMR in DbCM.
- To explore the effects of pharmacological interventions on AMR in DbCM.
Main Methods:
- AMR was measured in hospitalized patients with DbCM and control subjects.
- Incidence, clinical characteristics, and risk factors for CMD were assessed.
- Effects of pharmacological interventions on AMR were evaluated.
Main Results:
- AMR was significantly higher in patients meeting DbCM-2B criteria.
- Independent risk factors for abnormal AMR included diabetes, BMI, and NT-pro-BNP.
- ACEI/ARB, sacubitril/valsartan, and trimetazidine showed potential to lower AMR in patients with elevated NT-pro-BNP.
Conclusions:
- DbCM-2B diagnostic criteria strongly correlate with CMD.
- ACEI/ARB, sacubitril/valsartan, and trimetazidine may improve CMD in DbCM patients.
Backgrounds:
Coronary microvascular dysfunction (CMD) has been proposed as a major mechanism and a potential therapeutic target for diabetic cardiomyopathy (DbCM); however, it has not been fully investigated in a clinical setting. The angiography-derived index of microcirculatory resistance (AMR) is a novel non-invasive measurement of CMD that exhibits promising clinical applications.
Methods:
AMR was measured in hospitalized patients with DbCM and in control patients. The incidence, clinical characteristics, risk factors, and effects of pharmacological interventions on CMD were investigated.
Results:
AMR was significantly higher in patients who met the DbCM-2B diagnostic criteria. The independent risk factors for abnormal AMR included diabetes, body mass index (BMI), and N-terminal pro-brain natriuretic peptide (NT-pro-BNP). Patients with elevated NT-pro-BNP had high AMR, and those grouped by medication indicated that ACEI/ARB, sacubitril/valsartan, and trimetazidine might lower AMR in patients with elevated NT-pro-BNP.
Conclusions:
The DbCM-2B diagnostic criteria demonstrated a strong correlation with CMD. ACEI/ARB, sacubitril/valsartan, and trimetazidine might improve CMD in patients with DbCM.
