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Updated: May 13, 2026
Non-invasive Assessment of Microvascular and Endothelial Function
Published on: January 29, 2013
Novel Contrast-Derived Indices of Coronary Microvascular Function: Potential Clinical and Cost Benefits
Daniel T Y Ang1,2,3, Damien Collison1, Ross J McGeoch3
1West of Scotland Regional Heart and Lung Centre, Golden Jubilee University National Hospital, Clydebank, United Kingdom (D.T.Y.A., D.G.C., R.A.S., C. Bradley, R.A.B., P.J.M.C., J.P.R., A.P.A., K.E.R., A. Shaukat, A.G., F.R.J., R.I.S.G., H.E., M.M.L., C. Berry).
Insights
Contrast media can reliably assess coronary microvascular function, offering a cost-effective alternative to adenosine. This method aids in quickly ruling out microvascular dysfunction.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Techniques
Background:
- Adenosine is standard for myocardial hyperemia, but contrast media also induce hyperemia.
- Contrast media induce transient, submaximal hyperemia, prompting investigation into their diagnostic utility.
- Assessing feasibility, diagnostic value, and cost-effectiveness of contrast-derived microvascular function indices.
Purpose of the Study:
- To evaluate contrast-derived indices for assessing coronary microvascular function.
- To compare the diagnostic accuracy of contrast-derived indices against adenosine-derived indices.
- To determine the cost-effectiveness of using contrast media for microvascular function testing.
Main Methods:
- Coronary flow reserve, index of microvascular resistance, and microvascular resistance reserve were measured using a diagnostic guidewire.
- Intracoronary thermodilution was performed at rest, after contrast injections, and during adenosine infusion.
- Receiver operating characteristic analyses compared contrast-derived and adenosine-derived indices.
Main Results:
- Contrast-derived indices showed high diagnostic accuracy (AUC 0.81-0.82) for detecting microvascular dysfunction.
- Specific thresholds for contrast-derived indices accurately predicted adenosine-derived abnormalities.
- A hybrid approach reduced adenosine use by 40%, yielding significant cost savings.
Conclusions:
- Contrast-derived indices are specific and have high negative predictive value, useful for excluding microvascular dysfunction.
- This contrast-based method is feasible, clinically valuable, and more cost-effective than routine adenosine testing.
- Contrast media offer a viable alternative for coronary microvascular function assessment.
Background:
Intravenous adenosine induces stable myocardial hyperemia for coronary microvascular function testing. Iodinated radiographic contrast media induce transient, submaximal hyperemia. We assessed the feasibility, diagnostic value, and potential cost-effectiveness of contrast-derived indices of microvascular function.
Methods:
Coronary flow reserve, index of microvascular resistance, and microvascular resistance reserve were assessed using a diagnostic guidewire. Intracoronary bolus thermodilution injections were performed at rest, immediately after an 8-mL bolus of iohexol, repeated after a second 8-mL bolus, and during intravenous adenosine infusion. Receiver operating characteristic analyses assessed the discriminatory ability of the contrast-derived indices (contrast-derived coronary flow reserve, contrast-derived index of microcirculatory resistance, contrast-derived microvascular resistance reserve) to detect abnormal adenosine-derived indices (coronary flow reserve <2.0, index of microvascular resistance ≥25, and microvascular resistance reserve <2.1).
Results:
Among 106 coronary arteries from 93 patients (median age 63 years; 62% women; 13% with diabetes), 88% of assessments were undertaken in the left anterior descending artery. Median fractional flow reserve was 0.88 (interquartile range, 0.85-0.92). Contrast-derived coronary flow reserve <2.0 (area under the curve 0.81; sensitivity 67%, specificity 80%, positive predictive value 40%, negative predictive value 92%), contrast-derived index of microcirculatory resistance >47 (area under the curve 0.82; 80%, 79%, 60%, 91%), and contrast-derived microvascular resistance reserve <1.9 (area under the curve 0.82; 67%, 89%, 35%, 97%) were best for predicting their adenosine-derived counterpart indices. There was good correlation on repeatability testing from the second contrast bolus. A hybrid approach reduced adenosine use by 40%, saving $30 800 (USA) or £8000 (UK) per 1000 vessels assessed.
Conclusions:
Contrast-derived indices have high specificity and negative predictive value, enabling rapid exclusion of microvascular dysfunction. This method is feasible, clinically useful and cost-saving compared with routine adenosine testing.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04674449.
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