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Assessment of Microvascular Function in Angina Pectoris by Angiography-Based Index of Microcirculation Resistance: A
Wei Wen1, Yi Chi2, Mingwang Liu1
1Cardiovascular Department, Xiyuan Hospital of China Academy of Chinese Medical Sciences, 100091 Beijing, China.
Background:
While the invasive index of microcirculation resistance (IMR) remains the gold standard for diagnosing coronary microvascular dysfunction (CMD), its clinical adoption is limited by procedural complexity and cost. Angiography-based IMR (Angio-IMR), a computational angiography-based method, offers a promising alternative. This study evaluates the diagnostic efficacy of Angio-IMR for CMD detection in angina pectoris (AP).
Methods:
A comprehensive literature search was conducted across PubMed, Embase, Scopus, and the Cochrane Library to identify studies assessing Angio-IMR's diagnostic performance for CMD in AP populations. Primary outcomes included pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic (ROC) curve (AUC).
Results:
11 studies involving 927 patients were included. Angio-IMR demonstrated robust diagnostic performance: sensitivity 86% (95% CI: 0.83-0.90), specificity 90% (95% CI: 0.87-0.92), PPV 82% (95% CI: 0.78-0.86), NPV 91% (95% CI: 0.88-0.94), and AUC 0.91 (95% CI: 0.89-0.94), with low heterogeneity. Subgroup analyses revealed no significant differences in diagnostic accuracy between obstructive (stenosis ≥50%) and non-obstructive coronary artery disease. Hyperemic Angio-IMR measurements (adenosine-induced) showed superior sensitivity (89% vs. 86%) and specificity (94% vs. 91%) compared to resting-state assessments by AccuFFR system. Additionally, the sensitivity (88% vs. 82%), specificity (92% vs. 86%), PPV (82% vs. 78%) and NPV (91% vs. 88%) calculated based on AccuFFR were higher than that of quantitative flow ratio (QFR).
Conclusions:
Angio-IMR is a reliable, non-invasive tool for CMD identification in angina patients, particularly under hyperemic conditions. Its diagnostic consistency across stenosis severity subgroups supports broad clinical applicability.
Insights
Angiography-based IMR (Angio-IMR) is a reliable, non-invasive method for diagnosing coronary microvascular dysfunction (CMD) in angina patients. It shows high accuracy, especially under hyperemic conditions, making it a valuable clinical tool.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Tools
Background:
- Coronary microvascular dysfunction (CMD) diagnosis relies on invasive index of microcirculation resistance (IMR), which has limited clinical use due to complexity and cost.
- Angiography-based IMR (Angio-IMR) offers a promising, less invasive alternative for CMD assessment.
- This study aimed to evaluate the diagnostic efficacy of Angio-IMR for CMD detection in patients with angina pectoris (AP).
Purpose of the Study:
- To assess the diagnostic performance of Angio-IMR for detecting coronary microvascular dysfunction (CMD) in patients experiencing angina pectoris (AP).
- To compare the diagnostic accuracy of Angio-IMR with existing methods and under different physiological conditions (hyperemic vs. resting).
Main Methods:
- A systematic literature review was performed across major databases (PubMed, Embase, Scopus, Cochrane Library).
- Studies evaluating Angio-IMR's diagnostic performance in AP populations were included.
- Key outcomes analyzed included pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the ROC curve (AUC).
Main Results:
- Eleven studies with 927 patients confirmed Angio-IMR's robust diagnostic performance: sensitivity 86%, specificity 90%, PPV 82%, NPV 91%, and AUC 0.91.
- Diagnostic accuracy remained consistent across subgroups with obstructive and non-obstructive coronary artery disease.
- Hyperemic Angio-IMR showed superior sensitivity and specificity compared to resting-state assessments and outperformed quantitative flow ratio (QFR).
Conclusions:
- Angio-IMR is a reliable and non-invasive diagnostic tool for identifying CMD in patients with angina.
- Its diagnostic consistency, particularly under hyperemic conditions, supports broad clinical applicability.
- Angio-IMR presents a viable alternative to invasive IMR for CMD diagnosis.
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