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Intracoronary physiological indices for coronary microvascular dysfunction: from concept to clinical application

Tadashi Murai1, Tsunekazu Kakuta2, Kiyoshi Hibi3

  • 1Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.

Cardiovascular Intervention and Therapeutics
|June 2, 2026
PubMed

Insights

Coronary microvascular dysfunction (CMD) impacts heart health. Invasive physiological assessments (IPA) now offer precise diagnosis and treatment strategies for CMD, improving cardiovascular disease management.

Area of Science:

  • Cardiovascular Medicine
  • Physiology
  • Medical Diagnostics

Background:

  • Coronary microcirculation was historically difficult to assess, often termed a 'black box'.
  • Coronary microvascular dysfunction (CMD) is increasingly recognized as a key factor in myocardial ischemia and various cardiovascular diseases.
  • Accurate diagnosis and targeted treatments for CMD are crucial for patient outcomes.

Purpose of the Study:

  • To provide an overview of current intracoronary physiological indices (IPA) for assessing coronary microcirculation.
  • To summarize the clinical applications, strengths, and limitations of IPA in diagnosing and managing CMD.
  • To highlight the evolving role of IPA in risk stratification and personalized therapy for cardiovascular conditions.

Main Methods:

  • Review of intracoronary physiological assessment techniques used during coronary catheterization.
  • Analysis of data on the diagnostic capabilities of various physiological indices for CMD.
  • Evaluation of the strengths and limitations of current IPA methods.

Main Results:

  • IPA techniques allow for direct, patient-specific assessment of coronary microcirculation.
  • Established indices provide valuable information for diagnosing CMD.
  • IPA aids in risk stratification and guides the development of tailored treatment strategies.

Conclusions:

  • Invasive physiological assessments are essential tools for understanding and managing coronary microvascular dysfunction.
  • IPA offers precise diagnostic and prognostic information, moving beyond the 'black box' concept.
  • The role of IPA in cardiovascular medicine is expanding, impacting diagnosis, risk assessment, and therapeutic decisions.

Keywords:
Coronary flow reserveCoronary microvascular dysfunctionCoronary microvascular resistance

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