Cor Vasa 2025, 67(1):35-42 | DOI: 10.33678/cor.2024.101
(Continuous thermodilution - a novel method for direct measurement of coronary flow and resistance)
- Kardiologická klinika, 2. lékařská fakulta Univerzity Karlovy a Fakultní nemocnice v Motole, Praha, Česká republika
Angina with non-obstructive coronary artery disease is a frequent finding in patients with chest pain. Its pathophysiology involves two main mechanisms: structural and functional dysfunction of microcircula- tion, functional dysfunction of epicardial arteries, and their combination. The review article focuses on the diagnostics of microvascular dysfunction, particularly continuous thermodilution, as a safe, easy, fast, and operator-independent method. It describes both theoretical background and practical aspects with graphical examples of measurements.
Keywords: Angina with non-obstructive coronary artery disease (ANOCA), Coronary microcirculation, Coronary microvascular dysfunction, Coronary termodilution, Microvascular resistance reserve
Received: November 11, 2024; Revised: November 11, 2024; Accepted: December 5, 2024; Prepublished online: June 2, 2012; Published: March 1, 2025 Show citation
References
- Vrints C, Andreotti F, Koskinas KC, et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J 2024;45:3415-537.
Go to original source...
Go to PubMed...
- Kunadian V, Chieffo A, Camici PG, et al. An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International. Eur Heart J 2020;41:3504-3520.
Go to original source...
Go to PubMed...
- Aribas E, Roeters Van Lennep JE, Elias-Smale SE, et al. Prevalence of microvascular angina among patients with stable symptoms in the absence of obstructive coronary artery disease: A systematic review. Cardiovasc Res 2022;118:763-771.
Go to original source...
Go to PubMed...
- Paradies V, Smits PM, Maurina M, et al. Absolute coronary blood flow across different endotypes of ANOCA. EuroIntervention 2024;20:e1227-e1236.
Go to original source...
Go to PubMed...
- Lee SH, Shin D, Lee JM, et al. Clinical Relevance of Ischemia with Nonobstructive Coronary Arteries According to Coronary Microvascular Dysfunction. J Am Heart Assoc 2022;11:e025171.
- Boerhout CKM, de Waard GA, Lee JM, et al. Prognostic value of structural and functional coronary microvascular dysfunction in patients with non-obstructive coronary artery disease; from the multicentre international ILIAS registry. EuroIntervention 2022;18:719-728.
Go to original source...
Go to PubMed...
- Ford TJ, Stanley B, Good R, et al. Stratified Medical Therapy Using Invasive Coronary Function Testing in Angina: The CorMicA Trial. J Am Coll Cardiol 2018;72:2841-2855.
Go to original source...
Go to PubMed...
- Ford TJ, Stanley B, Sidik N, et al. 1-Year Outcomes of Angina Management Guided by Invasive Coronary Function Testing (CorMicA). JACC Cardiovasc Interv 2020;13:33-45.
Go to original source...
Go to PubMed...
- Candreva A, Gallinoro E, van 't Veer M, et al. Basics of Coronary Thermodilution. JACC Cardiovasc Interv 2021;14:595-605.
Go to original source...
Go to PubMed...
- Bastiany A, Pacheco C, Sedlak T, et al. A Practical Approach to Invasive Testing in Ischemia With No Obstructive Coronary Arteries (INOCA). CJC Open 2022;4:709-720.
Go to original source...
Go to PubMed...
- Ruddy TD, Tavoosi A, Taqueti VR. Role of nuclear cardiology in diagnosis and risk stratification of coronary microvascular disease. J Nucl Cardiol 2023;30:1327-1340.
Go to original source...
Go to PubMed...
- Sakai A, Nagao M, Yamamoto A, et al. 13N-ammonia positron emission tomography for diagnosis and monitoring of ischemia without obstructive coronary artery disease. Int J Cardiol 2024;395:131392.
Go to original source...
Go to PubMed...
- Ahmadvazir S, Shah BN, Zacharias K, Senior R. Incremental Prognostic Value of Stress Echocardiography With Carotid Ultrasound for Suspected CAD. JACC Cardiovasc Imaging 2018;11:173-180.
Go to original source...
Go to PubMed...
- Schroder J, Prescott E. Doppler Echocardiography Assessment of Coronary Microvascular Function in Patients With Angina and No Obstructive Coronary Artery Disease. Front Cardiovasc Med 2021;8:723542.
Go to original source...
Go to PubMed...
- Michelsen MM, Mygind ND, Pena A, et al. Transthoracic Doppler echocardiography compared with positron emission tomography for assessment of coronary microvascular dysfunction: The iPOWER study. Int J Cardiol 2017;228:435-443.
Go to original source...
Go to PubMed...
- Cortigiani L, Ciampi Q, Lombardo A, et al. Age- and Gender- -Specific Prognostic Cutoff Values of Coronary Flow Velocity Reserve in Vasodilator Stress Echocardiography. J Am Soc Echocardiogr 2019;32:1307-1317.
Go to original source...
Go to PubMed...
- Fahrni G, Wolfrum M, De Maria GL, et al. Index of microcirculatory resistance at the time of primary percutaneous coronary intervention predicts early cardiac complications: Insights from the OxAMI (Oxford Study in Acute Myocardial Infarction) Cohort. J Am Heart Assoc 2017;6:e005409.
Go to original source...
Go to PubMed...
- Keulards DCJ, Veer MVT, Zelis JM, et al. Safety of absolute coronary flow and microvascular resistance measurements by thermodilution. EuroIntervention 2021;17:229-232.
Go to original source...
Go to PubMed...
- Gallinoro E, Candreva A, Fernandez-Peregrina E, et al. Saline--induced coronary hyperemia with continuous intracoronary thermodilution is mediated by intravascular hemolysis. Atherosclerosis 2022;352:46-52.
Go to original source...
Go to PubMed...
- Fournier S, Keulards DCJ, van 't Veer M, et al. Normal values of thermodilution-derived absolute coronary blood flow and microvascular resistance in humans. EuroIntervention 2021;17:E309-E316.
Go to original source...
Go to PubMed...
- Jansen TPJ, Vos D, Annemiek, Paradies V, et al. Continuous Versus Bolus Thermodilution-Derived Coronary Flow Reserve and Microvascular Resistance Reserve and Their Association With Angina and Quality of Life in Patients With Angina and Nonobstructive Coronaries: A Head-to-Head Comparison. J Am Heart Assoc 2023;12:e030480.
Go to original source...
Go to PubMed...
- De Bruyne B, Pijls NHJ, Gallinoro E, et al. Microvascular Resistance Reserve for Assessment of Coronary Microvascular Function: JACC Technology Corner. J Am Coll Cardiol 2021;78:1541-1549.
Go to original source...
Go to PubMed...
- Xaplanteris P, Fournier S, Keulards DCJ, et al. Catheter- -based measurements of absolute coronary blood flow and microvascular resistance feasibility, safety, and reproducibility in humans. Circ Cardiovasc Interv 2018;11:1-8.
Go to original source...
Go to PubMed...
- De Bruyne B, Adjedj J, Xaplanteris P, et al. Saline-Induced Coronary Hyperemia. Circ Cardiovasc Interv 2017;10:1-8.
Go to original source...
Go to PubMed...
- Banai A, Lupu L, Borohovitz A, et al. Microvascular dysfunction in patients with angina and non-obstructive coronary artery disease - preliminary data from a single center registry. Eur Heart J 2021;42(Suppl. 1):2095.
Go to original source...
- Yoon GS, Ahn SG, Woo SI, et al. The Index of Microcirculatory Resistance after Primary Percutaneous Coronary Intervention Predicts Long-Term Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction. J Clin Med 2021;10:4752.
Go to original source...
Go to PubMed...
- Mahendiran T, Fawaz S, Viscusi M, et al. Simplification of continuous intracoronary thermodilution. EuroIntervention 2024;20:e1217-e1226.
Go to original source...
Go to PubMed...
- Gallinoro E, Bertolone DT, Fernandez-Peregrina E, et al. Reproducibility of bolus versus continuous thermodilution for assessment of coronary microvascular function in patients with ANOCA. EuroIntervention 2023;19:E155-E166.
Go to original source...
Go to PubMed...
- Zimmermann FM, Tonino PAL. The quest for accurate tools to open the black box of the microcirculation: continuous thermodilution and MRR. EuroIntervention 2023;19:E105-E106.
Go to original source...
Go to PubMed...
- Jansen TPJ, De Vos A, Damman P, et al. Absolute flow and resistance have a lower variability in repeated testing as compared to CFR and IMR: an EDIT-CMD substudy. Eur Heart J 2022;43(Suppl. 2):2022.
Go to original source...
- de Vos A, Jansen TPJ, van 't Veer M, et al. Microvascular Resistance Reserve to Assess Microvascular Dysfunction in ANOCA Patients. JACC Cardiovasc Interv 2023;16:470-481.
Go to original source...
Go to PubMed...
- Smilowitz NR, Toleva O, Chieffo A, et al. Coronary Microvascular Disease in Contemporary Clinical Practice. Circ Cardiovasc Interv 2023;16:E012568.
Go to original source...
Go to PubMed...
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