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Sakai K, Storozhenko T, Mizukami T, Ohashi H, Bouisset F, Tajima A, van Hoe L, Gallinoro E, Botti G, Mahendiran T, Pardaens S, Brouwers S, Fawaz S, Keeble TR, Davies JR, Sonck J, De Bruyne B, Collet C. Impact of vessel volume on thermodilution measurements in patients with coronary microvascular dysfunction. Catheter Cardiovasc Interv 2024. [PMID: 38566527 DOI: 10.1002/ccd.31020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/05/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Two invasive methods are available to estimate microvascular resistance: bolus and continuous thermodilution. Comparative studies have revealed a lack of concordance between measurements of microvascular resistance obtained through these techniques. AIMS This study aimed to examine the influence of vessel volume on bolus thermodilution measurements. METHODS We prospectively included patients with angina with non-obstructive coronary arteries (ANOCA) undergoing bolus and continuous thermodilution assessments. All patients underwent coronary CT angiography to extract vessel volume. Coronary microvascular dysfunction was defined as coronary flow reserve (CFR) < 2.0. Measurements of absolute microvascular resistance (in Woods units) and index of microvascular resistance (IMR) were compared before and after volumetric adjustment. RESULTS Overall, 94 patients with ANOCA were included in this study. The mean age was 64.7 ± 10.8 years, 48% were female, and 19% had diabetes. The prevalence of CMD was 16% based on bolus thermodilution, while continuous thermodilution yielded a prevalence of 27% (Cohen's Kappa 0.44, 95% CI 0.23-0.65). There was no correlation in microvascular resistance between techniques (r = 0.17, 95% CI -0.04 to 0.36, p = 0.104). The adjustment of IMR by vessel volume significantly increased the agreement with absolute microvascular resistance derived from continuous thermodilution (r = 0.48, 95% CI 0.31-0.63, p < 0.001). CONCLUSIONS In patients with ANOCA, invasive methods based on coronary thermodilution yielded conflicting results for the assessment of CMD. Adjusting IMR with vessel volume improved the agreement with continuous thermodilution for the assessment of microvascular resistance. These findings strongly suggest the importance of considering vessel volume when interpreting bolus thermodilution assessment.
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Affiliation(s)
- Koshiro Sakai
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Tatyana Storozhenko
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Prevention and Treatment of Emergency Conditions, L.T. Malaya Therapy National Institute NAMSU, Kharkiv, Ukraine
| | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Division of Clinical Pharmacology, Department of Pharmacology, Showa University, Tokyo, Japan
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Hirofumi Ohashi
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Frederic Bouisset
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | - Atomu Tajima
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | | | - Emanuele Gallinoro
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Giulia Botti
- Interventional Cardiology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | | | - Sofie Brouwers
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Samer Fawaz
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK
- MTRC, Anglia Ruskin School of Medicine, Chelmsford, Essex, UK
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK
- MTRC, Anglia Ruskin School of Medicine, Chelmsford, Essex, UK
| | - John R Davies
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK
- MTRC, Anglia Ruskin School of Medicine, Chelmsford, Essex, UK
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
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