Reproducibility of bolus versus continuous thermodilution for assessment of coronary microvascular function in patients with ANOCA
Reproducibility of bolus versus continuous thermodilution for assessment of coronary microvascular function in patients with ANOCA
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DOI：
10.4244/eij-d-22-00772
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发表时间：
2023-06-01
期刊：
影响因子：
6.2
通讯作者：
De Bruyne, Bernard
中科院分区：
文献类型：
--
作者：
Gallinoro, Emanuele;Bertolone, Dario Tino;De Bruyne, Bernard
背景：热调节衍生的微循环阻力指数（IMR）已成为评估冠状动脉微血管功能障碍（CMD）的标准。最近引入了连续热稀释作为直接量化绝对冠状动脉血流和微血管阻力的工具。微血管阻力储备（MRR）是一种新的测量微血管功能的指标，它与心外膜狭窄和心肌质量无关。目的：我们旨在评估大剂量和连续热稀释在评估冠状动脉微血管功能方面的可重复性。方法：前瞻性纳入心绞痛和非阻塞性冠状动脉疾病（ANOCA）血管造影患者。在左前降支（LAD）中进行了两次连续的冠状动脉内热稀释测量。患者以1:1的比例随机分配，首先进行大剂量热调节或首先进行连续热调节。结果：共纳入102例患者。平均分流储备（FFR）为0.86；PLUSMN;0.06。连续热调节（CFRcont）计算的冠状动脉血流储备（CFR）明显低于单剂量热调节计算的CFR (CFRbolus; 2.63 & PLUSMN;0.65 vs 3.29 & PLUSMN;1.17; p
Background: A bolus thermodilution-derived index of microcirculatory resistance (IMR) has emerged as the standard for assessing coronary microvascular dysfunction (CMD). Continuous thermodilution has recently been introduced as a tool to quantify absolute coronary flow and microvascular resistance directly. Microvascular resistance reserve (MRR) derived from continuous thermodilution has been proposed as a novel metric of microvascular function, which is independent of epicardial stenoses and myocardial mass.Aims: We aimed to assess the reproducibility of bolus and continuous thermodilution in assessing coronary microvascular function.Methods: Patients with angina and non-obstructive coronary artery disease (ANOCA) at angiography were prospectively enrolled. Bolus and continuous intracoronary thermodilution measurements were obtained in duplicate in the left anterior descending artery (LAD). Patients were randomly assigned in a 1:1 ratio to undergo either bolus thermodilution first or continuous thermodilution first.Results: A total of 102 patients were enrolled. The mean fractional flow reserve (FFR) was 0.86 & PLUSMN;0.06. Coronary flow reserve (CFR) calculated with continuous thermodilution (CFRcont) was significantly lower than bolus thermodilution-derived CFR (CFRbolus; 2.63 & PLUSMN;0.65 vs 3.29 & PLUSMN;1.17; p