Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2024 Aug;104(2):241-246.
doi: 10.1002/ccd.31122. Epub 2024 Jun 19.

Continuous thermodilution and microvascular resistance reserve during the index procedure in acute coronary syndrome without obstructive coronary artery disease: A pilot study

Jesse P A Demandt  1 , Mohamed El Farissi  1 , Annemiek de Vos  1 , Rob Eerdekens  1 , Koen Teeuwen  1 , Guus Brueren  1 , Frederik M Zimmermann  2 , Pim A L Tonino  1   3 , Nico H J Pijls  1 , Pieter J Vlaar  1
Affiliations
Observational Study

Continuous thermodilution and microvascular resistance reserve during the index procedure in acute coronary syndrome without obstructive coronary artery disease: A pilot study

Jesse P A Demandt et al. Catheter Cardiovasc Interv. 2024 Aug.

Abstract

Background: In 5%-25% of non-ST-elevation acute coronary syndrome (NSTE-ACS) patients, coronary angiography reveals no obstructive coronary arteries (MINOCA). Coronary microvascular disease (CMD) is a potential causal pathophysiological mechanism in these patients and can be diagnosed by continuous thermodilution assessment. Recently, the microvascular resistance reserve (MRR) has been introduced as a novel index to assess the vasodilatory capacity of the microcirculation. However, continuous thermodilution and MRR have never been investigated in the acute setting in MINOCA patients and invasive assessment of the microcirculation in these patients are currently lacking.

Aims: The objectives of the study were to investigate the incidence of CMD (MRR ≤ 2.7) in patients with MINOCA and to evaluate the feasibility and safety of continuous thermodilution-based assessment during index coronary angiography in the acute setting.

Methods: This study was a prospective, observational, pilot study investigating coronary physiology in the acute setting in MINOCA patients. Patients admitted with a diagnosis of NSTE-ACS were eligible for inclusion.

Results: In total, 19 MINOCA patients were included in this analysis; the mean age was 70 ± 9 years, and 79% were females. CMD was present in 6 patients (32%). Qrest was significantly higher in the MRR ≤ 2.7 group compared to the MRR > 2.7 group (0.076 [0.057-0.100] vs. 0.049 [0.044-0.071] L/min, p = 0.03). Rµ,rest was significantly lower in the MRR ≤ 2.7 group compared to the MRR > 2.7 group (1083 [710-1510] vs. 1563 [1298-1970] WU, p = 0.04). No periprocedural complications or hemodynamic instability have occurred during continuous thermodilution assessment during the index coronary angiography.

Conclusion: In patients admitted for MINOCA undergoing immediate coronary angiography, continuous thermodilution assessment and MRR are feasible and safe in the acute setting, and evidence of functional CMD could be observed in one-third of the MINOCA patients.

Keywords: MINOCA; MRR; NSTE‐ACS; continuous thermodilution; coronary microvascular dysfunction; coronary physiology.

PubMed Disclaimer

References

REFERENCES

    1. Gabaldon‐Perez A, Bonanad C, Garcia‐Blas S, et al. Clinical predictors and prognosis of myocardial infarction with non‐obstructive coronary arteries (MINOCA) without ST‐segment elevation in older adults. J Clin Med. 2023;12(3):1181. doi:10.3390/jcm12031181
    1. Safdar B, Spatz ES, Dreyer RP, et al. Presentation, clinical profile, and prognosis of young patients with myocardial infarction with nonobstructive coronary arteries (MINOCA): results from the VIRGO study. J Am Heart Assoc. 2018;7(13):e009174. doi:10.1161/JAHA.118.009174
    1. Tamis‐Holland JE, Jneid H, Reynolds HR, et al. Contemporary diagnosis and management of patients with myocardial infarction in the absence of obstructive coronary artery disease: a scientific statement from the American Heart Association. Circulation. 2019;139(18):e891‐e908. doi:10.1161/CIR.0000000000000670
    1. Collet JP, Thiele H, Barbato E, et al. 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST‐segment elevation. Eur Heart J. 2021;42(14):1289‐1367. doi:10.1093/eurheartj/ehaa575
    1. Agewall S, Beltrame JF, Reynolds HR, et al. ESC working group position paper on myocardial infarction with non‐obstructive coronary arteries. Eur Heart J. 2016;38(3):ehw149. doi:10.1093/eurheartj/ehw149

Publication types

MeSH terms

Grants and funding

LinkOut - more resources