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. 2025 Feb 14;13(2):466.
doi: 10.3390/biomedicines13020466.

Relationship Between Noninvasive Doppler-Derived Coronary Flow Reserve Measured by Transthoracic Echocardiography and Angiography Thermodilution-Measured Coronary Flow Reserve and the Index of Microcirculatory Resistance in Patients with Non-Obstructive Coronary Arteries

Milenko Čanković  1   2 , Aleksandra Milovančev  1   2 , Snežana Tadić  1   2 , Maja Stefanović  1   2 , Milovan Petrović  1   2 , Mila Kovačević  1   2 , Igor Tomas  2 , Dragana Dabović  1   2 , Vladimir Ivanović  1   2 , Aleksandra Ilić  1   2 , Anastazija Stojšić-Milosavljević  1   2 , Snežana Stojšić  2 , Nikola Komazec  1   2 , Bojan Mihajlović  1   2 , Igor Ivanov  1   2
Affiliations

Relationship Between Noninvasive Doppler-Derived Coronary Flow Reserve Measured by Transthoracic Echocardiography and Angiography Thermodilution-Measured Coronary Flow Reserve and the Index of Microcirculatory Resistance in Patients with Non-Obstructive Coronary Arteries

Milenko Čanković et al. Biomedicines. .

Abstract

Background/Objectives: Coronary microvascular dysfunction (CMD) is emerging as a critical factor in patients presenting with anginal symptoms without obstructive coronary artery disease (CAD). This study aims to investigate the relationship between invasive measurements of coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR) using thermodilution techniques, compared to non-invasive assessments of CFR with transthoracic Doppler echocardiography (TDE). Methods: In this observational prospective cross-sectional study, a total of 49 patients, clinically characterized as having angina with no obstructive CAD (ANOCA) or ischemia with no obstructive CAD (INOCA), underwent both TDE and invasive coronary angiography (ICA) followed by thermodilution assessment of CFR and IMR. Results: It was found that there is a statistically significant negative correlation between both non-invasive and invasive CFR measurements and IMR. Specifically, a negative moderate correlation was observed between non-invasive CFR and IMR (rs = -0.477, p < 0.01), as well as a high negative correlation between invasive CFR and IMR (r = -0.541, p < 0.01). Receiver operating characteristic (ROC) analysis indicated that both non-invasive and invasive CFRs are effective predictors of CMD, defined as IMR > 25. Conclusions: Both noninvasive and invasive CFR measurements are significant independent predictors of CMD. Our results indicate that noninvasive TDE CFR can be a reliable tool for assessing CMD in patients with ANOCA, potentially facilitating earlier diagnosis and management strategies for this patient population.

Keywords: coronary flow reserve; coronary microvascular dysfunction; index of microvascular resistance; microvascular angina; transthoracic Doppler echocardiography.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Scatter plot of Doppler echocardiography-measured CFR and invasive coronary angiography-measured IMR. Legend: IMR—index of microvascular resistance, CFR non-invasive—transthoracic Doppler echocardiography-derived coronary flow reserve.
Figure 2
Figure 2
Scatter plot invasive coronary angiography-measured CRF and IMR. Legend: IMR—index of microvascular resistance, CFRinvasive—invasive angiography-derived coronary flow reserve.
Figure 3
Figure 3
ROC curves, including noninvasive and invasive coronary flow reserve (CFR) for predicting IMR > 25. Legend: ROC—receiver-operating characteristic curve, CFRinvasive—invasive angiography-derived coronary flow reserve, CFRnon-invasive—transthoracic Doppler echocardiography-derived coronary flow reserve.
See this image and copyright information in PMC

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