Multicenter Prospective Assessment of Coronary Microvascular Dysfunction
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Coronary microvascular dysfunction (CMD) and vasospastic angina (VSA) are common, yet underdiagnosed. Existing studies of invasive CMD/VSA assessment have specified patient selection and procedural technique, with little known about testing use in real-world practice. OBJECTIVES: The purpose of the study was to observe procedural and therapeutic decision-making for patients undergoing invasive CMD/VSA assessment. METHODS: FlowLab was a multicenter, prospective study of patients with possible CMD in whom the treating physician used the CoroFlow bolus thermodilution system to measure coronary flow reserve and index of microcirculatory resistance (IMR). As the purpose was to observe how testing is performed in current practice, procedural technique, including whether to perform vasospasm testing, was at operator discretion. Procedural data were collected in real-time. RESULTS: A total of 253 procedures were performed at 14 U.S. sites. The most common presenting symptoms were chest pain (222/253; 88%) and dyspnea (93/253; 37%). The median CoroFlow duration was 10 (IQR: 7-14) minutes and provocative vasospasm testing was performed in 50% (124/246). Forty-three percent (110/253) of patients had abnormal coronary flow reserve (<2.5) and 28% (72/253) had abnormal IMR (≥25). CMD/VSA was identified in 53% (135/253) of patients, with a final diagnosis of CMD in 59% (19/32) of these and VSA in 28% (9/32). Anginal therapy addition was more common in those with elevated IMR (61% [44/72] vs 29% [53/181]; P < 0.0001). CONCLUSIONS: In a prospective assessment of invasive testing for CMD/VSA, we observed varied procedural and technical approaches. Testing was rapid, and a final diagnosis of CMD or VSA was common with immediate implications for patient management. Further integration of CMD/VSA evaluation may help address current gaps in diagnosis and treatment.
Source: JACC Advances
Authors: Brian A. Bergmark, Samit Shah, Olga Toleva, Aziz Maksoud, Kathleen E. Kearney, Yuhei Kobayashi, Akl C. Fahed, Hayder Hashim, Alok Sharma, John Blair, Bassem M. Chehab, Uday Kanakadandi, Farouc A. Jaffer, Allen Jeremias, David A. Gross, Raj Baljepally, Ziad A. Ali, Gautam Reddy, Evan Shlofmitz, Issam Moussa, Shuanglu Zhang, Sabina A. Murphy, Salma Ahmed, Joia Spinelli, Jennifer Meinen, Richard J. Rapoza, Marc S. Sabatine
Institutions: Brigham and Women's Hospital, Harvard University, Thrombolysis in Myocardial Infarction Study Group, Yale University, Northeast Georgia Medical Center, University of Washington, NewYork–Presbyterian Hospital, Massachusetts General Hospital, MedStar Washington Hospital Center, Minneapolis VA Health Care System, University of Kansas, Ascension Via Christi, Carle Foundation Hospital, St. Francis Hospital, University of Tennessee Medical Center, Huntsville Hospital, Abbott Vascular (United States)
Language: English
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,936
Funder: Abbott Vascular
OpenAlex ID: W4414570921