Reference values for intracoronary Doppler flow velocity-derived hyperaemic microvascular resistance index

Rutger G T Feenstra; Andreas Seitz; Coen K M Boerhout; Robbert J de Winter; Peter Ong; Marcel A M Beijk; Jan J Piek; Udo Sechtem; Tim P van de Hoef

doi:10.1016/j.ijcard.2022.09.054

Reference values for intracoronary Doppler flow velocity-derived hyperaemic microvascular resistance index

Rutger G T Feenstra, Andreas Seitz, Coen K M Boerhout, Robbert J de Winter, Peter Ong, Marcel A M Beijk, Jan J Piek, Udo Sechtem, Tim P van de Hoef

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Invasive assessments of microvascular function are rapidly becoming an integral part of physiological assessment in chronic coronary syndromes.

OBJECTIVE: We aimed to establish a reference range for Doppler flow velocity-derived hyperaemic microvascular resistance index (HMR) in a cohort of angina with no significant epicardial coronary obstruction (ANOCA) patients with no structural pathophysiological alterations in the coronary circulation.

METHODS: The reference population consisted of ANOCA patients undergoing invasive coronary vasomotor function assessment who had a coronary flow reserve (CFR) >2.5, and had either (1) tested negatively for spasm provocation (n = 12) or (2) tested positively with only angina at rest (n = 29). A reference range for HMR was established using a non-parametric method and correlations with clinical characteristics were determined using a spearman rank correlation analysis.

RESULTS: In 41 patients median HMR amounted to 1.6 mmHg/cm/s [Q1, Q3: 1.3, 2.2 mmHg/cm/s]. The reference range for HMR that is applicable to 95% of the population was 0.8 mmHg/cm/s (90% CI: 0.8-1.0 mmHg/cm/s) to 2.7 mmHg/cm/s (90% CI: 2.6-2.7 mmHg/cm/s). No significant correlations were found between HMR and clinical characteristics.

CONCLUSION: In this reference population undergoing invasive coronary vasomotor function testing, the 90% confidence interval of the HMR upper limit of normal ranges from 2.6 to 2.7 mmHg/cm/s. A > 2.5 mmHg/cm/s HMR threshold can be used to identify abnormal microvascular resistance in daily clinical practice.

Original language	English
Pages (from-to)	16-20
Number of pages	5
Journal	International Journal of Cardiology
Volume	371
DOIs	https://doi.org/10.1016/j.ijcard.2022.09.054
Publication status	Published - 15 Jan 2023
Externally published	Yes

Keywords

Angina Pectoris
Blood Flow Velocity
Coronary Angiography
Coronary Circulation/physiology
Coronary Vessels/diagnostic imaging
Humans
Hyperemia
Microcirculation
Vascular Resistance/physiology

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10.1016/j.ijcard.2022.09.054

Cite this

@article{5a7862ad1f2742acacea122bb3f7ec18,

title = "Reference values for intracoronary Doppler flow velocity-derived hyperaemic microvascular resistance index",

abstract = "BACKGROUND: Invasive assessments of microvascular function are rapidly becoming an integral part of physiological assessment in chronic coronary syndromes.OBJECTIVE: We aimed to establish a reference range for Doppler flow velocity-derived hyperaemic microvascular resistance index (HMR) in a cohort of angina with no significant epicardial coronary obstruction (ANOCA) patients with no structural pathophysiological alterations in the coronary circulation.METHODS: The reference population consisted of ANOCA patients undergoing invasive coronary vasomotor function assessment who had a coronary flow reserve (CFR) >2.5, and had either (1) tested negatively for spasm provocation (n = 12) or (2) tested positively with only angina at rest (n = 29). A reference range for HMR was established using a non-parametric method and correlations with clinical characteristics were determined using a spearman rank correlation analysis.RESULTS: In 41 patients median HMR amounted to 1.6 mmHg/cm/s [Q1, Q3: 1.3, 2.2 mmHg/cm/s]. The reference range for HMR that is applicable to 95\% of the population was 0.8 mmHg/cm/s (90\% CI: 0.8-1.0 mmHg/cm/s) to 2.7 mmHg/cm/s (90\% CI: 2.6-2.7 mmHg/cm/s). No significant correlations were found between HMR and clinical characteristics.CONCLUSION: In this reference population undergoing invasive coronary vasomotor function testing, the 90\% confidence interval of the HMR upper limit of normal ranges from 2.6 to 2.7 mmHg/cm/s. A > 2.5 mmHg/cm/s HMR threshold can be used to identify abnormal microvascular resistance in daily clinical practice.",

keywords = "Angina Pectoris, Blood Flow Velocity, Coronary Angiography, Coronary Circulation/physiology, Coronary Vessels/diagnostic imaging, Humans, Hyperemia, Microcirculation, Vascular Resistance/physiology",

author = "Feenstra, \{Rutger G T\} and Andreas Seitz and Boerhout, \{Coen K M\} and \{de Winter\}, \{Robbert J\} and Peter Ong and Beijk, \{Marcel A M\} and Piek, \{Jan J\} and Udo Sechtem and \{van de Hoef\}, \{Tim P\}",

note = "Publisher Copyright: {\textcopyright} 2022 The Author(s)",

year = "2023",

month = jan,

day = "15",

doi = "10.1016/j.ijcard.2022.09.054",

language = "English",

volume = "371",

pages = "16--20",

journal = "International Journal of Cardiology",

issn = "0167-5273",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Reference values for intracoronary Doppler flow velocity-derived hyperaemic microvascular resistance index

AU - Feenstra, Rutger G T

AU - Seitz, Andreas

AU - Boerhout, Coen K M

AU - de Winter, Robbert J

AU - Ong, Peter

AU - Beijk, Marcel A M

AU - Piek, Jan J

AU - Sechtem, Udo

AU - van de Hoef, Tim P

PY - 2023/1/15

Y1 - 2023/1/15

N2 - BACKGROUND: Invasive assessments of microvascular function are rapidly becoming an integral part of physiological assessment in chronic coronary syndromes.OBJECTIVE: We aimed to establish a reference range for Doppler flow velocity-derived hyperaemic microvascular resistance index (HMR) in a cohort of angina with no significant epicardial coronary obstruction (ANOCA) patients with no structural pathophysiological alterations in the coronary circulation.METHODS: The reference population consisted of ANOCA patients undergoing invasive coronary vasomotor function assessment who had a coronary flow reserve (CFR) >2.5, and had either (1) tested negatively for spasm provocation (n = 12) or (2) tested positively with only angina at rest (n = 29). A reference range for HMR was established using a non-parametric method and correlations with clinical characteristics were determined using a spearman rank correlation analysis.RESULTS: In 41 patients median HMR amounted to 1.6 mmHg/cm/s [Q1, Q3: 1.3, 2.2 mmHg/cm/s]. The reference range for HMR that is applicable to 95% of the population was 0.8 mmHg/cm/s (90% CI: 0.8-1.0 mmHg/cm/s) to 2.7 mmHg/cm/s (90% CI: 2.6-2.7 mmHg/cm/s). No significant correlations were found between HMR and clinical characteristics.CONCLUSION: In this reference population undergoing invasive coronary vasomotor function testing, the 90% confidence interval of the HMR upper limit of normal ranges from 2.6 to 2.7 mmHg/cm/s. A > 2.5 mmHg/cm/s HMR threshold can be used to identify abnormal microvascular resistance in daily clinical practice.

AB - BACKGROUND: Invasive assessments of microvascular function are rapidly becoming an integral part of physiological assessment in chronic coronary syndromes.OBJECTIVE: We aimed to establish a reference range for Doppler flow velocity-derived hyperaemic microvascular resistance index (HMR) in a cohort of angina with no significant epicardial coronary obstruction (ANOCA) patients with no structural pathophysiological alterations in the coronary circulation.METHODS: The reference population consisted of ANOCA patients undergoing invasive coronary vasomotor function assessment who had a coronary flow reserve (CFR) >2.5, and had either (1) tested negatively for spasm provocation (n = 12) or (2) tested positively with only angina at rest (n = 29). A reference range for HMR was established using a non-parametric method and correlations with clinical characteristics were determined using a spearman rank correlation analysis.RESULTS: In 41 patients median HMR amounted to 1.6 mmHg/cm/s [Q1, Q3: 1.3, 2.2 mmHg/cm/s]. The reference range for HMR that is applicable to 95% of the population was 0.8 mmHg/cm/s (90% CI: 0.8-1.0 mmHg/cm/s) to 2.7 mmHg/cm/s (90% CI: 2.6-2.7 mmHg/cm/s). No significant correlations were found between HMR and clinical characteristics.CONCLUSION: In this reference population undergoing invasive coronary vasomotor function testing, the 90% confidence interval of the HMR upper limit of normal ranges from 2.6 to 2.7 mmHg/cm/s. A > 2.5 mmHg/cm/s HMR threshold can be used to identify abnormal microvascular resistance in daily clinical practice.

KW - Angina Pectoris

KW - Blood Flow Velocity

KW - Coronary Angiography

KW - Coronary Circulation/physiology

KW - Coronary Vessels/diagnostic imaging

KW - Humans

KW - Hyperemia

KW - Microcirculation

KW - Vascular Resistance/physiology

U2 - 10.1016/j.ijcard.2022.09.054

DO - 10.1016/j.ijcard.2022.09.054

M3 - Article

C2 - 36174827

SN - 0167-5273

VL - 371

SP - 16

EP - 20

JO - International Journal of Cardiology

JF - International Journal of Cardiology

ER -

Reference values for intracoronary Doppler flow velocity-derived hyperaemic microvascular resistance index

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Keywords

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