Thabo Mahendiran, Daniëlle Keulards, Nico H J Pijls, Michele Viscusi, Emanuele Gallinoro, Dario Bertolone, Peter Damman, Niels van Royen, Jeroen Sonck, Carlos Collet, Adriaan Wilgenhof, Paul Knaapen, Bernard De Bruyne
{"title":"最小微血管阻力：连续和大剂量热调节的一致性。","authors":"Thabo Mahendiran, Daniëlle Keulards, Nico H J Pijls, Michele Viscusi, Emanuele Gallinoro, Dario Bertolone, Peter Damman, Niels van Royen, Jeroen Sonck, Carlos Collet, Adriaan Wilgenhof, Paul Knaapen, Bernard De Bruyne","doi":"10.1002/ccd.31515","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Continuous thermodilution quantifies absolute microvascular resistance (R<sub>μ</sub>, Wood units), a key metric of microvascular function. R<sub>μ</sub> is minimal during hyperemia (R<sub>μ,hyper</sub>) with increased R<sub>μ,hyper</sub> suggestive of microvascular dysfunction. Bolus thermodilution measures the index of microcirculatory resistance (IMR), a dimensionless surrogate of R<sub>μ,hyper</sub>.</p><p><strong>Aims: </strong>We compared R<sub>μ,hyper</sub> measured by continuous thermodilution (invasive R<sub>μ,hyper</sub>) with the gold standard [<sup>15</sup>O]H<sub>2</sub>O positron emission tomography (PET R<sub>μ,hyper</sub>), and assessed the correlation between invasive R<sub>μ,hyper</sub> and IMR.</p><p><strong>Methods: </strong>First, the accuracy of invasive R<sub>μ,hyper</sub> was assessed in a cohort of 24 patients in which both invasive R<sub>μ,hyper</sub> and PET R<sub>μ,hyper</sub> were measured in the left anterior descending (LAD) and circumflex (LCX) arteries, corresponding to 46 measurements of R<sub>μ,hyper</sub> in total (LAD = 24, LCX = 22). Next, agreement between invasive R<sub>μ,hyper</sub> and IMR was evaluated in the LAD in a cohort of 250 patients with angina and non-obstructive coronary arteries.</p><p><strong>Results: </strong>Invasive R<sub>μ,hyper</sub> exhibited a strong correlation with PET R<sub>μ,hyper</sub> (r = 0.86 [95% CI 0.76-0.92], p < 0.001), with good absolute agreement (ICC 0.82 [95% CI 0.70-0.90], p < 0.001). Passing-Bablok regression analysis found no significant systematic (intercept A: 54.53 [95% CI -18.95 to 120.96]) or proportional (slope B: 0.90 [95% CI 0.71-1.15]) bias between invasive R<sub>μ,hyper</sub> and PET R<sub>μ,hyper</sub>. However, invasive R<sub>μ,hyper</sub> exhibited no significant correlation with IMR (r = 0.11 [95% CI -0.01 to 0.23], p = 0.08).</p><p><strong>Conclusion: </strong>Invasive R<sub>μ,hyper</sub> derived from continuous thermodilution exhibited excellent agreement with noninvasive R<sub>μ,hyper</sub> measured by [<sup>15</sup>O]H<sub>2</sub>O PET, the current non-invasive standard of reference. In contrast, IMR exhibited no significant correlation with invasive R<sub>μ,hyper</sub> in patients with angina and non-obstructive coronary arteries.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Minimal Microvascular Resistance: Agreement Between Continuous and Bolus Thermodilution.\",\"authors\":\"Thabo Mahendiran, Daniëlle Keulards, Nico H J Pijls, Michele Viscusi, Emanuele Gallinoro, Dario Bertolone, Peter Damman, Niels van Royen, Jeroen Sonck, Carlos Collet, Adriaan Wilgenhof, Paul Knaapen, Bernard De Bruyne\",\"doi\":\"10.1002/ccd.31515\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Continuous thermodilution quantifies absolute microvascular resistance (R<sub>μ</sub>, Wood units), a key metric of microvascular function. R<sub>μ</sub> is minimal during hyperemia (R<sub>μ,hyper</sub>) with increased R<sub>μ,hyper</sub> suggestive of microvascular dysfunction. Bolus thermodilution measures the index of microcirculatory resistance (IMR), a dimensionless surrogate of R<sub>μ,hyper</sub>.</p><p><strong>Aims: </strong>We compared R<sub>μ,hyper</sub> measured by continuous thermodilution (invasive R<sub>μ,hyper</sub>) with the gold standard [<sup>15</sup>O]H<sub>2</sub>O positron emission tomography (PET R<sub>μ,hyper</sub>), and assessed the correlation between invasive R<sub>μ,hyper</sub> and IMR.</p><p><strong>Methods: </strong>First, the accuracy of invasive R<sub>μ,hyper</sub> was assessed in a cohort of 24 patients in which both invasive R<sub>μ,hyper</sub> and PET R<sub>μ,hyper</sub> were measured in the left anterior descending (LAD) and circumflex (LCX) arteries, corresponding to 46 measurements of R<sub>μ,hyper</sub> in total (LAD = 24, LCX = 22). Next, agreement between invasive R<sub>μ,hyper</sub> and IMR was evaluated in the LAD in a cohort of 250 patients with angina and non-obstructive coronary arteries.</p><p><strong>Results: </strong>Invasive R<sub>μ,hyper</sub> exhibited a strong correlation with PET R<sub>μ,hyper</sub> (r = 0.86 [95% CI 0.76-0.92], p < 0.001), with good absolute agreement (ICC 0.82 [95% CI 0.70-0.90], p < 0.001). Passing-Bablok regression analysis found no significant systematic (intercept A: 54.53 [95% CI -18.95 to 120.96]) or proportional (slope B: 0.90 [95% CI 0.71-1.15]) bias between invasive R<sub>μ,hyper</sub> and PET R<sub>μ,hyper</sub>. However, invasive R<sub>μ,hyper</sub> exhibited no significant correlation with IMR (r = 0.11 [95% CI -0.01 to 0.23], p = 0.08).</p><p><strong>Conclusion: </strong>Invasive R<sub>μ,hyper</sub> derived from continuous thermodilution exhibited excellent agreement with noninvasive R<sub>μ,hyper</sub> measured by [<sup>15</sup>O]H<sub>2</sub>O PET, the current non-invasive standard of reference. In contrast, IMR exhibited no significant correlation with invasive R<sub>μ,hyper</sub> in patients with angina and non-obstructive coronary arteries.</p>\",\"PeriodicalId\":9650,\"journal\":{\"name\":\"Catheterization and Cardiovascular Interventions\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-04-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Catheterization and Cardiovascular Interventions\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/ccd.31515\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Catheterization and Cardiovascular Interventions","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/ccd.31515","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Minimal Microvascular Resistance: Agreement Between Continuous and Bolus Thermodilution.
Background: Continuous thermodilution quantifies absolute microvascular resistance (Rμ, Wood units), a key metric of microvascular function. Rμ is minimal during hyperemia (Rμ,hyper) with increased Rμ,hyper suggestive of microvascular dysfunction. Bolus thermodilution measures the index of microcirculatory resistance (IMR), a dimensionless surrogate of Rμ,hyper.
Aims: We compared Rμ,hyper measured by continuous thermodilution (invasive Rμ,hyper) with the gold standard [15O]H2O positron emission tomography (PET Rμ,hyper), and assessed the correlation between invasive Rμ,hyper and IMR.
Methods: First, the accuracy of invasive Rμ,hyper was assessed in a cohort of 24 patients in which both invasive Rμ,hyper and PET Rμ,hyper were measured in the left anterior descending (LAD) and circumflex (LCX) arteries, corresponding to 46 measurements of Rμ,hyper in total (LAD = 24, LCX = 22). Next, agreement between invasive Rμ,hyper and IMR was evaluated in the LAD in a cohort of 250 patients with angina and non-obstructive coronary arteries.
Results: Invasive Rμ,hyper exhibited a strong correlation with PET Rμ,hyper (r = 0.86 [95% CI 0.76-0.92], p < 0.001), with good absolute agreement (ICC 0.82 [95% CI 0.70-0.90], p < 0.001). Passing-Bablok regression analysis found no significant systematic (intercept A: 54.53 [95% CI -18.95 to 120.96]) or proportional (slope B: 0.90 [95% CI 0.71-1.15]) bias between invasive Rμ,hyper and PET Rμ,hyper. However, invasive Rμ,hyper exhibited no significant correlation with IMR (r = 0.11 [95% CI -0.01 to 0.23], p = 0.08).
Conclusion: Invasive Rμ,hyper derived from continuous thermodilution exhibited excellent agreement with noninvasive Rμ,hyper measured by [15O]H2O PET, the current non-invasive standard of reference. In contrast, IMR exhibited no significant correlation with invasive Rμ,hyper in patients with angina and non-obstructive coronary arteries.
期刊介绍：
Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.
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