Radboudumc, Nijmegen, the Netherlands.
Robert Bosch Hospital, Stuttgart, Germany.
J Am Coll Cardiol. 2021 Oct 5;78(14):1471-1479. doi: 10.1016/j.jacc.2021.08.028.
Coronary microvascular dysfunction is a highly prevalent condition of both structural and functional coronary disorders in patients with angina and nonobstructive coronary artery disease (ANOCA). Current diagnostic modalities to assess microvascular function are related to prognosis, but these modalities have several technical shortcomings and lack the opportunity to determine true coronary blood flow and microvascular resistance. Intracoronary continuous thermodilution assessment of absolute coronary flow (Q) and microvascular resistance (R) was recently shown to be safe and feasible in ANOCA. Further exploration and implementation could lead to a better understanding and treatment of patients with ANOCA. This review discuss the coronary pathophysiology of microvascular dysfunction, provides an overview of noninvasive and invasive diagnostics, and focuses on the novel continuous thermodilution method. Finally, how these measurements of absolute Q and R could be integrated and how this would affect future clinical care are discussed.
冠状动脉微血管功能障碍是一种在心绞痛和非阻塞性冠状动脉疾病（ANOCA）患者中存在的结构性和功能性冠状动脉障碍的高发情况。目前评估微血管功能的诊断方法与预后相关，但这些方法存在一些技术缺陷，并且缺乏确定真正冠状动脉血流和微血管阻力的机会。最近，在 ANOCA 中，经冠状动脉连续热稀释法评估绝对冠状动脉血流（Q）和微血管阻力（R）被证明是安全可行的。进一步的探索和实施可能会导致更好地理解和治疗 ANOCA 患者。本文讨论了微血管功能障碍的冠状动脉病理生理学，概述了非侵入性和侵入性诊断方法，并重点介绍了新型连续热稀释法。最后，讨论了如何整合这些绝对 Q 和 R 的测量值，以及这将如何影响未来的临床护理。
