Ang Daniel T Y, Collison Damien G, McGeoch Ross J, Carrick David, Sykes Robert A, Bradley Conor, Kamdar Anna L, Jong Andy, Brogan Richard A, MacDougall David A, McCartney Peter J, Rocchiccioli J Paul, Apps Andrew P, Murphy C Aengus, Robertson Keith E, Shaukat Aadil, Ghattas Angie, Joshi Francis R, Sood Arvind, Good Richard I S, O'Rourke Brian, Eteiba Hany, Lindsay M Mitchell, McConnachie Alex, Berry Colin
West of Scotland Regional Heart and Lung Centre, Golden Jubilee University National Hospital, Clydebank, United Kingdom (D.T.Y.A., D.G.C., R.A.S., C. Bradley, R.A.B., P.J.M.C., J.P.R., A.P.A., K.E.R., A. Shaukat, A.G., F.R.J., R.I.S.G., H.E., M.M.L., C. Berry).
British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom (D.T.Y.A., R.A.S., A.L.K., R.I.S.G., C. Berry).
Circ Cardiovasc Interv. 2025 Jun;18(6):e015058. doi: 10.1161/CIRCINTERVENTIONS.124.015058. Epub 2025 May 1.
Intravenous adenosine induces stable myocardial hyperemia for coronary microvascular function testing. Iodinated radiographic contrast media induce transient, submaximal hyperemia. We assessed the feasibility, diagnostic value, and potential cost-effectiveness of contrast-derived indices of microvascular function.
Coronary flow reserve, index of microvascular resistance, and microvascular resistance reserve were assessed using a diagnostic guidewire. Intracoronary bolus thermodilution injections were performed at rest, immediately after an 8-mL bolus of iohexol, repeated after a second 8-mL bolus, and during intravenous adenosine infusion. Receiver operating characteristic analyses assessed the discriminatory ability of the contrast-derived indices (contrast-derived coronary flow reserve, contrast-derived index of microcirculatory resistance, contrast-derived microvascular resistance reserve) to detect abnormal adenosine-derived indices (coronary flow reserve <2.0, index of microvascular resistance ≥25, and microvascular resistance reserve <2.1).
Among 106 coronary arteries from 93 patients (median age 63 years; 62% women; 13% with diabetes), 88% of assessments were undertaken in the left anterior descending artery. Median fractional flow reserve was 0.88 (interquartile range, 0.85-0.92). Contrast-derived coronary flow reserve <2.0 (area under the curve 0.81; sensitivity 67%, specificity 80%, positive predictive value 40%, negative predictive value 92%), contrast-derived index of microcirculatory resistance >47 (area under the curve 0.82; 80%, 79%, 60%, 91%), and contrast-derived microvascular resistance reserve <1.9 (area under the curve 0.82; 67%, 89%, 35%, 97%) were best for predicting their adenosine-derived counterpart indices. There was good correlation on repeatability testing from the second contrast bolus. A hybrid approach reduced adenosine use by 40%, saving $30 800 (USA) or £8000 (UK) per 1000 vessels assessed.
Contrast-derived indices have high specificity and negative predictive value, enabling rapid exclusion of microvascular dysfunction. This method is feasible, clinically useful and cost-saving compared with routine adenosine testing.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04674449.
静脉注射腺苷可诱导稳定的心肌充血，用于冠状动脉微血管功能测试。碘化放射造影剂可诱导短暂的、未达最大值的充血。我们评估了微血管功能的造影剂衍生指标的可行性、诊断价值和潜在成本效益。
使用诊断导丝评估冠状动脉血流储备、微血管阻力指数和微血管阻力储备。在静息状态下、静脉注射8 mL碘海醇后立即、再次注射8 mL碘海醇后以及静脉输注腺苷期间，进行冠状动脉内团注热稀释注射。受试者工作特征分析评估造影剂衍生指标（造影剂衍生冠状动脉血流储备、造影剂衍生微循环阻力指数、造影剂衍生微血管阻力储备）检测异常腺苷衍生指标（冠状动脉血流储备<2.0、微血管阻力指数≥25、微血管阻力储备<2.1）的鉴别能力。
在93例患者（中位年龄63岁；62%为女性；13%患有糖尿病）的106条冠状动脉中，88%的评估在左前降支进行。中位血流储备分数为0.88（四分位间距，0.85 - 0.92）。造影剂衍生冠状动脉血流储备<2.0（曲线下面积0.81；灵敏度67%，特异性80%，阳性预测值40%，阴性预测值92%）、造影剂衍生微循环阻力指数>47（曲线下面积0.82；80%，79%，60%，91%）以及造影剂衍生微血管阻力储备<1.9（曲线下面积0.82；67%，89%，35%，97%）最能预测其腺苷衍生对应指标。第二次造影剂团注的重复性测试显示有良好的相关性。一种混合方法使腺苷使用量减少了40%，每评估1000条血管节省30800美元（美国）或8000英镑（英国）。
造影剂衍生指标具有高特异性和阴性预测值，能够快速排除微血管功能障碍。与常规腺苷测试相比，该方法可行、临床有用且节省成本。
