Comparison of bolus versus continuous thermodilution derived indices of microvascular dysfunction in revascularized coronary syndromes
Background: The assessment of coronary microvascular dysfunction (CMD) using invasive methods is a field of growing interest, however the preferred method remains debated. Bolus and continuous thermodilution are commonly used methods, but weak agreement has been observed in patients with angina with...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-04-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S235290672400040X |
| _version_ | 1797217100203294720 |
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| author | Samer Fawaz Federico Marin Sarosh A Khan Rupert F G Simpson Rafail A Kotronias Jason Chai Oxford Acute Myocardial Infarction (OxAMI) Study Investigators Firas Al-Janabi Rohan Jagathesan Klio Konstantinou Shah R Mohdnazri Gerald J Clesham Kare H Tang Christopher M Cook Keith M Channon Adrian P Banning John R Davies Grigoris V Karamasis Giovanni L De Maria Thomas R Keeble |
| author_facet | Samer Fawaz Federico Marin Sarosh A Khan Rupert F G Simpson Rafail A Kotronias Jason Chai Oxford Acute Myocardial Infarction (OxAMI) Study Investigators Firas Al-Janabi Rohan Jagathesan Klio Konstantinou Shah R Mohdnazri Gerald J Clesham Kare H Tang Christopher M Cook Keith M Channon Adrian P Banning John R Davies Grigoris V Karamasis Giovanni L De Maria Thomas R Keeble |
| author_sort | Samer Fawaz |
| collection | DOAJ |
| description | Background: The assessment of coronary microvascular dysfunction (CMD) using invasive methods is a field of growing interest, however the preferred method remains debated. Bolus and continuous thermodilution are commonly used methods, but weak agreement has been observed in patients with angina with non-obstructive coronary arteries (ANOCA). This study examined their agreement in revascularized acute coronary syndromes (ACS) and chronic coronary syndromes (CCS) patients. Objective: To compare bolus thermodilution and continuous thermodilution indices of CMD in revascularized ACS and CCS patients and assess their diagnostic agreement at pre-defined cut-off points. Methods: Patients from two centers underwent paired bolus and continuous thermodilution assessments after revascularization. CMD indices were compared between the two methods and their agreements at binary cut-off points were assessed. Results: Ninety-six patients and 116 vessels were included. The mean age was 64 ± 11 years, and 20 (21 %) were female. Overall, weak correlations were observed between the Index of Microcirculatory Resistance (IMR) and continuous thermodilution microvascular resistance (Rµ) (rho = 0.30p = 0.001). The median coronary flow reserve (CFR) from continuous thermodilution (CFRcont) and bolus thermodilution (CFRbolus) were 2.19 (1.76–2.67) and 2.55 (1.50–3.58), respectively (p < 0.001). Weak correlation and agreement were observed between CFRcont and CFRbolus (rho = 0.37, p < 0.001, ICC 0.228 [0.055–0.389]). When assessed at CFR cut-off values of 2.0 and 2.5, the methods disagreed in 41 (35 %) and 45 (39 %) of cases, respectively. Conclusions: There is a significant difference and weak agreement between bolus and continuous thermodilution-derived indices, which must be considered when diagnosing CMD in ACS and CCS patients. |
| first_indexed | 2024-04-24T11:56:29Z |
| format | Article |
| id | doaj.art-659aa0243cca4419aeb5a1ea4af6732d |
| institution | Directory Open Access Journal |
| issn | 2352-9067 |
| language | English |
| last_indexed | 2024-04-24T11:56:29Z |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj.art-659aa0243cca4419aeb5a1ea4af6732d2024-04-09T04:13:16ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672024-04-0151101374Comparison of bolus versus continuous thermodilution derived indices of microvascular dysfunction in revascularized coronary syndromesSamer Fawaz0Federico Marin1Sarosh A Khan2Rupert F G Simpson3Rafail A Kotronias4Jason Chai5Oxford Acute Myocardial Infarction (OxAMI) Study Investigators6Firas Al-Janabi7Rohan Jagathesan8Klio Konstantinou9Shah R Mohdnazri10Gerald J Clesham11Kare H Tang12Christopher M Cook13Keith M Channon14Adrian P Banning15John R Davies16Grigoris V Karamasis17Giovanni L De Maria18Thomas R Keeble19Essex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust, Basildon, SS16 5NL, United Kingdom; Department of Circulatory Health Research, Anglia Ruskin University, Chelmsford, CM1 1SQ, United KingdomDivision of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, U.K; NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, U.KEssex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust, Basildon, SS16 5NL, United Kingdom; Department of Circulatory Health Research, Anglia Ruskin University, Chelmsford, CM1 1SQ, United KingdomEssex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust, Basildon, SS16 5NL, United Kingdom; Department of Circulatory Health Research, Anglia Ruskin University, Chelmsford, CM1 1SQ, United KingdomDivision of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, U.K; NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, U.KAttikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, U.KDivision of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, U.K; NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, U.KEssex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust, Basildon, SS16 5NL, United KingdomEssex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust, Basildon, SS16 5NL, United KingdomEssex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust, Basildon, SS16 5NL, United KingdomEssex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust, Basildon, SS16 5NL, United KingdomEssex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust, Basildon, SS16 5NL, United Kingdom; Department of Circulatory Health Research, Anglia Ruskin University, Chelmsford, CM1 1SQ, United KingdomEssex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust, Basildon, SS16 5NL, United KingdomEssex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust, Basildon, SS16 5NL, United Kingdom; Department of Circulatory Health Research, Anglia Ruskin University, Chelmsford, CM1 1SQ, United KingdomDivision of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, U.K; NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, U.KDivision of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, U.K; NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, U.KEssex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust, Basildon, SS16 5NL, United Kingdom; Department of Circulatory Health Research, Anglia Ruskin University, Chelmsford, CM1 1SQ, United KingdomAttikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, GreeceDivision of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, U.K; NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, U.KEssex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust, Basildon, SS16 5NL, United Kingdom; Department of Circulatory Health Research, Anglia Ruskin University, Chelmsford, CM1 1SQ, United Kingdom; Corresponding author at: Research Office, Roding Ward The Essex Cardiothoracic Centre Basildon Hospital, Nethermayne Basildon SS16 5NL United Kingdom.Background: The assessment of coronary microvascular dysfunction (CMD) using invasive methods is a field of growing interest, however the preferred method remains debated. Bolus and continuous thermodilution are commonly used methods, but weak agreement has been observed in patients with angina with non-obstructive coronary arteries (ANOCA). This study examined their agreement in revascularized acute coronary syndromes (ACS) and chronic coronary syndromes (CCS) patients. Objective: To compare bolus thermodilution and continuous thermodilution indices of CMD in revascularized ACS and CCS patients and assess their diagnostic agreement at pre-defined cut-off points. Methods: Patients from two centers underwent paired bolus and continuous thermodilution assessments after revascularization. CMD indices were compared between the two methods and their agreements at binary cut-off points were assessed. Results: Ninety-six patients and 116 vessels were included. The mean age was 64 ± 11 years, and 20 (21 %) were female. Overall, weak correlations were observed between the Index of Microcirculatory Resistance (IMR) and continuous thermodilution microvascular resistance (Rµ) (rho = 0.30p = 0.001). The median coronary flow reserve (CFR) from continuous thermodilution (CFRcont) and bolus thermodilution (CFRbolus) were 2.19 (1.76–2.67) and 2.55 (1.50–3.58), respectively (p < 0.001). Weak correlation and agreement were observed between CFRcont and CFRbolus (rho = 0.37, p < 0.001, ICC 0.228 [0.055–0.389]). When assessed at CFR cut-off values of 2.0 and 2.5, the methods disagreed in 41 (35 %) and 45 (39 %) of cases, respectively. Conclusions: There is a significant difference and weak agreement between bolus and continuous thermodilution-derived indices, which must be considered when diagnosing CMD in ACS and CCS patients.http://www.sciencedirect.com/science/article/pii/S235290672400040XBolusContinuousThermodilutionCoronaryMicrovascular |
| spellingShingle | Samer Fawaz Federico Marin Sarosh A Khan Rupert F G Simpson Rafail A Kotronias Jason Chai Oxford Acute Myocardial Infarction (OxAMI) Study Investigators Firas Al-Janabi Rohan Jagathesan Klio Konstantinou Shah R Mohdnazri Gerald J Clesham Kare H Tang Christopher M Cook Keith M Channon Adrian P Banning John R Davies Grigoris V Karamasis Giovanni L De Maria Thomas R Keeble Comparison of bolus versus continuous thermodilution derived indices of microvascular dysfunction in revascularized coronary syndromes International Journal of Cardiology: Heart & Vasculature Bolus Continuous Thermodilution Coronary Microvascular |
| title | Comparison of bolus versus continuous thermodilution derived indices of microvascular dysfunction in revascularized coronary syndromes |
| title_full | Comparison of bolus versus continuous thermodilution derived indices of microvascular dysfunction in revascularized coronary syndromes |
| title_fullStr | Comparison of bolus versus continuous thermodilution derived indices of microvascular dysfunction in revascularized coronary syndromes |
| title_full_unstemmed | Comparison of bolus versus continuous thermodilution derived indices of microvascular dysfunction in revascularized coronary syndromes |
| title_short | Comparison of bolus versus continuous thermodilution derived indices of microvascular dysfunction in revascularized coronary syndromes |
| title_sort | comparison of bolus versus continuous thermodilution derived indices of microvascular dysfunction in revascularized coronary syndromes |
| topic | Bolus Continuous Thermodilution Coronary Microvascular |
| url | http://www.sciencedirect.com/science/article/pii/S235290672400040X |
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