A Systematic Approach to the Evaluation of the Coronary Microcirculation Using Bolus Thermodilution: CATH CMD
Carlos Collet, A. Yong, Daniel Munhoz, Takashi Akasaka, Colin Berry, John E. Blair, Damien Collison, Thomas Engstrøm, Javier Escaned, William F. Fearon, Tom Ford, Tommaso Gori, Bon‐Kwon Koo, Adrian F. Low, Steve Miner, M. Ng, Takuya Mizukami, Hiroaki Shimokawa, Nathaniel R. Smilowitz, Nadia R. Sutton, Johan Svanerud, Jennifer A. Tremmel, Takayuki Warisawa, Nick E.J. West, Ziad A. Ali
Abstract
Coronary microvascular dysfunction (CMD) can cause myocardial ischemia in patients presenting with angina without obstructive coronary artery disease (ANOCA). Evaluating for CMD by using the thermodilution technique offers a widely accessible means of assessing microvascular resistance. Through this technique, 2 validated indices, namely coronary flow reserve and the index of microcirculatory resistance, can be computed, facilitating investigation of the coronary microcirculation. The index of microcirculatory resistance specifically estimates minimum achievable microvascular resistance within the coronary microcirculation. We aim to review the bolus thermodilution method, outlining the fundamental steps for conducting measurements and introducing an algorithmic approach (CATH CMD) to systematically evaluate the coronary microcirculation. Embracing a standardized approach, exemplified by the CATH CMD algorithm, will facilitate adoption of this technique and streamline the diagnosis of CMD.