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Angiography derived assessment of the coronary microcirculation: is it ready for prime time?

Research output: Contribution to journalReview articlepeer-review

Jinying Zhou, Yoshinobu Onuma, Scot Garg, Nozomi Kotoku, Shigetaka Kageyama, Shinichiro Masuda, Kai Ninomiya, Yunlong Huo, Johan H.C. Reiber, Shengxian Tu, Jan J. Piek, Javier Escaned, Divaka Perera, Christos Bourantas, Hongbing Yan, Patrick W. Serruys

Original languageEnglish
Pages (from-to)549-566
Number of pages18
JournalExpert review of cardiovascular therapy
Issue number7
Accepted/In press2022

Bibliographical note

Funding Information: J Zhou declares scholarship from Chinese Scholarship Council (202106210330). PW Serruys declares consulting fees from Philips/Volcano, SMT, Xeltis, Novartis, and Merillife. N Kotoku declares a research grant from Fukuda Foundation for Medical Technology. S Tu declares consultancy and grants from Pulse Medical. Publisher Copyright: © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

King's Authors


Introduction: Non-obstructive coronary arteries (NOCA) are present in 39.7% to 62.4% of patients who undergo elective angiography. Coronary microcirculation (<400 µm) is not visible on angiography therefore functional assessment, invasive or noninvasive plays a prior role to help provide a more personalized diagnosis of angina. Area covered: In this review, we revisit the pathophysiology, clinical importance, and invasive assessment of the coronary microcirculation, and discuss angiography-derived indices of microvascular resistance. A comprehensive literature review over four decades is also undertaken. Expert opinion: The coronary microvasculature plays an important role in flow autoregulation and metabolic regulation. Invasive assessment of microvascular resistance is a validated modality with independent prognostic value, nevertheless, its routine application is hampered by the requirement of intravascular instrumentation and hyperemic agents. The angiography-derived index of microvascular resistance has emerged as a promising surrogate in pilot studies, however, more data are needed to validate and compare the diagnostic and prognostic accuracy of different equations as well as to illustrate the relationship between angiography-derived parameters for epicardial coronary arteries and those for the microvasculature.

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