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

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

doi:10.1080/14779072.2022.2098117

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

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^*

^*Corresponding author for this work

Cardiovascular Research

Research output: Contribution to journal › Review article › peer-review

8 Citations (Scopus)

Abstract

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.

Original language	English
Pages (from-to)	549-566
Number of pages	18
Journal	Expert review of cardiovascular therapy
Volume	20
Issue number	7
DOIs	https://doi.org/10.1080/14779072.2022.2098117
Publication status	Published - 2022

Keywords

angina with non-obstructive coronary artery
angiography
Coronary microvascular
index of microvascular resistance
ischemia with non-obstructive coronary artery

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1080/14779072.2022.2098117

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Zhou, J., Onuma, Y., Garg, S., Kotoku, N., Kageyama, S., Masuda, S., Ninomiya, K., Huo, Y., Reiber, J. H. C., Tu, S., Piek, J. J., Escaned, J., Perera, D., Bourantas, C., Yan, H., & W. Serruys, P. (2022). Angiography derived assessment of the coronary microcirculation: is it ready for prime time? Expert review of cardiovascular therapy, 20(7), 549-566. https://doi.org/10.1080/14779072.2022.2098117

@article{6566379fabdd49f081d468e44fefccbc,

title = "Angiography derived assessment of the coronary microcirculation: is it ready for prime time?",

abstract = "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.",

keywords = "angina with non-obstructive coronary artery, angiography, Coronary microvascular, index of microvascular resistance, ischemia with non-obstructive coronary artery",

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

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: {\textcopyright} 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.",

year = "2022",

doi = "10.1080/14779072.2022.2098117",

language = "English",

volume = "20",

pages = "549--566",

journal = "Expert review of cardiovascular therapy",

issn = "1477-9072",

publisher = "Taylor and Francis Ltd.",

number = "7",

}

Zhou, J, Onuma, Y, Garg, S, Kotoku, N, Kageyama, S, Masuda, S, Ninomiya, K, Huo, Y, Reiber, JHC, Tu, S, Piek, JJ, Escaned, J, Perera, D, Bourantas, C, Yan, H & W. Serruys, P 2022, 'Angiography derived assessment of the coronary microcirculation: is it ready for prime time?', Expert review of cardiovascular therapy, vol. 20, no. 7, pp. 549-566. https://doi.org/10.1080/14779072.2022.2098117

TY - JOUR

T1 - Angiography derived assessment of the coronary microcirculation

T2 - is it ready for prime time?

AU - Zhou, Jinying

AU - Onuma, Yoshinobu

AU - Garg, Scot

AU - Kotoku, Nozomi

AU - Kageyama, Shigetaka

AU - Masuda, Shinichiro

AU - Ninomiya, Kai

AU - Huo, Yunlong

AU - Reiber, Johan H.C.

AU - Tu, Shengxian

AU - Piek, Jan J.

AU - Escaned, Javier

AU - Perera, Divaka

AU - Bourantas, Christos

AU - Yan, Hongbing

AU - W. Serruys, Patrick

N1 - 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.

PY - 2022

Y1 - 2022

N2 - 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.

AB - 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.

KW - angina with non-obstructive coronary artery

KW - angiography

KW - Coronary microvascular

KW - index of microvascular resistance

KW - ischemia with non-obstructive coronary artery

UR - http://www.scopus.com/inward/record.url?scp=85135695853&partnerID=8YFLogxK

U2 - 10.1080/14779072.2022.2098117

DO - 10.1080/14779072.2022.2098117

M3 - Review article

AN - SCOPUS:85135695853

SN - 1477-9072

VL - 20

SP - 549

EP - 566

JO - Expert review of cardiovascular therapy

JF - Expert review of cardiovascular therapy

IS - 7

ER -

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

Abstract

Keywords

UN SDGs

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