European Heart Journal Advance Access originally published online on July 20, 2007
European Heart Journal 2007 28(18):2188-2194; doi:10.1093/eurheartj/ehm269
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A simple thermodilution technique to assess coronary endothelium-dependent microvascular function in humans: validation and comparison with coronary flow reserve
1 Cardiovascular Division, King's College London School of Medicine at Guy's, King's College and St Thomas' Hospitals, London, UK
2 Leeds Institute for Genetics Health and Therapeutics, The LIGHT Laboratories, University of Leeds, Leeds, UK
3 Cardiology Department, King's College Hospital, Denmark Hill, London SE5 9RS, UK
4 Cardiovascular Center, OLV Hospital, Aalst, Belgium
Received 12 July 2006; revised 20 April 2007; accepted 7 June 2007; online publish-ahead-of-print 20 July 2007.
* Corresponding author. Tel: +44 20 7737 4000; fax: +44 20 7346 3489. E-mail address: philip{at}maccarthy.co.uk
Aims: To validate a novel method for assessment of coronary endothelium-dependent microvascular function and compare this index with the adenosine-derived coronary flow reserve (CFR).
Methods and results: We validated use of intra-coronary pressure wire-derived thermodilution to assess changes in coronary flow compared to Doppler flow-wire/quantitative coronary angiography- (QCA) derived data in response to the endothelial agonist substance-P (endothelium-dependent response). There was a close correlation between Doppler/QCA- and thermodilution-derived assessment of endothelium-dependent microvascular function (r = 0.76; P < 0.001). Next, pressure wire-based thermodilution was employed to sequentially compare CFR (hyperaemia achieved with adenosine-140 µg/kg/mL) with changes in coronary flow in response to substance-P (20 pmol/min intra-coronary infusion; 2 min) in 65 unobstructed coronary arteries. There was no correlation between CFR and coronary endothelium-dependent microvascular response (r = 0.08; P = 0.50). Both indices were in turn compared with clinical markers of endothelial dysfunction, namely Framingham risk score (FRS—a marker for cardiovascular risk factor clustering, hence an indirect clinical measure of endothelial dysfunction) and presence/absence of diabetes. Patient's FRS correlated with coronary endothelium-dependent microvascular response (r = –0.48; P < 0.001), but not with CFR (r = 0.14; P = 0.25). Diabetic patients had greater endothelial dysfunction than non-diabetics (P < 0.001) whereas CFR was not influenced by diabetes (P = 0.10).
Conclusion: A simple pressure wire-based thermodilution technique can be used to assess coronary endothelium-dependent microvascular function. Adenosine-derived CFR does not adequately interrogate the endothelium-dependent component of coronary microvascular function.
Key Words: Coronary microcirculation • Coronary flow reserve • Endothelial function • Thermodilution
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