Abbott Coronary Microvascular Dysfunction Algorithm User Guide
- June 15, 2024
- Abbott
Table of Contents
Abbott Coronary Microvascular Dysfunction Algorithm
Catheter Engagement
(c)
- Flush thoroughly 1
- Coaxial guide engagement 1
- Ensure no damping1
(A)
Advance Wire
- Interrogate LAD unless there is a specific territory of interest 2
- Advance wire sensor 2/3 distally in vessel 3
- Administer GTN/NTG1
(T)
Transit Time at Rest
- Flush/purge pre-Tmn rest to clear any blood and contrast 3
- Room temperature saline 3
- Brisk 3 mL x 3 injections 3
- Address outliers (± 0.25s) before proceeding 4*
- Repeat measurement of Tmn rest
(H)
Hyperemic Transit Time
- Induce hyperemia 5
- Confirm hyperemia*6
- Flush/purge pre-Tmn hyp to clear any blood and contrast 6
- Room temperature saline 6
- Brisk 3 mL x 3 injections 6
- Address outliers (± 0.15s) before proceeding 4**
- Decrease in pressure, patient symptoms, FFR drop
Repeat measurement of Tmn hyp
(C)
Coronary Flow Reserve (CFR)
- CFR <2.5*4
- CFR grey zone 2.0-2.4*
- Evolving consensus
(M)
Index of Microcirculatory Resistance (IMR)
- IMR ≥252
- Use IMRcorr if FFR ≤0.807
(D)
Diagnosis
- Diagnosis of CMD based on IMR ≥25 and CFR <2.5*2,4
- CFR grey zone 2.0-2.4*
- Refer to guidelines and consensus document2,4, 8-9
- Evolving consensus
GTN (glyceryl trinitrate) |
NTG (nitroglycerin) |
LAD (left anterior descending) |
FFR (fractional flow reserve) |
IMRcorr (IMR corrected) |
CMD (coronary microvascular dysfunction) |
Tmnrest (resting transit mean time) |
Tmnhyp (hyperemic transit mean time)
References:
- Berry C. Fractional Flow Reserve, Coronary Flow Reserve and the Index of Microvascular Resistance in Clinical Practice. Radcliffe Cardiology. 2014, 1-6.
- Kunadian V, et al. EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries. EHJ. 2020; 0, 1-21.
- Fearon W, et al. Invasive Assessment of the Coronary Microvasculature: The Index of Microcirculatory Resistance. Circ Cardiovasc Interv. 2017; 10:e005361
- Perera D, et al. Invasive coronary physiology in patients with angina and non-obstructive coronary artery disease. Heart. 2022; 0, 1-8.
- Ford T, et al. Stratified Medical Therapy Using Invasive Coronary Function Testing in Angina: The CorMicA Trial. JACC. 2018, 72, 2841-55.
- Ang D, et al. Interventional Diagnostic Procedure: a Practical Guide for the Assessment of Coronary Vascular Function. JOVE 2022; 181, e2265.
- Yong A, et al. Calculation of the Index of Microcirculatory Resistance Without Coronary Wedge Pressure Measurement in the Presence of Epicardial Stenosis. JACC: Cardiovasc Interv. 2013; 6, 53-8.
- Knuuti J, et al. ESC guidelines. EHJ. 2020; 41, 407-477.
- Gulati M, et al. 2021 Chest Pain Guideline, Circulation. 2021; 144, e368-e454.
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