Trial reportCirculation2019
Coronary Microvascular Dysfunction Is Associated With Myocardial Ischemia and Abnormal Coronary Perfusion During Exercise.
Trial report in Circulation, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 119 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
119 citing papers in PubMed, 3 syntheses or guidelines pooled it, 202 citations in OpenAlex.
- The Relationship of Coronary Microvascular Dysfunction and Left Ventricular Systolic and Diastolic Dysfunction: A Systematic Review and Meta-Analysis.Echocardiography (Mount Kisco, N.Y.) · 2026Pooled it
- Prevalence of Coronary Microvascular Disease and Coronary Vasospasm in Patients With Nonobstructive Coronary Artery Disease: Systematic Review and Meta-Analysis.Journal of the American Heart Association · 2022Pooled it
- Evaluation of non-invasive imaging parameters in coronary microvascular disease: a systematic review.BMC medical imaging · 2021Pooled it
- Microvascular Function and Ambulatory Capacity in Peripheral Artery Disease.Circulation. Cardiovascular interventions · 2025Trial
- Coronary Microvascular Dysfunction Alters the Pulsatile Behavior of the Resting Coronary Blood Flow.Microcirculation (New York, N.Y. : 1994) · 2025Trial
- Objective Ischemia, Subjective Angina, and Psychological Distress in Angina With No Obstructive Coronary Disease.Journal of the American Heart Association · 2024Trial
- Primary versus iatrogenic (post-PCI) coronary microvascular dysfunction: a wire-based multimodal comparison.Open heart · 2023Trial
- Intracoronary physiological indices for coronary microvascular dysfunction: from concept to clinical application.Cardiovascular intervention and therapeutics · 2026Review
- Association of Ischemia Localization with Recorded PCI Procedural Category in Patients Undergoing Myocardial Perfusion Imaging.Diagnostics (Basel, Switzerland) · 2026Article
- Women's heart and echocardiography.Journal of cardiovascular imaging · 2026Review
- Myocardial perfusion reserve is low in heart transplant patients and is related to exercise capacity.Clinical physiology and functional imaging · 2026Article
- Review
- Beyond Stenosis: Mechanism-Based Multimodality Imaging and Invasive Coronary Function Testing for Endotype Definition in ANOCA/INOCA.Medicina (Kaunas, Lithuania) · 2026Review
- Hemoglobin levels and myocardial blood flow in patients undergoing positron emission tomography.European journal of nuclear medicine and molecular imaging · 2026Article
- Abnormal myocardial perfusion reserve and myocardial infarction determine cardiovascular outcomes in type 2 diabetes mellitus.European heart journal. Cardiovascular Imaging · 2026Article
- Relationship of Cardiopulmonary Exercise Capacity to Coronary Microvascular Function and Body Composition in Patients with Suspected Heart Failure with Preserved Ejection Fraction.Cardiac failure review · 2026Article
- Quantitative pancreatic MRI in diabetes mellitus: current advances and future directions.Frontiers in endocrinology · 2026Review
- Multiscale Coronary Arterial Network Generation and Hemodynamics Using Patient-Specific Fractional Myocardial Blood Volume.Bioengineering (Basel, Switzerland) · 2025Article
- Myocardial compression and recoil as determinants of coronary blood flow.European heart journal · 2025Review
- The Contribution of Echocardiography to the Diagnosis and Prognosis Stratification of Diabetic Cardiomyopathy.Diagnostics (Basel, Switzerland) · 2025Review
59 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
12 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundCoronary microvascular dysfunction (MVD) is defined by impaired flow augmentation in response to a pharmacological vasodilator in the presence of nonobstructive coronary artery disease. It is unknown whether diminished coronary vasodilator response correlates with abnormal exercise physiology or inducible myocardial ischemia.
methodsPatients with angina and nonobstructive coronary artery disease had simultaneous coronary pressure and flow velocity measured using a dual sensor-tipped guidewire during rest, supine bicycle exercise, and adenosine-mediated hyperemia. Microvascular resistance (MR) was calculated as coronary pressure divided by flow velocity. Wave intensity analysis quantified the proportion of accelerating wave energy (perfusion efficiency). Global myocardial blood flow and subendocardial:subepicardial perfusion ratio were quantified using 3-Tesla cardiac magnetic resonance imaging during hyperemia and rest; inducible ischemia was defined as hyperemic subendocardial:subepicardial perfusion ratio <1.0. Patients were classified as having MVD if coronary flow reserve <2.5 and controls if coronary flow reserve ≥2.5, with researchers blinded to the classification.
resultsEighty-five patients were enrolled (78% female, 57±10 years), 45 (53%) were classified as having MVD. Of the MVD group, 82% had inducible ischemia compared with 22% of controls (
conclusionIn patients with angina and nonobstructive coronary artery disease, diminished coronary flow reserve characterizes a cohort with inducible ischemia and a maladaptive physiological response to exercise. We have identified 2 endotypes of MVD with distinctive systemic vascular responses to exercise; whether endotypes have a different prognosis or require different treatments merits further investigation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.