ArticleJournal of the American College of Cardiology2020
Physiological Stratification of Patients With Angina Due to Coronary Microvascular Dysfunction.
Article in Journal of the American College of Cardiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 79 papers, 1 of them a synthesis that pooled it.
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Who cites it
79 citing papers in PubMed, 1 synthesis or guideline pooled it, 156 citations in OpenAlex.
- Pooled it
- Primary versus iatrogenic (post-PCI) coronary microvascular dysfunction: a wire-based multimodal comparison.Open heart · 2023Trial
- Trial
- Intracoronary physiological indices for coronary microvascular dysfunction: from concept to clinical application.Cardiovascular intervention and therapeutics · 2026Review
- Invasive Coronary Physiology in Contemporary Practice: From Lesion Selection to Comprehensive PCI Guidance and Functional Phenotyping.Journal of clinical medicine · 2026Review
- Review
- Diagnostic performance of exercise stress testing findings and coronary microvascular dysfunction in patients with angina with non-obstructive coronary artery disease.Heart (British Cardiac Society) · 2026Article
- Beyond Stenosis: Mechanism-Based Multimodality Imaging and Invasive Coronary Function Testing for Endotype Definition in ANOCA/INOCA.Medicina (Kaunas, Lithuania) · 2026Review
- Article
- Absolute coronary blood flow measurement and the principle of microvascular resistance reserve.Cardiovascular intervention and therapeutics · 2026Review
- Symptom phenotypes and coronary microvascular function in non-obstructive coronary artery disease: Insights beyond epicardial ischemia.American heart journal plus : cardiology research and practice · 2026Article
- Coronary flow and resistance patterns indexed by subtended myocardial mass in coronary microvascular dysfunction.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2025Article
- Definitions and standardized endpoints for the use of drug-coated balloon in coronary artery disease: consensus document of the Drug Coated Balloon Academic Research Consortium.European heart journal · 2025Article
- Unveiling the Causes of Acute and Non-Acute Myocardial Ischemic Syndromes: The Role of Optical Coherence Tomography.Medicina (Kaunas, Lithuania) · 2025Review
- Energetics of flow restoration after premature ventricular contractions depends on microvascular vasodilation capacity: Insights from wave intensity analysis.European heart journal open · 2025Article
- The impact of high microvascular resistance on coronary wave energetics depends on coronary microvascular functionality.European heart journal open · 2025Article
- Definitions and standardized endpoints for the use of drug-coated balloon in coronary artery disease: consensus document of the Drug Coated Balloon Academic Research Consortium.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2025Article
- Coronary Microvascular Dysfunction and Vasospastic Angina-Pathophysiology, Diagnosis and Management Strategies.Journal of clinical medicine · 2025Review
- Coronary Microvascular Dysfunction: Insights on Prognosis and Future Perspectives.Reviews in cardiovascular medicine · 2025Review
- Exploring coronary microvascular dysfunction from functional impairment and structural damage.Frontiers in cardiovascular medicine · 2025Review
19 more citing papers are in PubMed but not listed here.
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Authors and funding
9 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundCoronary microvascular dysfunction (CMD) is defined by diminished flow reserve. Functional and structural CMD endotypes have recently been described, with normal and elevated minimal microvascular resistance, respectively.
objectivesThis study determined the mechanism of altered resting and maximal flow in CMD endotypes.
methodsA total of 86 patients with angina but no obstructive coronary disease underwent coronary pressure and flow measurement during rest, exercise, and adenosine-mediated hyperemia and were classified as the reference group or as patients with CMD by a coronary flow reserve threshold of 2.5; functional or structural endotypes were distinguished by a hyperemic microvascular resistance threshold of 2.5 mm Hg/cm/s. Endothelial function was assessed by forearm blood flow (FBF) response to acetylcholine, and nitric oxide synthase (NOS) activity was defined as the inverse of FBF reserve to N
resultsOf the 86 patients, 46 had CMD (28 functional, 18 structural), and 40 patients formed the reference group. Resting coronary blood flow (CBF) (24.6 ± 2.0 cm/s vs. 16.6 ± 3.9 cm/s vs. 15.1 ± 4.7 cm/s; p < 0.001) and NOS activity (2.27 ± 0.96 vs. 1.77 ± 0.59 vs. 1.30 ± 0.16; p < 0.001) were higher in the functional group compared with the structural CMD and reference groups, respectively. The structural group had lower acetylcholine FBF augmentation than the functional or reference group (2.1 ± 1.8 vs. 4.1 ± 1.7 vs. 4.5 ± 2.0; p < 0.001). On exercise, oxygen demand was highest (rate-pressure product: 22,157 ± 5,497 beats/min/mm Hg vs. 19,519 ± 4,653 beats/min/mm Hg vs. 17,530 ± 4,678 beats/min/mm Hg; p = 0.004), but peak CBF was lowest in patients with structural CMD compared with the functional and reference groups.
conclusionsFunctional CMD is characterized by elevated resting flow that is linked to enhanced NOS activity. Patients with structural CMD have endothelial dysfunction, which leads to diminished peak CBF augmentation and increased demand during exercise. The value of pathophysiologically stratified therapy warrants investigation.
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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.