ArticleCardiology journal2026
Diagnostic performance of angiography-derived IMR for coronary microcirculation disease assessment in INOCA patients.
Article in Cardiology journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDiagnosis of coronary microcirculatory dysfunction with wire-based methodology imposes a risk of unplanned revascularization in patients with ischemia and no obstructive coronary arteries (INOCA). Non-invasive, angiography-based methods are introduced to alleviate this risk. The angiography-based index of microcirculatory resistance (IMRangio) is a computational fluid dynamics (CFD)-based index utilizing high-quality angiography and aortic pressures to calculate a surrogate of the index of microcirculatory resistance (IMR). AIM OF THE STUDY: This study aims to assess the correlation between IMRangio and invasive thermodilution-based IMR in INOCA patients qualified to the MOSAIC-COR registry.
methodsData from 74 patients (92 coronaries including 52 left anterior descending arteries) from the MOSAIC-COR registry were used for this sub-analysis. All patients had undergone complex coronary physiology assessment using a thermistor-equipped wire and thermodilution-based methodology with subsequent vasomotor acetylcholine vasospasm testing. Post-hoc, CFD-based angiogram analysis was performed to calculate IMRangio values.
resultsThe median age of patients was 64 years, and 59.3% were female. The median calculated value of IMRangio was 29 (Q1-Q3: 22-46), whereas the invasively measured IMR median value was 17 (Q1-Q3: 13-26). A significant correlation between IMRangio and invasive-IMR was observed (Spearman rho 0.29, < 0.001). Angiography based index of microcirculatory resistance area under the curve (AUC) was 62.2, and a value > 46.5 U was identified as the best cut-off for prediction of IMR > 25 and provided 38% sensitivity and 82% specificity to detect coronary microcirculatory dysfunction (CMD).
conclusionsThe angiography-based index of microcirculatory resistance significantly correlates with invasively measured IMR; however, a higher cut-off value should be considered to improve the specificity of the method to detect CMD.
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