What question did this study set out to answer?

The study aims to investigate the prevalence of coronary microvascular dysfunction and identify associated factors in patients with wild-type transthyretin amyloid cardiomyopathy.

April 3, 2026Journal of Cardiac Failure0 citationsOpen Access

Invasive assessment of coronary microvascular dysfunction in patients with wild-type transthyretin amyloid cardiomyopathy

DSDaisuke SunoharaShinshu University YUYasushi UekiShinshu University MMMasatoshi MinamisawaShinshu University

Key Result

Coronary microvascular dysfunction was highly prevalent (68.8%) in patients with wild-type transthyretin amyloid cardiomyopathy and significantly correlated with troponin T levels, unlike in LVH.

Key Points

The study aims to investigate the prevalence of coronary microvascular dysfunction and identify associated factors in patients with wild-type transthyretin amyloid cardiomyopathy.
Conducted a prospective, multicenter study between August 2022 and April 2025.
Evaluated patients with cardiac hypertrophy undergoing invasive assessment using intracoronary pressure-temperature wire.
Defined CMD using a coronary flow reserve (CFR) of <2.0 or index of microvascular resistance (IMR) of 25.
Found 68.8% prevalence of CMD in ATTRwt-CM and 59.4% in left ventricular hypertrophy (LVH), with no significant difference (P=0.434).
CFR and IMR showed significant negative correlations with troponin T in ATTRwt-CM patients.
Troponin T was significantly associated with CFR and IMR, indicating its role as a cardiac biomarker in ATTRwt-CM.

Structured PICO

Is coronary microvascular dysfunction highly prevalent and associated with cardiac biomarkers in patients with wild-type transthyretin amyloid cardiomyopathy compared to those with left ventricular hypertrophy?

Population

64 patients with cardiac hypertrophy (defined as interventricular septum ≥12 mm) undergoing invasive coronary microvascular dysfunction assessment, including 32 patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) and 32 patients with non-amyloidosis left ventricular hypertrophy (LVH). Key exclusion criteria: non-dialysis with eGFR <30 ml/min/1.73m2, decompensated heart failure, and significant coronary artery disease (visual stenosis >90%).

Intervention

Invasive assessment of coronary microvascular dysfunction (CMD) using an intracoronary pressure-temperature sensor guidewire (bolus thermodilution method) to measure coronary flow reserve (CFR) and index of microvascular resistance (IMR) during maximal hyperemia induced by intravenous adenosine (140 µg/kg/min).

Comparator

Patients with non-amyloidosis left ventricular hypertrophy (LVH) (n=32) undergoing the same invasive coronary physiology assessment.

Outcome

Prevalence of coronary microvascular dysfunction (CMD), defined as coronary flow reserve (CFR) <2.0 or index of microvascular resistance (IMR) ≥25.surrogate

Coronary microvascular dysfunction is highly prevalent in patients with ATTRwt-CM and correlates significantly with myocardial injury markers like troponin T, suggesting a pathophysiological role in the disease.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background: Coronary microvascular dysfunction (CMD) is frequently observed in patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM).We aimed to investigate the prevalence of CMD and identify factors associated with CMD in patients with ATTRwt-CM using intracoronary pressure-temperature wire.Methods: Patients with cardiac hypertrophy, defined as interventricular septum 12 mm, undergoing invasive CMD assessment using pressure wire were evaluated in the prospective, multicenter study conducted between August 2022 and April 2025.CMD was defined as coronary flow reserve (CFR) <2.0 or index of microvascular resistance (IMR) 25.Results: A total of 64 patients (ATTRwt-CM: n=32, LVH: n=32) were analyzed.A similar prevalence was observed between the 2 groups (ATTRwt-CM: 68.8%, left ventricular hypertrophy LVH: 59.4%, P=0.434).In patients with ATTRwt-CM, CFR and IMR were significantly correlated with troponin T (r=-0.503,P=0.004, and r=0.483,P=0.006, respectively), while such correlations were not observed in the LVH group (r=-0.128,P=0.501, r=0.130,P=0.493, respectively).Multivariable linear regression analysis demonstrated that troponin T was significantly associated with CFR (=-0.011,P=0.007) and IMR (=0.177,P=0.010) in patients with ATTRwt-CM.Conclusions: CMD was highly prevalent in patients with ATTRwt-CM.Modest association between CFR, IMR and cardiac biomarkers observed only in patients with ATTRwt-CM compared with those with LVH may suggest the pathophysiological role of CMD in myocardial injury among patients with ATTRwt-CM.

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