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February 6, 2026European Heart Journal

Doppler and thermodilution identify coronary microvascular dysfunction in 48% of ANOCA patients by detecting distinct impairments.

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Why the study?

Invasive coronary function testing identifies microvascular dysfunction in ANOCA, but challenges remain regarding different measurement techniques and adenosine injection routes.

Do thermodilution and Doppler techniques yield different frequencies of coronary microvascular dysfunction diagnosis in patients with ANOCA?

Population

238 consecutive ANOCA patients undergoing coronary function testing at 2 German cardiovascular centres

Comparison

Thermodilution vs Doppler techniques, and intracoronary vs intravenous adenosine administration

Design

Two-centre observational study

Key result

In patients with ANOCA, abnormal coronary flow reserve was detected less frequently with the thermodilution technique compared to the Doppler technique (26% vs 43%, p=0.007).

Authors

LLLouisa LauingerCHCatharina HammAHAstrid Hubert

Discussion

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Overview

Technique choice yields discrepant CMD rates in ANOCA; leaves open standardization of invasive testing.

Key Points

  • The study aims to evaluate different measurement techniques for identifying coronary microvascular dysfunction in ANOCA patients.
  • Invasive coronary function testing conducted on 238 patients with ANOCA in two centers from 2018 to 2024.
  • Coronary flow reserve and microvascular resistance measured using Doppler and thermodilution techniques.
  • Intracoronary or intravenous adenosine was administered for assessments.
  • 48% of patients were diagnosed with coronary microvascular dysfunction.
  • Doppler technique showed a higher rate of impaired coronary flow reserve (43% vs. 26% with thermodilution).
  • Median CFR was significantly higher with thermodilution compared to Doppler (3.4 vs. 2.6).
  • Impaired microvascular resistance was more common with thermodilution than Doppler (44% vs. 12%).

Study Design

Type

Observational (n=238)

Multicenter

Yes

Structured PICO

Do thermodilution and Doppler techniques yield different frequencies of coronary microvascular dysfunction diagnosis in patients with ANOCA?

P
Population
238 consecutive patients (mean age 63 years, 57% female) with angina and unobstructed coronary arteries undergoing coronary function testing.
E
Exposure
Invasive assessment of coronary flow reserve (CFR) and microvascular resistance using the bolus thermodilution technique (n=122) or Doppler technique (n=116) with intracoronary or intravenous adenosine.
C
Comparator
Comparison between thermodilution and Doppler techniques, and between intracoronary and intravenous adenosine administration.
O
Outcome
Frequency of impaired coronary flow reserve (CFR <2.5) and impaired microvascular resistance (HMR >2.5 or IMR >25).surrogate

Main Result

Absolute Event Rate: 26% vs 43%

p-value: p=0.007

The frequency of diagnosing impaired coronary flow reserve and microvascular resistance in ANOCA patients differs markedly depending on whether thermodilution or Doppler techniques are used.

Cite This Study

Lauinger et al. (2025) conducted an observational in Angina and unobstructed coronary arteries (ANOCA) (n=238). Thermodilution technique vs. Doppler technique was evaluated on Frequency of abnormal coronary flow reserve (CFR <2.5) (p=0.007). In patients with ANOCA, abnormal coronary flow reserve was detected less frequently with the thermodilution technique compared to the Doppler technique (26% vs 43%, p=0.007).

synapsesocial.com/papers/6985859b8f7c464f23009188https://doi.org/10.1093/eurheartj/ehaf784.3092
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