Key result
Angio-IMR accurately identifies coronary microvascular dysfunction with an AUC of ~0.91 vs. invasive IMR.
Why the study?
There is a lack of consensus on diagnosing coronary microvascular dysfunction using the angiography-based index of microcirculatory resistance due to an absence of evidence.
Does the angiography-based index of microcirculatory resistance (Angio-IMR) accurately diagnose coronary microvascular dysfunction compared to wire-based IMR in patients with ischemic heart disease?
Meta-Analysis (n=2,202)
Yes
Does the angiography-based index of microcirculatory resistance (Angio-IMR) accurately diagnose coronary microvascular dysfunction compared to wire-based IMR in patients with ischemic heart disease?
Angio-IMR demonstrates high diagnostic accuracy for coronary microvascular dysfunction and can serve as a reliable, pressure wire-free alternative to traditional IMR.
Supports Angio-IMR as a wire-free alternative for microvascular dysfunction; confirms high diagnostic accuracy in meta-analysis of 2202 patients.
INTRODUCTION: There is a lack of consensus on diagnosing coronary microvascular dysfunction (CMD) using the angiography-based index of microcirculatory resistance (Angio-IMR) due to the absence of evidence. This study aimed to explore the efficacy of Angio-IMR in diagnosing CMD. METHODS: A systematic search was conducted in PubMed, Embase, Scopus, and the Cochrane Library for studies primarily focusing on Angio-IMR diagnosing CMD, using IMR as the gold standard. The primary results were pooled sensitivity, specificity, and the area under the curve (AUC). RESULTS: A total of 15 studies involving 2,202 individuals and 2,330 vessels were included in our study, Angio-IMR demonstrated high performance in predicting IMR with overall pooled sensitivity and specificity of 0.84 (95% confidence interval (CI): 0.81-0.87) and 0.87 (95% CI: 0.83-0.99), respectively, and AUC = 0.91 (95% CI: 0.89-0.94). This indicates that Angio-IMR has good diagnostic characteristics. Subgroup analysis by indirect meta-analysis showed higher sensitivity in the rest state. However, there is no significant difference in sensitivity and specificity between the hyperemic and rest states when using the AccuIMR system. Furthermore, sensitivity and specificity were more pronounced in the group without coronary pressure monitoring compared to the group with monitoring. CONCLUSION: Angio-IMR is an alternative tool to identify CMD.
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Wen et al. (2024) conducted a meta-analysis in Coronary microvascular dysfunction (CMD) (n=2,202). Angiography-based index of microcirculatory resistance (Angio-IMR) vs. Invasive pressure wire-based index of microcirculatory resistance (IMR) was evaluated on Diagnostic accuracy (Area Under the Curve) of Angio-IMR for predicting IMR (AUC 0.91, 95% CI 0.89-0.94). Angio-IMR demonstrated high diagnostic performance for identifying coronary microvascular dysfunction compared to invasive IMR, with a pooled sensitivity of 0.84, specificity of 0.87, and an AUC of 0.91.
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