Coronary Microvascular Dysfunction in Ischemia With Nonobstructive Coronary Arteries and Associations With Sublingual Microvascular Abnormalities

Figures

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  Figure 1. Conceptual Illustration of Noninvasive Microvascular Measurements Sidestream darkfield (SDF) microscopy permits noninvasive imaging of red blood cells (RBCs) in the sublingual microcirculation to measure the perfused boundary region (PBR), RBC microvascular filling percentage (%RBC), and perfused microvascular density (PMVD).

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  Figure 2. Frequency Distribution of Sublingual Microvascular Measurements With and Without CMD Frequency distributions of sublingual microvascular perfused boundary region, RBC filling percentage, and perfused microvascular density in patients with INOCA with and without coronary microvascular dysfunction are shown. No significant difference in perfused boundary region, RBC filling percentage or perfused microvascular density in patients with and without CMD. CMD = coronary microvascular dysfunction; PBR = perfused boundary region; PMVD = perfused microvascular density; RBC = red blood cell.

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  Figure 3. Correlations Between Sublingual Microvascular Measurements and CFR and IMR Correlations between perfused boundary region, RBC filling percentage or perfused microvascular density and continuous measures of microvascular function, coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR), were not observed. Linear regression (solid lines) with 95% CIs (dashed lines) are shown. None of the linear regression slopes differed significantly from zero (all P > 0.05). Abbreviations as in Figure 2.

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  Figure 4. Correlations Between Sublingual Microvascular Measurements and MRR and RRR Associations between sublingual SDF imaging parameters and measures of microvascular resistance reserve (MRR) and resistive reserve ratio (RRR) were not observed. Linear regression (solid lines) with 95% CIs (dashed lines) are shown. None of the linear regression slopes differed significantly from zero (all P > 0.05) Abbreviations as in Figure 2.

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  Figure 5. Correlations Between Sublingual Measurements and Coronary Blood Flow Sublingual SDF imaging parameters were not correlated with coronary blood flow, at rest or with hyperemia. Linear regression (solid lines) with 95% CIs (dashed lines) are shown. None of the linear regression slopes differed significantly from zero (all P > 0.05). Abbreviations as in Figure 2.

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  Figure 6. Sublingual Microvascular Measurements and Subgroups of CMD Sublingual microvascular perfused boundary region, RBC filling percentage, and perfused microvascular density were stratified in a 2x2 factorial of normal vs abnormal CFR and IMR. No difference in SDF imaging parameters were observed within subgroups of CMD. Box and whisker plots show the median value (horizontal line), the first and third quartiles (box, middle 50% of data), and the minimum and maximum values. CFR = coronary flow reserve; IMR = index of microcirculatory resistance; other abbreviations as in Figure 2.

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  Central Illustration. In a Cohort of Patients With INOCA Undergoing Invasive Coronary Function Testing, Sublingual Sidestream Darkfield Imaging was not Associated With Coronary Microvascular Dysfunction CFR = coronary flow reserve; IMR = index of microcirculatory resistance; RBC = red blood cell.