Key result
Extra backup guide catheters link to ~1-point lower transit time variability vs Judkins left during BTh-iCFT.
Why the study?
Bolus thermodilution during invasive coronary function testing is limited by relatively high between-measurement variability, and whether guide catheter shape influences measurement variability and curve quality was unknown.
Does the use of extra backup (supportive shape) guide catheters reduce thermodilution curve variability and improve curve quality compared to Judkins left (standard shape) guide catheters in patients undergoing invasive coronary function testing for suspected coronary microvascular dysfunction?
Cohort (n=160)
No
Does the use of extra backup (supportive shape) guide catheters reduce thermodilution curve variability and improve curve quality compared to Judkins left (standard shape) guide catheters in patients undergoing invasive coronary function testing for suspected coronary microvascular dysfunction?
Answers are grounded in this paper and cite their sources.
Using supportive extra backup (EBU) guide catheters rather than standard Judkins left catheters during invasive coronary function testing reduces bolus thermodilution measurement variability and improves curve quality, enhancing diagnostic reproducibility.
Background Invasive coronary function testing (iCFT) is the reference standard for diagnosing coronary microvascular dysfunction and is most commonly performed utilizing bolus thermodilution (BTh). However, BTh is limited by relatively high between-measurement variability, which may affect measurement reproducibility. We evaluated whether guide catheter shape can influence the variability and quality of BTh-based iCFT. Methods In this retrospective cohort study, patients undergoing clinically indicated BTh-iCFT for suspected coronary microvascular dysfunction were included. Procedures were performed using either Judkins left (standard shape) or extra backup (EBU; supportive shape) guide catheters. Thermodilution curves were analyzed for variability, expressed as percentage deviation of transit mean time, time-to-peak, amplitude, and area under the curve of individual measurements from the triplicate mean, as well as the normalized area between triplicate curves. Curve quality was graded on a 0 to 3 scale. Results Among 160 patients, 94 (58.8%) underwent BTh-iCFT with Judkins left and 66 (41.2%) with EBU catheters. At rest, variability in transit mean time (7.7% ± 3.9% vs 6.5% ± 4.0%, P = .04), time-to-peak (6.4% ± 3.6 vs 5.0% ± 3.4%, P = .05), area under the curve (22.7% ± 13.7% vs 17.0% ± 10.2%, P = .01), amplitude (21.5% ± 13.8% vs 14.0% ± 9.3%, P < .001), and area between triplicate curves (47.7% ± 19.7% vs 37.5% ± 15.5%, P < .001) were all significantly lower with EBU. During hyperemia, variability in time-to-peak (5.6% ± 3.2% vs 4.7% ± 3.3%, P = .03) differed significantly between Judkins left and EBU-based iCFT. Curve quality scores were significantly higher with EBU both at rest (2.4 ± 0.8 vs 2.7 ± 0.6, P = .02) and during hyperemia (2.7 ± 0.6 vs 2.9 ± 0.4, P = .04). Conclusions Use of supportive guide catheters was associated with reduced variability and improved curve quality during BTh-iCFT, suggesting optimizing guide catheter selection enhances the reproducibility of BTh-based coronary microvascular function assessment.
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Al-Gully et al. (2026) conducted a cohort in Suspected coronary microvascular dysfunction (n=160). Extra backup (EBU; supportive shape) guide catheter vs. Judkins left (standard shape) guide catheter was evaluated on Bolus thermodilution curve variability (e.g., resting transit mean time deviation) and curve quality (0-3 scale) (p=0.04). Extra backup guide catheters reduced resting transit mean time variability (6.5% vs 7.7%, P=.04) and improved curve quality (2.7 vs 2.4, P=.02) compared with Judkins left catheters during BTh-iCFT.
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