Reference values for intracoronary Doppler flow velocity-derived hyperaemic microvascular resistance index

Rutger G. T. Feenstra, Andreas Seitz, Coen K. M. Boerhout, Robbert J. de Winter, Peter Ong, Marcel A. M. Beijk, Jan J. Piek, Udo Sechtem, Tim P. van de Hoef

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Background: Invasive assessments of microvascular function are rapidly becoming an integral part of physiological assessment in chronic coronary syndromes. Objective: We aimed to establish a reference range for Doppler flow velocity-derived hyperaemic microvascular resistance index (HMR) in a cohort of angina with no significant epicardial coronary obstruction (ANOCA) patients with no structural pathophysiological alterations in the coronary circulation. Methods: The reference population consisted of ANOCA patients undergoing invasive coronary vasomotor function assessment who had a coronary flow reserve (CFR) >2.5, and had either (1) tested negatively for spasm provocation (n = 12) or (2) tested positively with only angina at rest (n = 29). A reference range for HMR was established using a non-parametric method and correlations with clinical characteristics were determined using a spearman rank correlation analysis. Results: In 41 patients median HMR amounted to 1.6 mmHg/cm/s [Q1, Q3: 1.3, 2.2 mmHg/cm/s]. The reference range for HMR that is applicable to 95% of the population was 0.8 mmHg/cm/s (90% CI: 0.8–1.0 mmHg/cm/s) to 2.7 mmHg/cm/s (90% CI: 2.6–2.7 mmHg/cm/s). No significant correlations were found between HMR and clinical characteristics. Conclusion: In this reference population undergoing invasive coronary vasomotor function testing, the 90% confidence interval of the HMR upper limit of normal ranges from 2.6 to 2.7 mmHg/cm/s. A > 2.5 mmHg/cm/s HMR threshold can be used to identify abnormal microvascular resistance in daily clinical practice.
Original languageEnglish
Pages (from-to)16-20
Number of pages5
JournalInternational journal of cardiology
Early online date2022
Publication statusPublished - 15 Jan 2023


  • Angina
  • Coronary vasomotor dysfunction
  • Hyperaemic microvascular resistance
  • Non-obstructive coronary artery disease
  • Reference value

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