Coronary Venous Pressure and Microvascular Hemodynamics in Patients With Microvascular Angina

doi:10.1001/jamacardio.2023.2566

Coronary disease & ACSRandomised controlled trial

Coronary Venous Pressure and Microvascular Hemodynamics in Patients With Microvascular Angina

JAMA CardiolPublished 1 Oct 2023

Randomised controlled trial
blinded
sham-controlled
crossover
single-centre

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Authors' conclusion

Increased coronary venous pressure led to a reduction of microvascular resistances in patients with microvascular angina, a mechanism with potential implications for the therapy of this complex disease.

Study context

Population: Patients with moderate/severe angina (CCS class 2–4) due to microvascular dysfunction (IMR >25 mm Hg × s), without epicardial coronary diseasecrossover
Participants: 20 patients

Comparison: Coronary sinus (CS) balloon inflation vs sham
Primary endpoint: Hyperemic coronary resistance

Primary result

As reported in the abstract

Sham31mean · IQR 23–53 · mm Hg × s

Balloon14mean · IQR 8–26 · mm Hg × s

P < 0.001

Further findings

Hyperemic distal coronary pressure (Pd)

P = 0.01

Balloonmedian 79 mm HgIQR 75–93

Shammedian 92 mm HgIQR 80–100

Mean transit time

P = 0.008

Balloonmedian 0.26 sIQR 0.17–0.46

Shammedian 0.39 sIQR 0.23–0.62

Resting coronary resistance

P = 0.005

Balloonmedian 42 mm Hg × sIQR 31–67

Shammedian 59 mm Hg × sIQR 37–87

CS pressure increase vs sham

Increase at rest: 300%
Increase during hyperemia: 317%

both P < .001

Original publication

Coronary Venous Pressure and Microvascular Hemodynamics in Patients With Microvascular Angina. JAMA Cardiol. Published 1 October 2023. doi:10.1001/jamacardio.2023.2566

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Summarised from the published abstract; every number is checked against it