Differential Interaction of High Microvascular Resistance With Coronary Flow Reserve Across Coronary Microvascular Dysfunction Endotypes
Authors' conclusion
In this hypothesis-generating study, patients with high hMR-normal CFR exhibit favorable characteristics of coronary and aortic hemodynamics and reservoir function.
Study context
- Population
- Patients with stable chronic coronary syndromes assessed for coronary microvascular dysfunctionvessel-level analysis
- Participants
- 77 / 149 / 42 / 26
- Exposure
- Coronary microvascular dysfunction (CMD) endotypes by coronary flow reserve (CFR) and hyperemic microvascular resistance (hMR)
- Functional CMDn = 77
- Structural CMDn = 149
- No CMD-low hMRn = 42reference
- No CMD-high hMRn = 26
- Outcome
- Diastolic rate constant (s-1)
Methodological detailshypothesis-generating
- Hypothesis-generating
Main finding
As reported in the abstract
- Across endotypes
- P = 0.006
Observational data: associations, not effects.
Further findings
| Outcome | Functional CMD | Structural CMD | No CMD-low hMR | No CMD-high hMR |
|---|---|---|---|---|
| Pr/Pxs | 18.8 (interval 17.6–20.1) | 19.6 (interval 18.5–20.8) | 21.9 (interval 20.1–23.8) | 23.8 (interval 22.4–25.2) |
| Pxs | — not stated in the abstract | 5.1 (interval 4.8–5.4) mm Hg | — not stated in the abstract | 4.0 (interval 3.4–4.6) mm Hg |
— not stated in the abstract
- Pr/Pxs — Across endotypes
- P < 0.001
- Pxs — Lowest in No CMD-high hMR, highest in Structural CMD
- P < 0.001
hMR vs basal microvascular resistance
- No CMD: β
- 0.128 [0.106-0.149], P < 0.001
- CMD: β
- 0.167 [0.155-0.180], P < 0.001
- Difference
- P = 0.002
hMR vs CFR
- CMD: β
- −0.057 [−0.082 to −0.033], P < 0.001
- No CMD: β
- 0.066 [0.013-0.118] P = 0.014
Original publication
Differential Interaction of High Microvascular Resistance With Coronary Flow Reserve Across Coronary Microvascular Dysfunction Endotypes. JACC Adv. Published 19 November 2025. doi:10.
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