Novel Contrast-Derived Indices of Coronary Microvascular Function: Potential Clinical and Cost Benefits
Authors' conclusion
Contrast-derived indices have high specificity and negative predictive value, enabling rapid exclusion of microvascular dysfunction. This method is feasible, clinically useful and cost-saving compared with routine adenosine testing.
Study context
- Population
- Patients undergoing coronary microvascular function testing with a diagnostic guidewire (median age 63 years; 62% women; 13% with diabetes)patients, 106 coronary arteries · coronary arteries 106 · patients 93
- Participants
- 93 patients
- Comparison
- Contrast-derived indices vs abnormal adenosine-derived indices
- Outcome
- Contrast-derived coronary flow reserve <2.0 for predicting adenosine-derived coronary flow reserve
Performance
As reported in the abstract
| Test or model | Area under the curve | Sensitivity | Specificity | Positive predictive value | Negative predictive value |
|---|---|---|---|---|---|
| Contrast-derived coronary flow reserve <2.0 | 0.81 | 67% | 80% | 40% | 92% |
Contrast-derived coronary flow reserve <2.0
Area under the curve0.81
Sensitivity67%
Specificity80%
Positive predictive value40%
Negative predictive value92%
Further findings
| Outcome | Values |
|---|---|
| Contrast-derived index of microcirculatory resistance >47 for predicting adenosine-derived index | contrast-derived index of microcirculatory resistance >47 area under the curve 0.82 · sensitivity 80% · specificity 79% · positive predictive value 60% · negative predictive value 91% |
| Contrast-derived microvascular resistance reserve <1.9 for predicting adenosine-derived microvascular resistance reserve | contrast-derived microvascular resistance reserve <1.9 area under the curve 0.82 · sensitivity 67% · specificity 89% · positive predictive value 35% · negative predictive value 97% |
Assessments in left anterior descending artery
- Assessments undertaken in the left anterior descending artery
- 88%
Fractional flow reserve
- Median fractional flow reserve (interquartile range, 0.85-0.92)
- 0.88
Repeatability from the second contrast bolus
- Good correlation on repeatability testing
Hybrid approach: adenosine use and cost
- Reduction in adenosine use
- 40%
- Saving per 1000 vessels assessed (USA)
- $30 800
- Saving per 1000 vessels assessed (UK)
- £8000
Original publication
Novel Contrast-Derived Indices of Coronary Microvascular Function: Potential Clinical and Cost Benefits. Circ Cardiovasc Interv. Published 1 May 2025. doi:10.
Summarised from the published abstract; every number is checked against it