Viscusi, Michele Mattia (2025) Continuous Intracoronary Thermodilution in the Evaluation of Coronary Microvascular Dysfunction: From Conceptual Validation to Clinical Translation. [Tesi di dottorato]

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Abstract

Coronary microvascular dysfunction (CMD) is a major cause of angina in the absence of obstructive coronary artery disease, yet its assessment traditionally relies on indirect, flow-velocity–based indices such as coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR). Continuous intracoronary thermodilution has emerged as a novel technique capable of quantifying absolute coronary flow and absolute microvascular resistance independently of pharmacologically induced hyperemia. This thesis spans the conceptual validation, methodological refinement, and clinical translation of this technique. It demonstrates its accuracy, reproducibility, and operator independence, and compares its performance with bolus thermodilution and positron emission tomography. Applications across key clinical scenarios—including ANOCA/INOCA, coexistence of epicardial disease, CMD endotyping, aortic stenosis before and after TAVI, and MINOCA—highlight its ability to disentangle epicardial from microvascular physiology. Overall, continuous thermodilution offers a quantitative, physiologically specific approach to diagnosing and phenotyping CMD, supporting more precise and individualized patient management.

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