Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://cr.elmerpub.com

Original Article

Volume 17, Number 6, December 2026, pages 664-669

Virtual Assessment of Coronary Microcirculation Before and After Rotational Atherectomy

↓ Figure 1. Example of microFR and AMR measurements with AngioPlus (Pulse Medical). Left panel: angiogram with the reconstructed LM–LAD. B1 to B5 designate the side branches identified along the vessel, with the microFR value computed at the level of each branch. The yellow value (0.81; 1.5 mm) indicates the microFR and the minimal lumen diameter at the site of the lesion. Upper-right values: vessel microFR (0.72), lesion length (28.6 mm), proximal/distal reference diameters (4.0/2.4 mm), pressure drop across the lesion = 0.16 (it is the variation of microFR after treatment ΔmicroFR) and predicted residual microFR after treatment of the lesion (0.88). Lower values: estimated contrast flow velocity (14.6 cm/s) and simulated hyperemic microvascular resistance, AMR (2.02 mm Hg·s/cm, corresponding to 202 mm Hg·s/m). Right upper panel (branch map): schematic representation of the LM and LAD from proximal (P) to distal (D), showing the position and diameter of each side branch. Right lower panel (LM + LAD pullback curve): virtual microFR pullback along the vessel. The vertical line marks the minimal lumen diameter site (1.5 mm; 49% diameter stenosis and 74% area stenosis; microFR, 0.81). AMR: angiography-derived microvascular resistance; LAD: left anterior descending artery; LM: left main coronary artery; microFR: Murray-law-based quantitative flow ratio.

↓ **Table 1.** Clinical Characteristics
Variable	Non-CMD group (n = 23)	CMD group (n = 17)	P
AMR: angiography-derived microvascular resistance; CABG: coronary artery bypass grafting; CMD: coronary microvascular dysfunction; LVEF: left ventricular ejection fraction; PCI: percutaneous coronary interventions; SD: standard deviation.
Age, years (mean ± SD)	76.1 ± 9	74.1 ± 9	0.501
Male sex, n (%)	19 (83)	16 (94)	0.37
Diabetes mellitus, n (%)	7 (30)	12 (70)	0.028
Hypertension, n (%)	19 (82)	14 (82)	1
Dyslipidemia, n (%)	10 (40)	10 (58)	0.52
Current/former smoking, n (%)	13 (56)	11 (64)	0.74
Chronic kidney disease, n (%)	1 (4)	2 (11)	0.56
Prior myocardial infarction, n (%)	5 (21)	3 (17)	1
Prior PCI, n (%)	7 (30)	8 (47)	0.45
Prior CABG, n (%)	1 (4)	0 (0)	1
Atrial fibrillation, n (%)	2 (8)	3 (17)	0.63
Prior stroke, n (%)	4 (17)	4 (23)	0.70
Stable angina, n (%)	13 (57)	13 (77)	0.21
Acute coronary syndrome, n (%)	10 (43)	4 (23)	1
Preserved LVEF (≥ 50%), n (%)	19 (83)	10 (59)	0.15
Pre-procedural AMR, mm Hg·s/m (mean)	177	176	—
Postprocedural AMR, mm Hg·s/m (mean)	201	315	—

↓ Table 1. Clinical Characteristics

Variable

Non-CMD group (n = 23)

CMD group (n = 17)

AMR: angiography-derived microvascular resistance; CABG: coronary artery bypass grafting; CMD: coronary microvascular dysfunction; LVEF: left ventricular ejection fraction; PCI: percutaneous coronary interventions; SD: standard deviation.

Age, years (mean ± SD)

76.1 ± 9

74.1 ± 9

0.501

Male sex, n (%)

19 (83)

16 (94)

0.37

Diabetes mellitus, n (%)

7 (30)

12 (70)

0.028

Hypertension, n (%)

19 (82)

14 (82)

Dyslipidemia, n (%)

10 (40)

10 (58)

0.52

Current/former smoking, n (%)

13 (56)

11 (64)

0.74

Chronic kidney disease, n (%)

1 (4)

2 (11)

0.56

Prior myocardial infarction, n (%)

5 (21)

3 (17)

Prior PCI, n (%)

7 (30)

8 (47)

0.45

Prior CABG, n (%)

1 (4)

0 (0)

Atrial fibrillation, n (%)

2 (8)

3 (17)

0.63

Prior stroke, n (%)

4 (17)

4 (23)

0.70

Stable angina, n (%)

13 (57)

13 (77)

0.21

Acute coronary syndrome, n (%)

10 (43)

4 (23)

Preserved LVEF (≥ 50%), n (%)

19 (83)

10 (59)

0.15

Pre-procedural AMR, mm Hg·s/m (mean)

177

176

—

Postprocedural AMR, mm Hg·s/m (mean)

201

315

—

↓ **Table 2.** Procedural Characteristics
Variable	Non-CMD group (n = 23)	CMD group (n = 17)	Between-group comparison
^aNS: not significant (P ≥ 0.05) for the comparison between the non-CMD and CMD groups; for these variables, values are reported for the overall population (n = 40). ^bNot formally tested: no statistical test was performed for this variable because of the small number of patients per group; values are presented descriptively. LAD: left anterior descending artery; CMD: coronary microvascular dysfunction; LCX: left circumflex artery; OFDI: optical frequency-domain imaging; RA: rotational atherectomy; RCA: right coronary artery.
Radial access, n (%)	39/40 (97.5) overall		NS^a
Target lesion, n (%)
LAD	26/40 (65) overall		NS^a
RCA	11/40 (27) overall		NS^a
LCX	3/40 (8) overall		NS^a
Lesion length > 20 mm, n (%)	13 (56)	12 (70)	Not formally tested^b
Three-vessel disease, n (%)	Majority in both groups		NS^a
Left main lesion, n (%)	4/40 (10) overall		NS^a
Intracoronary imaging (OFDI), n (%)	7/40 (17.5) overall		NS^a
Burr size 1.5 mm, n (%)	17 (74)	12 (70)	Not formally tested^b
Burr size 1.75 mm, n (%)	0 (0)	3 (18)	Not formally tested^b
Mean number of RA passes	2	4	Not formally tested^b
Burr run time, s	20 (median)	60 (mean)	Not formally tested^b

↓ Table 2. Procedural Characteristics

Variable

Non-CMD group (n = 23)

CMD group (n = 17)

Between-group comparison

^aNS: not significant (P ≥ 0.05) for the comparison between the non-CMD and CMD groups; for these variables, values are reported for the overall population (n = 40). ^bNot formally tested: no statistical test was performed for this variable because of the small number of patients per group; values are presented descriptively. LAD: left anterior descending artery; CMD: coronary microvascular dysfunction; LCX: left circumflex artery; OFDI: optical frequency-domain imaging; RA: rotational atherectomy; RCA: right coronary artery.

Radial access, n (%)

39/40 (97.5) overall

NS^a

Target lesion, n (%)

LAD

26/40 (65) overall

NS^a

RCA

11/40 (27) overall

NS^a

LCX

3/40 (8) overall

NS^a

Lesion length > 20 mm, n (%)

13 (56)

12 (70)

Not formally tested^b

Three-vessel disease, n (%)

Majority in both groups

NS^a

Left main lesion, n (%)

4/40 (10) overall

NS^a

Intracoronary imaging (OFDI), n (%)

7/40 (17.5) overall

NS^a

Burr size 1.5 mm, n (%)

17 (74)

12 (70)

Not formally tested^b

Burr size 1.75 mm, n (%)

0 (0)

3 (18)

Not formally tested^b

Mean number of RA passes

Not formally tested^b

Burr run time, s

20 (median)

60 (mean)

Not formally tested^b