{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T16:29:36Z","timestamp":1792427376675,"version":"4.5.0"},"reference-count":15,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Bolus thermodilution is the most commonly used invasive assessment for coronary microvascular dysfunction (CMD). However, variability in thermodilution transit time measurements (TTM) affects calculated Coronary Flow Reserve (CFR) and Index of Microvascular Resistance (IMR) values. This study determined variables associated with transit time variability and quantified confidence intervals for the range of measured CFR and IMR values.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The CoroFlow Cardiovascular System (Coroventis, Sweden) and PressureWire\u2122 X Guidewire (Abbott) were used to collect 2541 TTM from 259 vessels at 14 US sites included in the FlowLab Study. Correlations with baseline patient and procedural variables were determined by both linear and mixed linear models. Mixed linear models with the physician or vessel as the random effect were computed. Monte Carlo simulations of CFR and IMR were performed to determine 95% confidence intervals for thresholds of 2.5 for CFR and 25 for IMR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mixed linear analysis with vessel as the random effect provided the best model fit (\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.948). In this model, RCA vessel location (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and pressure sensor distance &lt;\u20095\u2009cm (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.005) were significantly associated with transit time. Monte Carlo simulations identified a \u201cgray zone\u201d range of 2.1\u20133.1 for CFR and 19\u201331 for IMR.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Minimizing variability in invasive CMD assessment is essential for improving diagnostic accuracy and guiding clinical decision\u2010making as testing becomes more widespread. In this study, target vessel choice (RCA) and pressure sensor placement were identified as key modifiable sources of transit time variability. Clinically applicable confidence intervals around CFR and IMR values were defined.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccd.70301","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T12:11:04Z","timestamp":1762431064000},"page":"153-161","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Predictors of Variability in Coronary Flow Reserve and Microvascular Resistance Measurement Using the Bolus Thermodilution Technique"],"prefix":"10.1002","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9036-7049","authenticated-orcid":false,"given":"Jason","family":"Galo","sequence":"first","affiliation":[{"name":"Medstar Washington Hospital Center Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aziz","family":"Maksoud","sequence":"additional","affiliation":[{"name":"Kansas Heart Hospital Wichita Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samit","family":"Shah","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine Yale School of Medicine New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Toleva","sequence":"additional","affiliation":[{"name":"Georgia Heart Institute Gainesville Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhei","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"New York Presbyterian Brooklyn Methodist Hospital New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akl C.","family":"Fahed","sequence":"additional","affiliation":[{"name":"Cardiovascular Division Massachusetts General Hospital, Harvard Medical School Boston Massachusetts 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