Journal article
Interpreting Coronary Perfusion Endpoints: A Multidimensional Framework for Physiologic and Clinical Integration
Cardiology in review, Forthcoming
10 Jun 2026
PMID: 42269017
Abstract
Third-generation β-blockers such as carvedilol and nebivolol exhibit vasodilatory properties mediated through α1-adrenergic antagonism and nitric oxide-related pathways, respectively. Although these mechanisms are well supported by receptor-level and ex vivo data, their translation into definitive human vascular effects remains incompletely defined. Human interventional studies have primarily relied on composite perfusion endpoints, including coronary flow reserve, which are influenced by heart rate, myocardial oxygen demand, perfusion pressure, and extravascular compression. Consequently, changes in these indices reflect integrated hemodynamic effects, limiting mechanistic specificity. Existing literature has largely characterized these endpoints individually or in relation to clinical outcomes, with less emphasis on interpretation of underlying physiologic mechanisms. This review proposes a structured, context-dependent framework in which coronary flow reserve, the index of microcirculatory resistance, an invasive measure of minimal microvascular resistance, and microvascular resistance reserve, a metric of vasodilatory reserve utilization, are interpreted in combination to contextualize dominant physiologic contributors across disease states. Although precise mechanistic attribution remains limited in vivo, this hypothesis-generating approach may provide a more coherent basis for interpreting perfusion-based endpoints. When applied in appropriate clinical contexts, it may improve characterization of pharmacologic vascular effects and inform future studies aimed at distinguishing intrinsic microvascular responses from systemic influences.
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Details
- Title
- Interpreting Coronary Perfusion Endpoints: A Multidimensional Framework for Physiologic and Clinical Integration
- Creators
- Aryan Manglik - Drexel UniversityYanmin Qu - Thomas Jefferson University
- Publication Details
- Cardiology in review, Forthcoming
- Publisher
- Lippincott Williams & Wilkins
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Other Identifier
- 991022195558604721