Coronary microvascular function in patients with sepsis and myocardial injury: an invasive coronary physiology study
An erratum to this article was published (Crit Care, 18 Sep 2026 ↗)
Authors' conclusion
CMD was common and heterogeneous and exhibited distinct phenotypes in patients with sepsis and myocardial injury. Measures of coronary microvascular function were not associated with troponin release.
Study context
- Population
- Consecutive adults with sepsis (Sepsis-3) and myocardial injury (hs-cTnT ≥ 15 ng/L), June 2019–December 202449 completed invasive assessment
- Participants
- 55 adults
- Exposure
- Sepsis vs chronic coronary syndrome (CCS)
- Outcome
- Coronary microvascular function (CMD: IMR > 25 and/or MRR ≤ 3) and its relationship with cardiac troponin release
Methodological detailsinvasive coronary physiology, consecutive enrolment, matched CCS comparison
- Invasive coronary physiology
- Consecutive enrolment
- Matched CCS comparison
Main finding
As reported in the abstract
CMD (IMR > 25 and/or MRR ≤ 3)
Coronary microvascular dysfunction (CMD) present
30 of 49
61%
Observational data: associations, not effects.
Further findings
Obstructive coronary artery disease (CAD)
- Obstructive CAD identified
- 12/55 (22%)
CMD phenotypes
- Elevated index of microcirculatory resistance (IMR) only
- 8/49 (16%)
- Functional CMD (microvascular resistance reserve (MRR) ≤ 3 and IMR ≤ 25)
- 9/49 (18%)
- Structural CMD (MRR ≤ 3 and IMR > 25)
- 13/49 (27%)
Association of hs-cTnT with IMR and MRR (restricted cubic spline)
- hs-cTnT vs IMR, overall P
- P = 0.899
- hs-cTnT vs IMR, non-linearity P
- P = 0.687
- hs-cTnT vs MRR, overall P
- P = 0.987
- hs-cTnT vs MRR, non-linearity P
- P = 0.954
- No evidence of associations
Echocardiographic variables
- CMD associated with higher prevalence of ventriculo-arterial uncoupling, RV systolic dysfunction and impaired RV-pulmonary arterial coupling
MRR, sepsis vs matched CCS controls
- MRR in sepsis, median [IQR]
- 3.2 [IQR 2.4-4.5]
- MRR in matched CCS controls, median [IQR]
- 4.0 [2.7-6.2]
- IMR similar between groups
- Age-, sex- and CAD-matched; mixed-effects models
Original publication
Coronary microvascular function in patients with sepsis and myocardial injury: an invasive coronary physiology study. Crit Care. Published 2 July 2026. doi:10.
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