Assessment of hemodynamic indices of conjunctival microvascular function in patients with coronary microvascular dysfunction

Jonathan Mailey , Julie Moore, Paul Brennan, Min Jing, Agnes Awuah, James McLaughlin, M. Andrew Nesbit, Tara C. B. Moore, Mark S. Spence

Research output: Contribution to journalArticlepeer-review


Coronary microvascular dysfunction (CMD) is a cause of ischaemia with non-obstructive coronary arteries (INOCA). It is notoriously underdiagnosed due to the need for invasive microvascular function testing. We hypothesized that systemic microvascular dysfunction could be demonstrated non-invasively in the microcirculation of the bulbar conjunctiva in patients with CMD.

Patients undergoing coronary angiography for the investigation of chest pain or dyspnoea, with physiologically insignificant epicardial disease (fractional flow reserve ≥0.80) were recruited. All patients underwent invasive coronary microvascular function testing. We compared a cohort of patients with evidence of CMD (IMR ≥25 or CFR
A total of 111 patients were included (43 CMD and 68 controls). There were no differences in baseline demographics, co-morbidities or epicardial coronary disease severity. The mean number of vessel segments analysed per patient was 21.0 ± 12.8 (3.2 ± 3.5 arterioles and 14.8 ± 10.8 venules). In the CMD cohort, significant reductions were observed in axial/cross-sectional velocity, blood flow, wall shear rate and stress.

The changes in microvascular function linked to CMD can be observed non-invasively in the bulbar conjunctiva. Conjunctival vascular imaging may have utility as a non-invasive tool to both diagnose CMD and augment conventional cardiovascular risk assessment.
Original languageEnglish
Article number104480
JournalMicrovascular Research
Early online date20 Jan 2023
Publication statusPublished online - 20 Jan 2023

Bibliographical note

Publisher Copyright:
© 2023 Elsevier Inc.


  • Microvascular angina
  • Microvascular dysfunction
  • Conjunctiva
  • Cardiovascular screening


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