Coronary Microvascular Dysfunction

Go Beyond the Angiogram to Get to the Root Cause of Persistent Angina

Assessing for Coronary Microvascular Dysfunction (CMD)

How-to CMD Masterclass

Expert-Led Video Series with Dr. Hayder Hashim

This series covers Coronary Microvascular Dysfunction (CMD) testing, diagnosis, troubleshooting, and treatment, and highlights how it supports full physiological assessments to provide clear diagnosis for patients with persistent angina. 

Hayder Hashim, MD
Assistant Professor, Division of Cardiology
Georgetown University
Interventional Cardiologist - Medstar Washington Hospital Center

Dr. Hayder Hashim

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Part 1: Access
Learn about different access options guiding catheter choices, catheter hygiene, and pre-CATH medication before performing CMD testing.

How to choose access for CMD assessment video with Dr. Hashim

Part 2: CMD Testing Set-Up
Learn the steps to prepare for CMD testing, perform a reliable zero, equalize, and measure Resting Full-cycle Ratio (RFR).

How to set up for CMD Testing Video with Dr. Hashim

Part 3: Procedure Process and Review
Learn how to set up PressureWire™ X Guidewire and CoroFlow Cardiovascular System to take measurements, and analyze results.

  • Resting Full-cycle Ratio (RFR)
  • Coronary Flow Reserve (CFR)
  • Index of Microcirculatory Resistance (IMR)
  • Fractional Flow Reserve (FFR)
How to perform CMD procedure and take measurements video

Part 4: CMD Procedure Validation
Learn how to ensure an accurate CMD assessment and how to validate the results, including troubleshooting and safety tips.

CMD procedure validation video

Part 5: CFR, IMR, and RRR Indices
Gain a deeper understanding of each index, how they are calculated and what are the normal values.

  • Coronary Flow Reserve (CFR) and Index of Microcirculatory Resistance (IMR)
  • Resistive Reserve Ratio (RRR)
  • CFR (Norm) & IMR (Corrected)
Understand CFR, IMR and RRR Indices video

Part 6: Understanding the Software
Learn how to check results when the CMD testing is done, how to identify borderline results, and what are some of the check points for an adequate CMD study.

Learn how to understand the Coroflow Software Vide

Part 7: Analyzing Testing Results
Learn how to interpret CMD test measurements and values, and how to use them to help treat the patient.

  • How to decide between IMR & CFR results?
  • What are the first two values to look at?
  • What indices to look for in a case of myocardial bridging?
How to analyze CMD testing results Video

Part 8: CMD Case Reviews
Learn how to validate and interpret the readings including FFR, CFR, IMR, RRR, and Pd/Pa through these case-based reviews.

CMD Case Reviews Video with Dr. Hashim

Part 9: Prognostic Data / CorMicA Trial
Learn about the prognostic CFR data and CorMicA Trial.

  • What does a low CFR indicate?
  • Why does a low CFR occur?
  • How does IMR data link to prognosis?
Prognostic CFR data and CorMicA Trial Results Video

Part 10: CMD Treatment
Learn how to approach CMD diagnosis and treatment.

Approach to CMD Treatment & Diagnosis Video

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