BACKGROUND: A considerable number of symptomatic patients leave the cardiac catheterization lab without a definitive diagnosis for their symptoms because no epicardial stenoses are found. The significance of disorders of coronary microvasculature and vasomotion as the cause of symptoms and signs of ischemia has only recently been appreciated. Today we have a wide spectrum of invasive coronary physiology tools but little is known about when and how these tools are used in clinical practice. STUDY DESIGN AND METHODOLOGY: SoutheAsTern eUrope microciRculATION (SATURATION) registry will study the regional practice of patient selection for coronary function testing, indications, non-invasive ischemia testing, medications, procedural aspects of invasive physiology evaluation, and treatment changes after testing. The registry is expected to include 1600 patients in participating centers in Southeastern Europe from 2024 to 2029, using the thermodilution technique for evaluation of microcirculation. Major adverse cardiovascular events as well as patient-centered outcomes such as burden of angina and quality of life using Seattle Angina Questionnaire (SAQ) and EQ-5D-5L will be recorded. The study will include patients with different stages of coronary artery disease (presence of disease or degree of stenosis) to elucidate the effect of coronary microcirculation on the outcomes in this broad group. CONCLUSION: The registry will provide information regarding the current practice of invasive coronary physiology assessment in populations at high cardiovascular risk in Southeastern Europe. This could lead to a better understanding of coronary microvascular dysfunction and its relationship to various degrees of coronary atherosclerosis together with potential interventions that can be beneficial.

1st Department of Cardiology National and Kapodistrian University of Athens Hippocration Hospital Athens Greece

2nd Department of Medicine Department of Cardiovascular Medicine 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Cardiology Department Heraklion University Hospital Heraklion Greece

Cardiology Division University Hospital of Patras Rio Greece

Department of Cardiology Mitera General Hospital Hygeia Healthcare Group Athens Greece

Department of Cardiovascular Diseases University Hospital Center Zagreb Zagreb Croatia

Department of Internal Medicine and Cardiology Faculty of Medicine Masaryk University Brno Czech Republic

Division of Cardiology Tel Aviv Sourasky Medical Centre and Sackler School of Medicine Tel Aviv University Tel Aviv Israel

Faculty of Medicine University of Belgrade Belgrade Serbia; Clinical Hospital Center Bezanijska kosa Belgrade Serbia

Faculty of Medicine University of Belgrade Belgrade Serbia; University Clinical Center of Serbia Belgrade Serbia

Faculty of Medicine University of Novi Sad Novi Sad Serbia; Institute for Cardiovascular Diseases of Vojvodina Sremska Kamenica Serbia

Gottsegen National Cardiovascular Center Budapest Hungary

Institute for Cardiovascular Diseases Dedinje Belgrade Serbia

Institute for Cardiovascular Diseases Dedinje Belgrade Serbia; Faculty of Medicine University of Belgrade Belgrade Serbia

Invasive Cardiology Internal Medicine Department University of Szeged Szeged Hungary

Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT United States of America; Veterans Affairs Connecticut Healthcare System West Haven CT United States of America

Sheba Medical Center Tel Aviv University Faculty of Medicine Tel Aviv Israel

University Hospital Centre Rijeka Rijeka Croatia

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