TY - JOUR
T1 - Coronary Microvascular Dysfunction
T2 - Clinical Considerations and Noninvasive Diagnosis
AU - Schindler, Thomas H.
AU - Dilsizian, Vasken
N1 - Funding Information:
The recent work was supported by a departmental fund from Washington University (No. 12-3271-93128 to Dr. Schindler), St. Louis, Missouri. Dr. Dilsizian has reported that he has no relationships relevant to the contents of this paper to disclose. Dr. James Udelson served as Guest Editor for this paper.
Publisher Copyright:
© 2020 American College of Cardiology Foundation
PY - 2020/1
Y1 - 2020/1
N2 - Chest pain in patients without obstructive coronary artery disease has been realized as a frequent problem encountered in clinical practice. Invasive flow investigations have suggested that up to two-thirds of patients with nonobstructive coronary atherosclerosis may have microvascular dysfunction (MVD). Positron emission tomography myocardial perfusion imaging in conjunction with tracer-kinetic modeling enables the concurrent quantification of myocardial blood flow (MBF) in milliliters per minute per gram of tissue. This allows the assessment of hyperemic MBFs and myocardial flow reserve for the noninvasive identification and characterization of MVD as an important functional substrate for angina symptoms amenable to intensified and individualized medical intervention with nitrates, calcium-channel blockers, statins, angiotensin-converting enzyme inhibitors, and/or angiotensin II type 1 receptor blockers. Recent investigations suggest that cardiac magnetic resonance and computed tomography may also be suitable for the noninvasive detection of MVD. Whether intensified and individualized treatment related improvement or even normalization of hyperemic MBF and/or myocardial flow reserve may lead to a persistent reduction in angina symptoms and/or improved cardiovascular outcome as compared to standard care, deserves further testing in large-scale randomized clinical trials.
AB - Chest pain in patients without obstructive coronary artery disease has been realized as a frequent problem encountered in clinical practice. Invasive flow investigations have suggested that up to two-thirds of patients with nonobstructive coronary atherosclerosis may have microvascular dysfunction (MVD). Positron emission tomography myocardial perfusion imaging in conjunction with tracer-kinetic modeling enables the concurrent quantification of myocardial blood flow (MBF) in milliliters per minute per gram of tissue. This allows the assessment of hyperemic MBFs and myocardial flow reserve for the noninvasive identification and characterization of MVD as an important functional substrate for angina symptoms amenable to intensified and individualized medical intervention with nitrates, calcium-channel blockers, statins, angiotensin-converting enzyme inhibitors, and/or angiotensin II type 1 receptor blockers. Recent investigations suggest that cardiac magnetic resonance and computed tomography may also be suitable for the noninvasive detection of MVD. Whether intensified and individualized treatment related improvement or even normalization of hyperemic MBF and/or myocardial flow reserve may lead to a persistent reduction in angina symptoms and/or improved cardiovascular outcome as compared to standard care, deserves further testing in large-scale randomized clinical trials.
KW - PET
KW - cardiovascular risk factors
KW - coronary atherosclerosis
KW - microvascular dysfunction
KW - myocardial blood flow
KW - myocardial flow reserve
KW - prognosis
UR - http://www.scopus.com/inward/record.url?scp=85064258428&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2018.11.036
DO - 10.1016/j.jcmg.2018.11.036
M3 - Review article
C2 - 30982670
AN - SCOPUS:85064258428
SN - 1936-878X
VL - 13
SP - 140
EP - 155
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 1
ER -