scholarly journals Non-invasive assessment of microvascular dysfunction in patients with microvascular angina

2017 ◽  
Vol 248 ◽  
pp. 433-439 ◽  
Author(s):  
Caroline Jaarsma ◽  
Hans Vink ◽  
Judith van Haare ◽  
Sebastiaan C.A.M. Bekkers ◽  
Bart D. van Rooijen ◽  
...  
Keyword(s):  
Microvascular Dysfunction ◽  
Microvascular Angina ◽  
Non Invasive

scholarly journals Prevalence of microvascular angina among patients with stable symptoms in the absence of obstructive coronary artery disease: a systematic review

2021 ◽  
Author(s):  
Elif Aribas ◽  
Jeanine E Roeters van Lennep ◽  
Suzette E Elias-Smale ◽  
Jan J Piek ◽  
Maurits Roos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Comprehensive Evaluation ◽  
Obstructive Coronary Artery Disease ◽  
Microvascular Dysfunction ◽  
Microvascular Angina ◽  
Non Invasive ◽  
Artery Disease ◽  
Reported Data

Abstract Our purpose was to perform a systematic review to assess the prevalence of microvascular angina (MVA) among patients with stable symptoms in the absence of obstructive coronary artery disease (CAD). We performed a systematic review of the literature to group the prevalence of MVA, based on diagnostic pathways and modalities. We defined MVA using three definitions: (i) suspected MVA using non-invasive ischaemia tests; proportion of patients with non-obstructive CAD among patients with symptoms and a positive non-invasive ischaemia test result, (ii) suspected MVA using specific modalities for MVA; proportion of patients with evidence of impaired microvascular function among patients with symptoms and non-obstructive CAD, and (iii) definitive MVA; proportion of patients with positive ischaemia test results among patients with an objectified impaired microvascular dysfunction. We further examined the ratio of women-to-men for the different groups. Of the 4547 abstracts, 20 studies reported data on MVA prevalence. The median prevalence was 43% for suspected MVA using non-invasive ischaemia test, 28% for suspected MVA using specific modalities for MVA, and 30% for definitive MVA. Overall, more women were included in the studies reporting sex-specific data. The women-to-men ratio for included participants was 1.29. However, the average women-to-men ratio for the MVA cases was 2.50. In patients with stable symptoms of ischaemia in the absence of CAD, the prevalences of suspected and definitive MVA are substantial. The results of this study should warrant cardiologists to support, promote and facilitate the comprehensive evaluation of the coronary microcirculation for all patients with symptoms and non-obstructive CAD.

scholarly journals Diagnostic Approach to Patients with Stable Angina and No Obstructive Coronary Arteries

2019 ◽  
Vol 14 (2) ◽  
pp. 97-102 ◽  
Author(s):  
Gaetano Antonio Lanza
Keyword(s):  
Coronary Arteries ◽  
Microvascular Dysfunction ◽  
Definitive Diagnosis ◽  
Diagnostic Approach ◽  
Coronary Microvascular Dysfunction ◽  
Stress Tests ◽  
Transthoracic Doppler Echocardiography ◽  
Microvascular Angina ◽  
Non Invasive ◽  
Intracoronary Doppler

The diagnosis of microvascular angina (MVA) is usually considered in patients presenting with angina symptoms and evidence of MI on non-invasive stress tests but normal coronary arteries at angiography. A definitive diagnosis of MVA, however, would require the presence of coronary microvascular dysfunction. Several invasive (e.g. intracoronary Doppler wire recording and thermodilution) and non-invasive (e.g. PET, cardiac MRI, transthoracic Doppler echocardiography) methods can be applied to obtain a diagnosis. Both endothelium- dependent and -independent coronary microvascular dilator function, as well as increased microvascular constrictor activity, should be investigated. The main issues in the assessment of clinical and diagnostic findings in patients with suspected MVA are discussed and a diagnostic approach is suggested.

scholarly journals ‘Primary’ Microvascular Angina: Clinical Characteristics, Pathogenesis and Management

2018 ◽  
Vol 13 (3) ◽  
pp. 108 ◽  
Author(s):  
Gaetano Antonio Lanza ◽  
Antonio De Vita ◽  
Juan-Carlos Kaski ◽  
◽  
◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Characteristics ◽  
Microvascular Dysfunction ◽  
Coronary Microcirculation ◽  
Diagnostic Tools ◽  
Coronary Microvascular Dysfunction ◽  
Pharmacological Treatments ◽  
Microvascular Angina ◽  
Non Invasive ◽  
Prognostic Implications

Microvascular angina (MVA), i.e. angina caused by abnormalities of the coronary microcirculation, is increasingly recognised in clinical practice. The pathogenetic mechanisms of MVA are heterogeneous and may involve both structural and functional alterations of coronary microcirculation, and functional abnormalities may variably involve an impairment of coronary microvascular dilatation and an increased microvascular constrictor activity. Both invasive and non-invasive diagnostic tools exist to identify patients with MVA in clinical practice. Prognosis has been reported to be good in primary MVA patients, although the prognostic implications of coronary microvascular dysfunction (CMVD) in more heterogeneous populations of angina patients need further assessment. Management of primary MVA can be challenging, but pharmacological and non-pharmacological treatments exist that allow satisfactory control of symptoms in most patients

scholarly journals Non-invasive assessment of microvascular dysfunction in families with premature coronary artery disease

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P263-P263 ◽  
Author(s):  
T. A. Mulders ◽  
M. Nieuwdorp ◽  
E. S. G. Stroes ◽  
H. Vink ◽  
S. J. Pinto-Sietsma
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Microvascular Dysfunction ◽  
Premature Coronary Artery Disease ◽  
Non Invasive ◽  
Artery Disease

scholarly journals Clinical and imaging variables associated to Microvascular Angina, a 13N-AMMONIA MPI Approach

2021 ◽  
Vol 22 (Supplement_3) ◽  
Author(s):  
JK Rojas-Senarque ◽  
H Gurrola-Luna ◽  
I Carvajal-Juarez ◽  
ME Soto-Lopez ◽  
B Belen-Rivera ◽  
...  
Keyword(s):  
Risk Factors ◽  
Microvascular Dysfunction ◽  
Wilcoxon Test ◽  
Systemic Hypertension ◽  
Categorical Variables ◽  
Microvascular Angina ◽  
Cardiac Computed Tomography Angiography ◽  
Pet Ct ◽  
Group B ◽  
Severe Ischemia

Abstract Funding Acknowledgements Type of funding sources: None. On Behalf of MiniFellows Research Group CLINICAL AND IMAGING VARIABLES IN MICROVASCULAR ANGINA. A 13N-AMMONIA MPI APPROACH Background Patients with typical angina may have no obstructive artery disease1 and 2/3 may present microvascular dysfunction(MVD)2 which is associated with poor prognosis3,4,5. In 2017 the Coronary Vasomotion Disorders International Study Group (COVADIS) included it as a criteria of MVA6; later, included in MINOCA ESC 2020 guidelines.7 For diagnosis6,7: symptoms of ischemia; absence of relevant epicardial CAD (<50% diameter reduction or FFR >0.80); myocardial ischemia; impaired coronary microvascular function (CFR < 2 or <2.5 depending on methodology). Our aim was to identify clinical and imaging variables in patients with MVA due to 13N-ammonia Positron Emission Tomography/Cardiac Tomography(PET/CT) and Cardiac Computed Tomography Angiography(CCTA) in a cardiovascular imaging referral center. Methods.Retrospective, cross-sectional study of patients with suspected CAD. For inclusion: ischemia quantitation (summed stress score,SDS < 3) and obstruction <50% in all vessels. Exclusion criteria: previous infarction, intervention, or incomplete study. Clinical data was assessed. Both studies performed on the same day. Frequencies and percentages to report categorical variables; x2 and Fisher´s exact tests to compare them. Mean (+/-DE) or median (interquartile range) to report continuous variables according to their distribution, and T student or Wilcoxon test to compare them. Results 274 patients included: Group A (CFR <2) and group B (CFR 2)(108vs166). Difference for systemic hypertension(p <0.001), type 2 diabetes mellitus(p <0.001), dyslipidemia(p = 0.019), smoking(p <0.001). Group B presented higher incidence for mild ischemia(p = 0.004) while MVA for severe ischemia(p = 0.002). Difference between groups for EDV and ESV at rest (p = 0.002), EDV at stress(p = 0.03) and at rest(p < 0.001), LVEF at rest and stress(p < 0.001) and for a negative change of LVEF(p < 0.001). Also, reduced Calcium Score(SC)(p < 0.001) Discussion With a higher prevalence reported in women8,9, no difference for women in both groups. Presentation been reported as atypical 3,6,10, as in our study. Traditional risk factors may affect the microvascular circulation earlier in the disease. Regarding mild and severe ischemia, CFR´s may be lower in defect perfusion zones and presence of both ischemia and MVD has worse prognosis11 suggesting ischemia could had already developed in this group. LVEF drop supports the relation between CFR and ventricular function12. Finally, MVA group had a reduced CS, associated with CAD and worse prognosis, suggesting it also affects the microvasculature function. Conclusions 13N-ammonia PET/CT MPI with CCTA is a great combination to diagnose MVA, whose main component is microvascular dysfunction. Recognizing the risk factors associated with this pathology allows making opportune detections, implementing early treatment strategies, controlling symptoms and avoiding the disease"s evolution

PET-CT and detection of coronary artery disease

2021 ◽  
pp. 421-434
Author(s):  
Marcelo F. Di Carli
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Microvascular Dysfunction ◽  
Quantitative Information ◽  
Left Ventricular ◽  
Coronary Microvascular Dysfunction ◽  
Non Invasive ◽  
Atherosclerotic Burden ◽  
Pet Ct ◽  
Artery Disease

Myocardial perfusion PET/CT imaging has emerged as a powerful and comprehensive non-invasive approach for the management of patients with suspected or known coronary artery disease (CAD). The multiparametric PET/CT approach provides quantitative information about the extent and severity of focal and diffuse CAD, coronary microvascular dysfunction (CMD), atherosclerotic burden, and left ventricular function. Contemporary evidence demonstrates that this comprehensive approach is one of the most accurate non-invasive tools for diagnosis, risk prediction, and guiding management in patients with CAD. This chapter summarizes the versatility of the integrated PET/CT scan to provide detailed quantitative information tailored to the patient and clinical question. I then review patient-centred clinical applications using case vignettes to illustrate indications of PET/CT and how to present the findings into clinically actionable information for the practising cardiologist. In each case, I review the available data highlighting the diagnostic and prognostic value of the integrated PET/CT protocol.

scholarly journals Coronary Microvascular Dysfunction: An Update

2020 ◽  
Vol 16 (1) ◽  
pp. 43-49
Author(s):  
Sm Mustafa Zaman ◽  
Harisul Hoque ◽  
Khurshed Ahmed ◽  
Md Mukhlesur Rahman ◽  
Msi Tipu Chowdhury ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Myocardial Perfusion ◽  
Current Knowledge ◽  
Systolic Dysfunction ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Resonance Spectroscopy ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors ◽  
Microvascular Angina

Structural and functional abnormalities of the microcirculation can impair myocardial perfusion which is called coronary microvascular dysfunction and the resulting ischemia is known as microvascular ischaemia. Most of the researches have focused on the epicardial coronary arteries while addressing angina pectoris. Although the importance of the coronary microcirculation in maintaining appropriate myocardial perfusion has been recognized for several decades, the substantial morbidity of coronary microvascular dysfunction (CMD) has not been appreciated until recently. It is not possible to diagnose of microvascular angina clinically with the current knowledge. Resting or exercise electrocardiogram is nondiagnostic. Imaging with speckle tracking in echocardiography may reveal focal diastolic and/or systolic dysfunction. Other noninvasive investigations includes, Contrast stress echocardiography, 99Tc-sestamibi imaging, cardiovascular magnetic resonance (CMR),Nuclear magnetic resonance spectroscopy may show some degree of abnormality. Invasive methods like intracoronary adenosine and acetylecholine test may guide us to diagnose CMD. No guideline directed medical therapy is still available for the CMD. Risk factors modification like smoking cessation and weight-loss may improve endothelial dysfunction and CMD. Beta blockers, calcium channel blockers, Angiotensin converting enzyme inhibitors and statin are now used in different clinical condition related to microvascular angina. After these medical treatment patient with microvascular angina have higher risk of MACE compared with people without angina. So, physicians must be aware of this potentially fatal but under recognized clinical entity. University Heart Journal Vol. 16, No. 1, Jan 2020; 43-49

scholarly journals Clinico-pathophysiological considerations in coronary microvascular disorders

Vessel Plus ◽  
2022 ◽  
Author(s):  
Sarena La ◽  
Rosanna Tavella ◽  
Sivabaskari Pasupathy ◽  
John F. Beltrame
Keyword(s):  
Coronary Arteries ◽  
Myocardial Ischaemia ◽  
Pain Perception ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Microvascular Angina ◽  
Common Clinical Presentation ◽  
Microvascular Spasm ◽  
Underlying Mechanisms ◽  
Microvascular Resistance

Around half of the patients undergoing an elective coronary angiogram to investigate typical stable angina symptoms are found to have non-obstructive coronary arteries (defined as < 50% stenosis). These patients are younger with a female predilection. While underlying mechanisms responsible for these presentations are heterogeneous, structural and functional abnormalities of the coronary microvasculature are highly prevalent. Thus, coronary microvascular dysfunction (CMD) is increasingly recognised as an important consideration in patients with non-obstructive coronary arteries. This review will focus on primary coronary microvascular disorders and summarise the four common clinical presentation pictures which can be considered as endotypes - Microvascular Ischaemia (formerly “Syndrome X”), Microvascular Angina, Microvascular Spasm, and Coronary Slow Flow. Furthermore, the pathophysiological mechanisms associated with CMD are also heterogenous. CMD may arise from an increased microvascular resistance, impaired microvascular dilation, and/or inducible microvascular spasm, ultimately causing myocardial ischaemia and angina. Alternatively, chest pain may arise from hypersensitivity of myocardial pain receptors rather than myocardial ischaemia. These two major abnormalities should be considered when assessing an individual clinical picture, and ultimately, the question arises whether to target the heart or the pain perception to treat the anginal symptoms.

The coronary microcirculation and coronary microvascular dysfunction

2021 ◽  
pp. 18-21
Author(s):  
Romana Herscovici ◽  
C. Noel Bairey Merz
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Signs And Symptoms ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Microvascular Angina ◽  
Cardiac Syndrome ◽  
Artery Disease

The role of revascularization in the treatment of obstructive coronary artery disease is well established, and its impact on improving survival has been proven. Nevertheless, patients with signs and symptoms considered of cardiac origin but with no obstructive coronary artery disease on coronary angiography are increasingly seen. Initially described as a ‘paradox’ or cardiac syndrome X and subsequently defined as microvascular angina, angina-like chest pain and evidence of ischaemia with non-obstructive coronary artery disease, is the consequence of altered coronary microvascular response to various stimuli despite non-obstructed epicardial vessels.

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