Evaluation of Non-invasive Imaging Parameters in Coronary Microvascular Disease: A Systematic Review

Abstract Background: Coronary microvascular dysfunction (CMD) is an important underlying cause of angina pectoris. Currently, no diagnostic tool is available to directly visualize the coronary microvasculature. Invasive microvascular reactivity testing is the diagnostic standard for CMD, but several non-invasive imaging techniques are being evaluated. However, evidence on reported non-invasive parameters and cut-off values is limited. Thus, we aimed to provide an overview of reported non-invasive parameters and corresponding cut-off values for CMD.Methods: Pubmed and EMBASE databases were systematically searched for studies enrolling patients with angina pectoris without obstructed coronary arteries, investigating at least one non-invasive imaging technique to quantify CMD. Methodological quality assessment of included studies was performed using QUADAS-2.Results: Thirty-six studies were included. Nine cardiac magnetic resonance (CMR) studies reported MPRI (n = 9) and nine positron emission tomography (PET) and transthoracic echocardiography (TTE) studies reported CFR. Mean MPRI ranged from 1.47 ± 0.36 to 1.83 ± 0.50 in patients and from 1.50 ± 0.47 to 2.23 ± 0.37 in healthy controls. Reported mean CFR in PET and TTE ranged from 1.39 ± 0.31 to 2.85 ± 1.35 and 1.69 ± 0.40 to 2.40 ± 0.40 for patients, and 2.68 ± 0.83 to 4.32 ± 1.78 and 2.65 ± 0.65 to 3.31 ± 1.10 for controls, respectively.Conclusions: This systematic review summarized current evidence on reported parameters and cut-off values to diagnose CMD for various non-invasive imaging modalities. Nonetheless, standardization of methodology and reporting of outcome measures is required to provide clinically applicable reference values.

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Evaluation of non-invasive imaging parameters in coronary microvascular disease: a systematic review

BMC Medical Imaging ◽

10.1186/s12880-020-00535-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

F. Groepenhoff ◽

R. G. M. Klaassen ◽

G. B. Valstar ◽

S. H. Bots ◽

N. C. Onland-Moret ◽

...

Keyword(s):

Systematic Review ◽

Angina Pectoris ◽

Imaging Technique ◽

Imaging Techniques ◽

Microvascular Disease ◽

Microvascular Dysfunction ◽

Current Evidence ◽

Coronary Microvascular Dysfunction ◽

Non Invasive ◽

Positron Emission

Abstract Background Coronary microvascular dysfunction (CMD) is an important underlying cause of angina pectoris. Currently, no diagnostic tool is available to directly visualize the coronary microvasculature. Invasive microvascular reactivity testing is the diagnostic standard for CMD, but several non-invasive imaging techniques are being evaluated. However, evidence on reported non-invasive parameters and cut-off values is limited. Thus, we aimed to provide an overview of reported non-invasive parameters and corresponding cut-off values for CMD. Methods Pubmed and EMBASE databases were systematically searched for studies enrolling patients with angina pectoris without obstructed coronary arteries, investigating at least one non-invasive imaging technique to quantify CMD. Methodological quality assessment of included studies was performed using QUADAS-2. Results Thirty-seven studies were included. Ten cardiac magnetic resonance studies reported MPRI and nine positron emission tomography (PET) and transthoracic echocardiography (TTE) studies reported CFR. Mean MPRI ranged from 1.47 ± 0.36 to 2.01 ± 0.41 in patients and from 1.50 ± 0.47 to 2.68 ± 0.49 in controls without CMD. Reported mean CFR in PET and TTE ranged from 1.39 ± 0.31 to 2.85 ± 1.35 and 1.69 ± 0.40 to 2.40 ± 0.40 for patients, and 2.68 ± 0.83 to 4.32 ± 1.78 and 2.65 ± 0.65 to 3.31 ± 1.10 for controls, respectively. Conclusions This systematic review summarized current evidence on reported parameters and cut-off values to diagnose CMD for various non-invasive imaging modalities. In current clinical practice, CMD is generally diagnosed with a CFR less than 2.0. However, due to heterogeneity in methodology and reporting of outcome measures, outcomes could not be compared and no definite reference values could be provided.

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Coronary Microvascular Dysfunction: PET, CMR and CT Assessment

Journal of Clinical Medicine ◽

10.3390/jcm10091848 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1848

Author(s):

Elisabetta Tonet ◽

Graziella Pompei ◽

Evelina Faragasso ◽

Alberto Cossu ◽

Rita Pavasini ◽

...

Keyword(s):

Chest Pain ◽

Cardiac Computed Tomography ◽

Obstructive Coronary Artery Disease ◽

Microvascular Disease ◽

Microvascular Dysfunction ◽

Current Evidence ◽

Coronary Microvascular Dysfunction ◽

Advanced Imaging ◽

Persistent Symptoms ◽

Positron Emission

Microvascular dysfunction is responsible for chest pain in various kinds of patients, including those with obstructive coronary artery disease and persistent symptoms despite revascularization, or those with myocardial disease without coronary stenosis. Its diagnosis can be performed with an advanced imaging technique such as positron emission tomography, which represents the gold standard for diagnosing microvascular abnormalities. In recent years, cardiovascular magnetic resonance and cardiac computed tomography have demonstrated to be emerging modalities for microcirculation assessment. The identification of microvascular disease represents a fundamental step in the characterization of patients with chest pain and no epicardial coronary disease: its identification is important to manage medical strategies and improve prognosis. The present overview summarizes the main techniques and current evidence of these advanced imaging strategies in assessing microvascular dysfunction and, if present, their relationship with invasive evaluation.

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Imaging of microvascular disease

The ESC Textbook of Cardiovascular Imaging ◽

10.1093/med/9780198849353.003.0033 ◽

2021 ◽

pp. 481-494

Author(s):

Paolo G. Camici ◽

Ornella Rimoldi

Keyword(s):

Myocardial Ischaemia ◽

Imaging Techniques ◽

Microvascular Disease ◽

Microvascular Dysfunction ◽

Microvascular Function ◽

Coronary Microvascular Dysfunction ◽

Maximal Increase ◽

Asymptomatic Subjects ◽

Coronary Microvascular Function

Beside obstructive disease of the epicardial coronary arteries dysfunction of the coronary microvasculature has emerged in the past 20 years as an additional mechanism of myocardial ischaemia. The coronary microvasculature cannot be directly visualized in vivo, therefore, both invasive and non-invasive techniques, have been developed to assess parameters that depend directly on coronary microvascular function. Studies at the microcirculatory level entail the use of vasodilators to obtain near-maximal vasodilation. The ratio of the maximal increase of blood flow above its resting value the coronary flow reserve (CFR) allows to gain an insight into the integrated circulatory function. The diagnostic accuracy of imaging techniques can be exploited to detect impairments of myocardial perfusion in asymptomatic subjects with cardiovascular risk factors. The assessment of the coronary microvascular function has provided novel details on the pathophysiological role of coronary microvascular dysfunction in the development of myocardial ischaemia bearing also important prognostic implications.

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Coronary Microvascular Dysfunction and the Role of Noninvasive Cardiovascular Imaging

Diagnostics ◽

10.3390/diagnostics10090679 ◽

2020 ◽

Vol 10 (9) ◽

pp. 679

Author(s):

Muhammad Talha Ayub ◽

Dinesh Kalra

Keyword(s):

Imaging Techniques ◽

Oxygen Demand ◽

Microvascular Dysfunction ◽

Cardiac Imaging Techniques ◽

Myocardial Oxygen Demand ◽

Coronary Microvascular Dysfunction ◽

Non Invasive ◽

Treatment Prognosis

Patients with coronary microvascular dysfunction (CMD) have significantly higher rates of cardiovascular events, including hospitalization for heart failure, sudden cardiac death, and myocardial infarction (MI). In CMD, several pathophysiological changes lead to functional and structural abnormalities in the coronary microvasculature, which disrupt the ability of the vessels to vasodilate and augment myocardial blood flow in response to increased myocardial oxygen demand, causing ischemia and angina. With the advent of more advanced non-invasive cardiac imaging techniques, the coronary microvasculature has been subjected to more intense study in the past two decades—this has led to further insights into the diagnosis, pathophysiology, treatment, prognosis and follow-up of CMD. This review will highlight and compare the salient features of the currently available non-invasive imaging modalities used in these patients, and discuss the clinical utility of these techniques in the workup and management of these patients.

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In Vivo Imaging of Biodegradable Implants and Related Tissue Biomarkers

Polymers ◽

10.3390/polym13142348 ◽

2021 ◽

Vol 13 (14) ◽

pp. 2348

Author(s):

Leon Riehakainen ◽

Chiara Cavallini ◽

Paolo Armanetti ◽

Daniele Panetta ◽

Davide Caramella ◽

...

Keyword(s):

Imaging Modality ◽

Imaging Techniques ◽

Special Focus ◽

Tissue Remodelling ◽

Biodegradable Implant ◽

Advantages And Disadvantages ◽

Non Invasive ◽

Positron Emission ◽

Longitudinal Imaging

Non-invasive longitudinal imaging of osseointegration of bone implants is essential to ensure a comprehensive, physical and biochemical understanding of the processes related to a successful implant integration and its long-term clinical outcome. This study critically reviews the present imaging techniques that may play a role to assess the initial stability, bone quality and quantity, associated tissue remodelling dependent on implanted material, implantation site (surrounding tissues and placement depth), and biomarkers that may be targeted. An updated list of biodegradable implant materials that have been reported in the literature, from metal, polymer and ceramic categories, is provided with reference to the use of specific imaging modalities (computed tomography, positron emission tomography, ultrasound, photoacoustic and magnetic resonance imaging) suitable for longitudinal and non-invasive imaging in humans. The advantages and disadvantages of the single imaging modality are discussed with a special focus on preclinical imaging for biodegradable implant research. Indeed, the investigation of a new implant commonly requires histological examination, which is invasive and does not allow longitudinal studies, thus requiring a large number of animals for preclinical testing. For this reason, an update of the multimodal and multi-parametric imaging capabilities will be here presented with a specific focus on modern biomaterial research.

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Ventricular repolarization alterations in women with angina pectoris and suspected coronary microvascular dysfunction

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2017.08.017 ◽

2018 ◽

Vol 51 (1) ◽

pp. 15-20

Author(s):

Nynne Dose ◽

Marie Mide Michelsen ◽

Naja Dam Mygind ◽

Adam Pena ◽

Christina Ellervik ◽

...

Keyword(s):

Angina Pectoris ◽

Microvascular Dysfunction ◽

Ventricular Repolarization ◽

Coronary Microvascular Dysfunction

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EEG Based Detection of Alcoholics

Substance Abuse and Addiction ◽

10.4018/978-1-5225-7666-2.ch007 ◽

2019 ◽

pp. 141-160

Author(s):

T. K. Padma Shri ◽

N. Sriraam

Keyword(s):

Human Brain ◽

Imaging Techniques ◽

Cost Effective ◽

The Body ◽

Long Term Effects ◽

Non Invasive ◽

Positron Emission ◽

Signal Processing Algorithms ◽

Magnetic Resonance Imaging Mri ◽

Neuro Imaging

The short term and long term effects of alcohol on various organs of the body, especially on the human brain is well established by numerous studies. Invasive methods such as Transcranial Magnetic Stimulation (TMS) and non invasive imaging techniques such as Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET), and functional MRI activated electro-encephalogram (EEG) have been used to study the changes in EEG activity due to alcoholism. Even with the advent of neuro imaging techniques, EEG happens to be an important tool for brain study providing a non- invasive and cost effective method to detect the effects of alcohol on the human brain. This paper discusses the harmful effects of alcohol on different organs of the body. The advances in the development of EEG signal processing algorithms over the past decade for alcoholic detection are reviewed and their limitations are reported. Further the use of EEG for mass screening of alcoholics and biometric application is discussed in detail.

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PET-CT and detection of coronary artery disease

The ESC Textbook of Cardiovascular Imaging ◽

10.1093/med/9780198849353.003.0029 ◽

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.

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