scholarly journals Coronary Microvascular Dysfunction: PET, CMR and CT Assessment

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.

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

2020 ◽  
Author(s):  
Floor 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-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.

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

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.

scholarly journals Clinical outcomes in patients with primary stable microvascular angina: is the jury still out?

2019 ◽  
Vol 5 (4) ◽  
pp. 283-291 ◽  
Author(s):  
Gaetano Antonio Lanza ◽  
Filippo Crea ◽  
Juan Carlos Kaski
Keyword(s):  
Chest Pain ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Obstructive Coronary Artery Disease ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Published Data ◽  
Microvascular Angina ◽  
Coronary Events ◽  
Artery Disease

Abstract Several studies have demonstrated that angina chest pain in presence of normal or near normal coronary arteries (NCAs) is mainly related to coronary microvascular dysfunction (CMD). However, controversial findings exist about clinical outcome of these patients. In this article, we critically review characteristics and results of the main clinical studies reporting clinical outcome of stable patients with angina chest pain and non-obstructive coronary artery disease (NO-CAD). Published data indicate that clinical outcomes of these patients are heterogeneous, but those with strict criteria for primary stable microvascular angina (MVA, i.e. typical angina with NCAs mainly related to efforts) do not appear to have an increased mortality or risk of major coronary events. A major determinant of outcome in patients with MVA and NO-CAD seems instead related to non-critical atherosclerotic disease, the presence of which should suggest a more aggressive management of cardiovascular risk factors and preventive management. Future studies should assess whether CMD may have a relevant prognostic role in the latter clinical context and/or in other clinical settings of NO-CAD different from primary stable MVA.

scholarly journals Untangling the pathophysiologic link between coronary microvascular dysfunction and heart failure with preserved ejection fraction

2021 ◽  
Author(s):  
Aish Sinha ◽  
Haseeb Rahman ◽  
Andrew Webb ◽  
Ajay M Shah ◽  
Divaka Perera
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Obstructive Coronary Artery Disease ◽  
Microvascular Disease ◽  
Microvascular Dysfunction ◽  
Common Finding ◽  
Coronary Microvascular Dysfunction ◽  
Preserved Ejection Fraction ◽  
Flow Reserve ◽  
Artery Disease

Abstract Coronary microvascular disease (CMD), characterized by impaired coronary flow reserve (CFR), is a common finding in patients with stable angina. Impaired CFR, in the absence of obstructive coronary artery disease, is also present in up to 75% of patients with heart failure with preserved ejection fraction (HFpEF). Heart failure with preserved ejection fraction is a heterogeneous syndrome comprising distinct endotypes and it has been hypothesized that CMD lies at the centre of the pathogenesis of one such entity: the CMD–HFpEF endotype. This article provides a contemporary review of the pathophysiology underlying CMD, with a focus on the mechanistic link between CMD and HFpEF. We discuss the central role played by subendocardial ischaemia and impaired lusitropy in the development of CMD–HFpEF, as well as the clinical and research implications of the CMD–HFpEF mechanistic link. Future prospective follow-up studies detailing outcomes in patients with CMD and HFpEF are much needed to enhance our understanding of the pathological processes driving these conditions, which may lead to the development of physiology-stratified therapy to improve the quality of life and prognosis in these patients.

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