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Updated: Jul 10, 2026
Non-invasive Assessment of Microvascular and Endothelial Function
Published on: January 29, 2013
Noninvasive assessment of coronary microvascular function in women at risk for ischaemic heart disease
1Fundación Centro Diagnóstico Nuclear, Buenos Aires, Argentina. rcampisi@fcdn.org.ar
Insights
Assessing coronary microvascular function using noninvasive imaging is crucial for women with ischaemic heart disease (IHD). Positron emission tomography (PET) can detect microvascular dysfunction, even without obstructive coronary artery disease (CAD).
Area of Science:
- Cardiology
- Diagnostic Imaging
- Vascular Biology
Background:
- Coronary artery disease (CAD) in women often presents with normal or minimally obstructive coronary arteries on angiography.
- A significant proportion of women with ischaemia symptoms exhibit coronary microvascular dysfunction, indicating localized issues in the microcirculation.
- Noninvasive imaging techniques are vital for assessing coronary microvascular function, particularly in women.
Purpose of the Study:
- To review the assessment of coronary microvascular function in women at risk for or with ischaemic heart disease (IHD) using noninvasive imaging.
- To highlight the role of positron emission tomography (PET) in quantifying myocardial blood flow (MBF) and detecting microvascular dysfunction.
- To explore the association between abnormal coronary vascular function and adverse cardiovascular outcomes in women.
Main Methods:
- Literature review of studies published in the PubMed database.
- Focus on noninvasive imaging techniques, specifically radionuclide methods like positron emission tomography (PET).
- Analysis of PET-derived estimates of myocardial blood flow (MBF) to assess coronary microvascular function.
Main Results:
- PET can measure MBF in absolute units, enabling the detection of microvascular dysfunction even in the absence of obstructive CAD.
- Abnormal coronary microvascular function was observed in women with chest pain and non-obstructive CAD, and in high-risk women.
- A significant relationship exists between abnormal coronary vascular function, particularly endothelial dysfunction, and adverse cardiovascular outcomes.
Conclusions:
- Assessment of coronary microvascular function is clinically relevant in women at risk for or with IHD.
- Noninvasive imaging, especially PET, is valuable for identifying microvascular dysfunction in this population.
- Further research is needed to determine if evaluating coronary vascular function impacts cardiac event reduction.
Abstract:
The primary objective of the current review is to describe the assessment of coronary microvascular function by noninvasive imaging techniques in women at risk for and with ischaemic heart disease (IHD). The search criteria were the analyses of the related bibliography published in PUBMED database. Normal or minimal obstructive coronary artery disease (CAD) at angiography is a common finding in women with signs of ischaemia. Up to 50% of them will have coronary microvascular dysfunction, suggesting that the mechanism of ischaemia may be localised at coronary microcirculation level. Noninvasive measurements of coronary microvascular function can be performed by radionuclide techniques. In particular, positron emission tomography (PET) measures myocardial blood flow (MBF) not only relatively but also in absolute units. Thus, PET offers the possibility to uncover microvascular dysfunction even in patients without obstructive CAD. PET-derived estimates of MBF showed an abnormal coronary microvascular function in women with chest pain and non-obstructive CAD and in women with high-risk conditions for CAD. Interestingly, there is a relationship between an abnormal coronary vascular function and adverse cardiovascular outcomes. In particular, this significant relationship was observed with measurements related to endothelial function. Recent evidence suggests that vascular dysfunction plays a central role as an estimator of outcomes in women at risk for or with IHD. Therefore, assessment of coronary vascular function in these women appears to be of clinical relevance. Whether such evaluation may have an impact to reduce cardiac events needs further investigation.
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