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Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
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Prevalence of Coronary Microvascular Dysfunction Among Patients With Chest Pain and Nonobstructive Coronary Artery

Jaskanwal D Sara1, R Jay Widmer1, Yasushi Matsuzawa1

  • 1Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, Minnesota.

JACC. Cardiovascular Interventions
|September 26, 2015
PubMed

Insights

Coronary microvascular abnormalities are common in patients with chest pain and nonobstructive coronary artery disease. These issues are not well predicted by standard risk factors or noninvasive tests.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Imaging

Background:

  • Coronary microvascular dysfunction contributes to ischemia and elevates cardiovascular event risk.
  • Understanding microvascular abnormalities is crucial for managing patients with chest pain and nonobstructive coronary artery disease.

Purpose of the Study:

  • To determine the prevalence of coronary microvascular abnormalities in patients with chest pain and nonobstructive coronary artery disease.
  • To assess the correlation between microvascular dysfunction and cardiovascular risk factors.
  • To evaluate the relationship between microvascular function and noninvasive functional testing results.

Main Methods:

  • Intracoronary Doppler guidewire was used to assess endothelial-dependent microvascular function via coronary blood flow changes in response to acetylcholine.
  • Endothelial-independent microvascular function was evaluated by measuring coronary flow velocity reserve changes in response to intracoronary adenosine.
  • Patients were categorized into four groups based on normal or abnormal responses to acetylcholine and adenosine.

Main Results:

  • Two-thirds of patients exhibited some form of microvascular dysfunction.
  • Women constituted a higher percentage across all groups (56%–82%).
  • Age was the sole independent predictor of abnormal microvascular function in multivariable analysis.

Conclusions:

  • Coronary microvascular abnormalities are highly prevalent in patients with chest pain and nonobstructive coronary artery disease.
  • These abnormalities show a weak correlation with conventional cardiovascular risk factors.
  • Microvascular dysfunction is dissociated from the findings of noninvasive functional testing.
Abstract

Keywords:
coronary microvascular dysfunctionendothelial dysfunctionnonobstructive coronary artery disease

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