Diagnosis of coronary microvascular dysfunction - Present status

Area of Science:

• Cardiology
• Diagnostic Imaging
• Vascular Medicine

Background:

• Microvascular angina diagnosis is difficult with current knowledge.
• Standard noninvasive tests like ECG and echocardiography often yield normal or unremarkable results.

Purpose of the Study:

• To review the diagnostic challenges of microvascular angina.
• To outline current definitive diagnostic criteria and invasive evaluation recommendations.

Main Methods:

• Review of existing diagnostic modalities for microvascular angina.
• Description of invasive diagnostic criteria including coronary flow reserve and spasm provocation.

Main Results:

• Noninvasive methods like echocardiography and radio-isotope imaging have limited diagnostic accuracy for microvascular angina.
• Definitive diagnosis requires invasive assessment: normal epicardial coronaries, coronary flow reserve < 2.5, and absence of epicardial spasm.

Conclusions:

• A high index of suspicion is crucial for noninvasive diagnosis.
• Invasive evaluation is reserved for patients with intractable symptoms and unconfirmed diagnosis despite empirical therapy.
• Further evaluation of therapeutic and prognostic implications of diagnostic parameters is needed.