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Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
Published on: August 17, 2022
Current perspectives in coronary microvascular dysfunction
Joy S Shome1, Divaka Perera2, Sven Plein1,3
1Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London, St. Thomas' Hospital, London, UK.
Insights
Coronary microvascular dysfunction (CMD) affects women disproportionately, presenting with ischemia despite clear arteries. Advanced imaging like cardiac MRI and PET are crucial for diagnosing CMD and assessing coronary microvascular function.
Area of Science:
- Cardiology
- Vascular Biology
- Medical Imaging
Background:
- The coronary arterial system, including epicardial arteries and microcirculation, regulates coronary blood flow (CBF).
- Coronary microvascular dysfunction (CMD) arises from microcirculation abnormalities and can mimic obstructive coronary artery disease (CAD).
- CMD often presents with ischemic symptoms in women, even without significant epicardial CAD.
Purpose of the Study:
- To highlight the prevalence and clinical presentation of CMD, particularly in women.
- To discuss the limitations of conventional angiography in visualizing the microcirculation.
- To emphasize the role of advanced imaging in assessing coronary microvascular function.
Main Methods:
- Utilizing invasive indices like CBF and CFR.
- Employing non-invasive imaging modalities such as cardiac MRI (CMR) and Positron Emission Tomography (PET).
- Quantifying absolute myocardial blood flow (MBF) for accurate assessment.
Main Results:
- CMD can present with symptoms suggestive of obstructive CAD but without significant epicardial lesions.
- CMR and PET enable direct and accurate assessment of coronary microvascular function.
- CMD is more prevalent in women and has a less favorable prognosis.
Conclusions:
- CMD diagnosis and evaluation require methods beyond conventional angiography.
- Cardiac MRI and PET are essential tools for evaluating suspected CMD.
- Understanding CMD mechanisms requires further investigation, though imaging aids detection.
Abstract:
The coronary arterial system consists of large epicardial coronary arteries, pre-arterioles, and arterioles, which together closely regulate CBF. Structural, functional, and extravascular abnormalities of the microcirculation lead to CMD. CMD can present with symptoms suggestive of CAD, often in the absence of significant obstructive epicardial CAD. Conventional invasive angiography does not allow direct visualization of the microcirculation. Invasive indices, such as CBF and CFR, and non-invasive imaging modalities, such as CMR and PET, can be used to quantify absolute MBF and enable a direct and accurate assessment of coronary microvascular function. CMD appears to be more prevalent in women, typically presenting with symptoms of ischemia with unobstructed coronary arteries, and has a relatively unfavorable prognosis. CMD is classified clinically depending on the presence or absence of epicardial CAD, myocardial disease, or iatrogenic causes. Although invasive intracoronary techniques can be used to detect CMD, these cannot provide insight into the mechanisms involved in its pathogenesis. Imaging modalities such as CMR and cardiac PET are becoming indispensable tools in the evaluation of suspected CMD.
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