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Coronary Microvascular Dysfunction: Clinical Considerations and Noninvasive Diagnosis

Thomas H Schindler1, Vasken Dilsizian2

  • 1Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Washington University School of Medicine, Saint Louis, Missouri.

JACC. Cardiovascular Imaging
|April 16, 2019
PubMed

Insights

Microvascular dysfunction (MVD) is common in patients with chest pain and nonobstructive coronary artery disease. Positron emission tomography can identify MVD, guiding personalized medical treatments for angina symptoms.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Physiology

Background:

  • Chest pain in patients without obstructive coronary artery disease is a frequent clinical problem.
  • Microvascular dysfunction (MVD) affects up to two-thirds of patients with nonobstructive coronary atherosclerosis.
  • MVD is an important functional substrate for angina symptoms.

Purpose of the Study:

  • To highlight the role of positron emission tomography (PET) myocardial perfusion imaging in identifying and characterizing MVD.
  • To discuss the potential of cardiac magnetic resonance and computed tomography in MVD detection.
  • To emphasize the need for further research into the long-term benefits of intensified MVD treatment.

Main Methods:

  • Utilizing positron emission tomography myocardial perfusion imaging with tracer-kinetic modeling.
  • Quantifying myocardial blood flow (MBF) in milliliters per minute per gram of tissue.
  • Assessing hyperemic MBFs and myocardial flow reserve.

Main Results:

  • PET imaging enables noninvasive identification and characterization of MVD.
  • MVD is amenable to intensified and individualized medical intervention.
  • Emerging evidence suggests cardiac MRI and CT may also detect MVD.

Conclusions:

  • Noninvasive assessment of MVD using PET is crucial for managing angina.
  • Personalized medical interventions can target MVD.
  • Further large-scale randomized trials are needed to confirm the long-term impact of MVD treatment on cardiovascular outcomes.

Keywords:
PETcardiovascular risk factorscoronary atherosclerosismicrovascular dysfunctionmyocardial blood flowmyocardial flow reserveprognosis

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