Coronary Microvascular Dysfunction: Clinical Considerations and Noninvasive Diagnosis

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.