Related Experiment Video
Updated: Jan 24, 2026
Measurement of Myocardial Lactate Production for Diagnosis of Coronary Microvascular Spasm
Published on: September 17, 2021
Coronary Microvascular Dysfunction by Myocardial Contrast Echocardiography in Nonelderly Patients Referred for
Sahar Taqui1, Maros Ferencik1, Brian P Davidson1
1Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
Insights
Microvascular dysfunction (MVD) is common in younger patients with chest pain but no significant coronary artery disease (CAD). Neither nonobstructive CAD nor reduced flow-mediated dilation (FMD) predicts MVD in this population.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Microvascular dysfunction (MVD) is a potential cause of chest pain in younger individuals.
- Nonelderly patients with chest pain and nonobstructive coronary artery disease (CAD) require further investigation for underlying causes.
- Computed tomographic angiography (CTA) is often used to evaluate for CAD, but may not identify MVD.
Purpose of the Study:
- To determine the prevalence of MVD in nonelderly patients referred for CTA without significant coronary stenosis.
- To assess if nonobstructive CAD or reduced brachial flow-mediated dilation (FMD) predicts MVD.
Main Methods:
- Recruited subjects ≤60 years old undergoing CTA with no or mild CAD (<50% stenosis) and high-risk plaque features.
- Performed quantitative myocardial contrast echocardiography (MCE) for MVD assessment during regadenoson stress.
- Measured brachial artery flow-mediated dilation (FMD).
Main Results:
- 41% (12/29) of patients exhibited MVD.
- MVD was associated with lower hyperemic perfusion and microvascular flux rate on MCE.
- No significant difference in FMD or MVD prevalence was found between patients with or without nonobstructive CAD.
Conclusions:
- MVD is a common finding in nonelderly patients evaluated for chest pain without obstructive CAD.
- Noncritical atherosclerotic disease or abnormal FMD does not increase the likelihood of detecting MVD in this cohort.
Background:
Microvascular dysfunction (MVD) is a potential cause of chest pain in younger individuals. The authors hypothesized that nonelderly patients referred for computed tomographic angiography (CTA) but without significant stenosis would have a high prevalence of MVD by myocardial contrast echocardiography (MCE). Secondary aims were to test whether the presence of nonobstructive coronary artery disease (CAD) or reduced brachial flow-mediated dilation (FMD) predicted MVD.
Methods:
Subjects ≤60 years of age undergoing CTA were recruited if they had either no evidence of coronary plaque or evidence of mild CAD (<50% stenosis) and at least one high-risk plaque feature. Subjects underwent quantitative perfusion imaging using MCE at rest and during regadenoson vasodilator stress. MVD was defined as global or segmental delay of microvascular refill (≥2 sec) during regadenoson. FMD of the brachial artery was also performed.
Results:
Of the 29 patients in whom MCE could be performed, 12 (41%) had MVD. These subjects, compared with those with normal microvascular function, had lower hyperemic perfusion (mean, 236 ± 68 vs 354 ± 161 intensity units/sec; P = .02) and microvascular flux rate (mean, 1.6 ± 0.4 vs 2.5 ± 0.9 sec-1; P = .002) on quantitative MCE. The degree of FMD was not significantly different in those with or without MVD (mean, 11 ± 4% vs 9 ± 4%; P = .32), and there was a poor correlation between results on stress MCE and FMD. Only eight of the 29 subjects were classified as having nonobstructive CAD. There were no groupwise differences in the prevalence of MVD function in those with versus without CAD (43% vs 38% for negative and positive findings on CTA, respectively, P = .79).
Conclusions:
MVD is a common finding in the nonelderly population referred for CTA for evaluation of possible CAD but without obstructive stenosis. Neither the presence of noncritical atherosclerotic disease nor abnormal FMD increases the likelihood for detecting MVD in this population.
More Related Videos
Related Concept Videos
01:21Coronary Circulation
Coronary circulation begins at the base of the aorta, where two main arteries arise—the left and right coronary arteries. These arteries encircle the heart in the coronary sulcus and supply the...
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:30Acute Coronary Syndrome I: Introduction
01:26Acute Coronary Syndrome V: Nursing Management
01:27Coronary Artery Disease V: Interprofessional Care