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Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
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Coronary microvascular dysfunction in stable ischaemic heart disease (non-obstructive coronary artery disease and

Udo Sechtem1, David Brown2, Shigeo Godo3

  • 1Department of Cardiology, Robert Bosch Krankenhaus, Auerbachstr. 110, D-70376 Stuttgart, Germany.

Cardiovascular Research
|January 21, 2020
PubMed

Insights

Coronary artery disease (CAD) often involves epicardial disease and coronary microvascular dysfunction (CMD). Recognizing CMD is crucial for understanding persistent symptoms and improving prognostic assessments in patients with CAD.

Area of Science:

  • Cardiology
  • Vascular Biology

Background:

  • Coronary artery disease (CAD) can present as diffuse or focal epicardial disease, often coexisting with coronary microvascular abnormalities.
  • Distinguishing the independent and combined contributions of epicardial disease and coronary microvascular dysfunction (CMD) in the coronary circulation is clinically challenging.

Purpose of the Study:

  • This review aims to address the complexities in identifying CMD within the spectrum of non-obstructive and obstructive CAD.
  • It will explore the pathophysiology, clinical context, and diagnostic approaches for CMD in patients with CAD.

Main Methods:

  • Literature review focusing on the pathophysiology and clinical presentation of CMD in conjunction with epicardial CAD.
  • Discussion of non-invasive diagnostic modalities for evaluating coronary microvascular function.

Main Results:

  • Coronary microvascular dysfunction (CMD) is an important, often overlooked, factor in patients with coronary artery disease (CAD).
  • CMD may explain persistent symptoms and the prognostic significance of global coronary flow reserve over single-vessel fractional flow reserve.

Conclusions:

  • Accurate identification of CMD is essential for comprehensive patient assessment and management in CAD.
  • Understanding the interplay between epicardial disease and CMD is critical for improving treatment strategies and patient outcomes.

Keywords:
Coronary microvascular dysfunctionFractional flow reserveIndex of microvascular resistanceNon-obstructive coronary artery diseaseObstructive coronary artery diseasePathophysiology

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