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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
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Coronary microvascular dysfunction: Considerations for diagnosis and treatment
Benita Tjoe1, Lili Barsky1, Janet Wei2
1Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
Cleveland Clinic Journal of Medicine
|October 2, 2021
Summary
Ischemia and no obstructive coronary artery disease (INOCA) affects many women and is often caused by coronary microvascular dysfunction (CMD). This review covers CMD pathophysiology, diagnosis, and management strategies.
Area of Science:
- Cardiology
- Vascular Biology
Background:
- Ischemia and no obstructive coronary artery disease (INOCA) is a growing clinical concern, particularly in women.
- Coronary microvascular dysfunction (CMD) underlies approximately 50% of INOCA cases.
- CMD involves abnormal constriction and dilation of the heart's small blood vessels.
Purpose of the Study:
- To review the pathophysiology of coronary microvascular dysfunction.
- To discuss diagnostic approaches for INOCA and CMD, including invasive and noninvasive methods.
- To outline current management strategies and identify knowledge gaps in INOCA and CMD.
Main Methods:
- Literature review of studies on INOCA and coronary microvascular dysfunction.
- Synthesis of information on pathophysiology, diagnostic techniques, and therapeutic implications.
- Identification of areas requiring further research.
Main Results:
- Coronary microvascular dysfunction is a key mechanism in INOCA.
- Both invasive and noninvasive testing modalities are crucial for diagnosing CMD.
- Effective management strategies for INOCA often target CMD.
Conclusions:
- Understanding CMD pathophysiology is essential for diagnosing and managing INOCA.
- Further research is needed to refine diagnostic criteria and optimize treatment for INOCA.
- CMD represents a significant challenge in cardiovascular medicine, particularly for female patients.
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