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Published on: June 28, 2019
Invasive evaluation of coronary microvascular dysfunction
Alejandro Travieso1, Adrian Jeronimo-Baza1, Daniel Faria1
1Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, c/ Profesor Martin Lagos, s/n, 28040, Madrid, Spain.
Insights
Coronary microvascular dysfunction (CMD) impacts heart health, causing ischemia even without blockages. Invasive assessment helps diagnose CMD, guiding treatments to improve patient quality of life.
Area of Science:
- Cardiology
- Vascular Biology
- Diagnostic Procedures
Background:
- Coronary microvascular dysfunction (CMD) is a significant cause of ischemic heart disease.
- CMD can lead to ischemia independently or exacerbate obstructive coronary artery disease (CAD).
- Abnormalities in coronary microcirculation impact patient quality of life and outcomes.
Purpose of the Study:
- To review invasive assessment methods for coronary microvascular dysfunction (CMD).
- To focus on evaluating CMD in patients with ischemia and non-obstructive CAD.
- To highlight the importance of understanding these procedures for improving patient care.
Main Methods:
- Invasive assessment of the entire coronary vascular tree.
- Vasoreactivity testing to evaluate vasomotor function.
- Utilizing acetylcholine, thermodilution, or Doppler guidewires for flow and resistance indices.
Main Results:
- Invasive CMD evaluation provides comprehensive insights into microcirculation.
- Standard methods include acetylcholine testing and flow/resistance index calculation.
- Tailored treatments based on invasive findings can reduce angina.
Conclusions:
- Invasive assessment is crucial for diagnosing and managing CMD.
- Understanding these diagnostic procedures is vital for patient care.
- Effective management of CMD improves patient quality of life and outcomes.
Abstract:
Coronary microvascular dysfunction (CMD) is a prevalent cause of ischemic heart disease and is associated with poorer quality of life and worse patient outcomes. Both functional and structural abnormalities of the microcirculation can generate ischemia in the absence of epicardial stenosis or worsen concomitant obstructive coronary artery disease (CAD). The invasive assessment of CMD allows for the evaluation of the entirety of the coronary vascular tree, from the large epicardial vessels to the microcirculation, and enables the study of vasomotor function through vasoreactivity testing. The standard evaluation of CMD includes vasomotor assessment with acetylcholine, as well as flow- and resistance-derived indices calculated with either thermodilution or Doppler guidewires. Tailored treatment based upon the information gathered from the invasive evaluation of CMD has been demonstrated to reduce the burden of angina; therefore, a thorough understanding of these procedures is warranted with the aim of improving the quality of life of the patient. This review summarizes the most widespread approaches for the invasive evaluation of CMD, with a focus on patients with ischemia and non-obstructive CAD.
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