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Evolution of Coronary Microvascular Dysfunction Prevalence over Time and Across Diagnostic Modalities in Patients
Aurelia Zimmerli1, Adil Salihu1, Panagiotis Antiochos1
1Department of Cardiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland.
Insights
Coronary microvascular disease (CMD) prevalence in patients with non-obstructive coronary arteries (ANOCA) is converging towards 50%. Recent studies show increasing CMD detection across various diagnostic methods, aligning with stable PET-CT findings.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Public Health
Background:
- Many patients with angina have non-obstructive coronary arteries (ANOCA) but may have underlying coronary microvascular disease (CMD).
- The reported prevalence of CMD in ANOCA patients varies significantly across studies.
- Understanding CMD prevalence is crucial for accurate diagnosis and management in this patient group.
Purpose of the Study:
- To systematically review and document the prevalence of coronary microvascular disease (CMD) in patients with non-obstructive coronary arteries (ANOCA).
- To analyze how CMD prevalence has changed over time based on different diagnostic modalities.
- To identify trends and convergence in prevalence rates across various imaging techniques.
Main Methods:
- A systematic literature review was performed using PubMed, Cochrane Library, and Embase up to May 1, 2024.
- Included studies reported CMD prevalence in ANOCA patients diagnosed via invasive coronary angiography (ICA), PET-CT, TTE, or CMR.
- 53 studies involving 16,602 patients, published between 1998 and 2024, were analyzed.
Main Results:
- A statistically significant increase in CMD prevalence was observed over time across ICA, TTE, and CMR modalities (p < 0.05).
- Positron emission tomography-computed tomography (PET-CT) demonstrated a consistent and stable CMD prevalence over the study period.
- Prevalence rates from all diagnostic methods converged towards approximately 50%, aligning with PET-CT findings.
Conclusions:
- The prevalence of coronary microvascular disease (CMD) in ANOCA patients remains a subject of ongoing research and debate.
- However, current evidence indicates a convergence towards a 50% prevalence rate across most diagnostic modalities.
- PET-CT consistently reports this 50% prevalence, serving as a benchmark for other diagnostic techniques.
Abstract:
Background: A considerable number of patients with angina undergo invasive coronary angiography, which might reveal non-obstructive coronary arteries (ANOCA). In this setting, they might have coronary microvascular disease (CMD). Its prevalence significantly varies in the literature. This systematic review aims to document the prevalence of CMD over time according to the diagnostic modalities. Methods: A systematic literature review was conducted using PubMed, the Cochrane Library, and Embase, covering publications from inception to 1 May 2024. Among 1471 identified articles, 297 full-text articles were assessed for eligibility. All studies reporting the prevalence of CMD in ANOCA patients based on invasive coronary artery (ICA), positron emission tomography-computed tomography (PET-CT), transthoracic echocardiography (TTE), or cardiac magnetic resonance (CMR) were included. Results: The review included 53 studies (published between 1998 and 2024), encompassing a total of 16,602 patients. Of these studies, 23 used ICA, 15 used PET-CT, 8 used TTE, and 7 used CMR. A statistically significant increase in CMD prevalence over time was observed across all diagnostic modalities (p < 0.05), except for PET-CT, which showed a consistent and stable prevalence over time. Notably, the prevalence rates from all of the diagnostic methods converged towards the 50% prevalence detected by PET-CT. Conclusions: The prevalence of CMD in patients with ANOCA is subject to debate. However, the current data suggest that regardless of the diagnostic method used, the most recent studies tend to converge towards a prevalence value of 50%, which has been consistently reported by PET-CT from the beginning.
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