Definition and epidemiology of coronary microvascular disease

Bradley, C. and Berry, C. (2022) Definition and epidemiology of coronary microvascular disease. Journal of Nuclear Cardiology, 29(4), pp. 1763-1775. (doi: 10.1007/s12350-022-02974-x) (PMID:35534718)

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Ischemic heart disease remains one of the leading causes of death and disability worldwide. However, most patients referred for a noninvasive computed tomography coronary angiogram (CTA) or invasive coronary angiogram for the investigation of angina do not have obstructive coronary artery disease (CAD). Approximately two in five referred patients have coronary microvascular disease (CMD) as a primary diagnosis and, in addition, CMD also associates with CAD and myocardial disease (dual pathology). CMD underpins excess morbidity, impaired quality of life, significant health resource utilization, and adverse cardiovascular events. However, CMD often passes undiagnosed and the onward management of these patients is uncertain and heterogeneous. International standardized diagnostic criteria allow for the accurate diagnosis of CMD, ensuring an often overlooked patient population can be diagnosed and stratified for targeted medical therapy. Key to this is assessing coronary microvascular function—including coronary flow reserve, coronary microvascular resistance, and coronary microvascular spasm. This can be done by invasive methods (intracoronary temperature-pressure wire, intracoronary Doppler flow-pressure wire, intracoronary provocation testing) and non-invasive methods [positron emission tomography (PET), cardiac magnetic resonance imaging (CMR), transthoracic Doppler echocardiography (TTDE), cardiac computed tomography (CT)]. Coronary CTA is insensitive for CMD. Functional coronary angiography represents the combination of CAD imaging and invasive diagnostic procedures.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Bradley, Dr Conor
Authors: Bradley, C., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Journal of Nuclear Cardiology
ISSN (Online):1532-6551
Published Online:09 May 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in Journal of Nuclear Cardiology 29(4): 1763-1775
Publisher Policy:Reproduced under a Creative Commons License

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