Coronary microvascular disease in contemporary clinical practice

Smilowitz, N. R., Toleva, O., Chieffo, A., Perera, D. and Berry, C. (2023) Coronary microvascular disease in contemporary clinical practice. Circulation: Cardiovascular Interventions, 16(6), pp. 386-395. (doi: 10.1161/CIRCINTERVENTIONS.122.012568) (PMID:37259860) (PMCID:PMC10330260)

Abstract

Coronary microvascular disease (CMD) causes myocardial ischemia in a variety of clinical scenarios. Clinical practice guidelines support routine testing for CMD in patients with ischemia with nonobstructive coronary artery disease. Invasive testing to identify CMD requires Doppler or thermodilution measures of flow to determine the coronary flow reserve and measures of microvascular resistance. Acetylcholine coronary reactivity testing identifies concomitant endothelial dysfunction, microvascular spasm, or epicardial coronary spasm. Comprehensive testing may improve symptoms, quality of life, and patient satisfaction by establishing a diagnosis and guiding-targeted medical therapy and lifestyle measures. Beyond ischemia with nonobstructive coronary artery disease, testing for CMD may play a role in patients with acute myocardial infarction, angina following coronary revascularization, heart failure with preserved ejection fraction, Takotsubo syndrome, and after heart transplantation. Additional education and provider awareness of CMD and its role in cardiovascular disease is needed to improve patient-centered outcomes of ischemic heart disease.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Berry, Professor Colin
• Authors: Smilowitz, N. R., Toleva, O., Chieffo, A., Perera, D., and Berry, C.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Circulation: Cardiovascular Interventions
• Publisher: American Heart Assocation
• ISSN: 1941-7640
• ISSN (Online): 1941-7632
• Published Online: 01 June 2023

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
303944		BHF Centre of Excellence	Colin Berry	British Heart Foundation (BHF)	RE/18/6/34217	SCMH - Cardiovascular & Metabolic Health
304896		EPSRC-IAA: Early Stage Commercialisation of a PET Imaging Agent for the Detection of Cardiovascular Disease and Cancer	Andrew Sutherland	Engineering and Physical Sciences Research Council (EPSRC)	EP/R511705/1	Chemistry
303232		EPSRC Centre for Multiscale soft tissue mechanics with MIT and POLIMI (SofTMech-MP)	Xiaoyu Luo	Engineering and Physical Sciences Research Council (EPSRC)	EP/S030875/1	M&S - Mathematics
303684		A randomized, double-blind, placebo-controlled Phase 2A cross-over trial of oral zibotentan in patients with angina due to small vessel disease: a proof-of-concept, developmental trial for safety, efficacy and biomarkers development	Colin Berry	Medical Research Council (MRC)	MR/S018905/1	SCMH - Cardiovascular & Metabolic Health