Coronary Microvascular Disease in Contemporary Clinical Practice-Reference-Cited by-同舟云学术

Coronary Microvascular Disease in Contemporary Clinical Practice

Published:2023-06 Issue:6 Volume:16 Page:
ISSN:1941-7640
Container-title:Circulation: Cardiovascular Interventions
language:en
Short-container-title:Circ: Cardiovascular Interventions

Author:

Smilowitz Nathaniel R.¹²^ORCID,Toleva Olga³,Chieffo Alaide⁴^ORCID,Perera Divaka⁵⁶^ORCID,Berry Colin⁷⁸^ORCID

Affiliation:

1. Division of Cardiology, Department of Medicine, NYU Langone Health, NY (N.R.S.).

2. Cardiology Section, Department of Medicine, Veterans Affairs New York Harbor Healthcare System, NY (N.R.S.).

3. Emory University, Atlanta, GA (O.T.).

4. Interventional Cardiology Unit, San Raffaele Hospital, Milan, Italy (A.C.).

5. School of Cardiovascular and Metabolic Medicine and Sciences, King’s College London, UK (D.P.).

6. Guy’s and St Thomas’ Hospital, London, UK (D.P.).

7. British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK (C.B.).

8. The West of Scotland Heart and Lung Centre, NHS Golden Jubilee, Glasgow, Scotland, UK (C.B.).

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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