Coronary Microvascular Disease in Contemporary Clinical Practice

被引：39

作者：

Smilowitz, Nathaniel R. ^{[1
,2
,3
]}

Toleva, Olga ^{[4
]}

Chieffo, Alaide ^{[5
]}

Perera, Divaka ^{[6
,7
]}

Berry, Colin ^{[8
,9
]}

机构：

[1] NYU, NYU Langone Hlth, Leon H Charney Div Cardiol, Sch Med, 423 East 23rd St,12-W, New York, NY 10010 USA

[2] NYU Langone Hlth, Dept Med, Div Cardiol, New York, NY USA

[3] Vet Affairs New York Harbor Healthcare Syst, Dept Med, Cardiol Sect, New York, NY USA

[4] Emory Univ, Atlanta, GA USA

[5] Osped San Raffaele, Intervent Cardiol Unit, Milan, Italy

[6] Kings Coll London, Sch Cardiovasc & Metab Med & Sci, London, England

[7] Guys & St Thomas Hosp, London, England

[8] Univ Glasgow, British Heart Fdn, Glasgow Cardiovasc Res Ctr, Glasgow, Scotland

[9] NHS Golden Jubilee, West Scotland Heart & Lung Ctr, Glasgow, Scotland

来源：

CIRCULATION-CARDIOVASCULAR INTERVENTIONS | 2023年 / 16卷 / 06期

基金：

英国科研创新办公室; 英国医学研究理事会; 英国工程与自然科学研究理事会; 美国国家卫生研究院;

关键词：

acetylcholine; adenosine; angina; coronary circulation; ischemia; microcirculation; microvascular angina; ARTERY-DISEASE; INTERNATIONAL STANDARDIZATION; INTRACORONARY ACETYLCHOLINE; DIAGNOSTIC-CRITERIA; DYSFUNCTION; ISCHEMIA; ANGINA; MICROCIRCULATION; THERMODILUTION; VALIDATION;

D O I：

10.1161/CIRCINTERVENTIONS.122.012568

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页数：10

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