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Current perspectives in coronary microvascular dysfunction
Author(s) -
Shome Joy S.,
Perera Divaka,
Plein Sven,
Chiribiri Amedeo
Publication year - 2017
Publication title -
microcirculation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.793
H-Index - 83
eISSN - 1549-8719
pISSN - 1073-9688
DOI - 10.1111/micc.12340
Subject(s) - medicine , cardiology , microcirculation , coronary arteries , coronary artery disease , ischemia , coronary flow reserve , coronary anatomy , coronary angiography , modalities , radiology , artery , myocardial infarction , social science , sociology
The coronary arterial system consists of large epicardial coronary arteries, pre‐arterioles, and arterioles, which together closely regulate CBF. Structural, functional, and extravascular abnormalities of the microcirculation lead to CMD . CMD can present with symptoms suggestive of CAD , often in the absence of significant obstructive epicardial CAD . Conventional invasive angiography does not allow direct visualization of the microcirculation. Invasive indices, such as CBF and CFR , and non‐invasive imaging modalities, such as CMR and PET , can be used to quantify absolute MBF and enable a direct and accurate assessment of coronary microvascular function. CMD appears to be more prevalent in women, typically presenting with symptoms of ischemia with unobstructed coronary arteries, and has a relatively unfavorable prognosis. CMD is classified clinically depending on the presence or absence of epicardial CAD , myocardial disease, or iatrogenic causes. Although invasive intracoronary techniques can be used to detect CMD , these cannot provide insight into the mechanisms involved in its pathogenesis. Imaging modalities such as CMR and cardiac PET are becoming indispensable tools in the evaluation of suspected CMD .