TY - JOUR
T1 - Coronary microvascular dysfunction in stable ischaemic heart disease (non-obstructive coronary artery disease and obstructive coronary artery disease)
AU - Sechtem, U
AU - Brown, D
AU - Godo, S
AU - Lanza, Gaetano Antonio
AU - Shimokawa, H
AU - Sidik, N
PY - 2020
Y1 - 2020
N2 - Diffuse and focal epicardial coronary disease and coronary microvascular abnormalities may exist side-by-side. Identifying the contributions of each of these three players in the coronary circulation is a difficult task. Yet identifying coronary microvascular dysfunction (CMD) as an additional player in patients with coronary artery disease (CAD) may provide explanations of why symptoms may persist frequently following and why global coronary flow reserve may be more prognostically important than fractional flow reserve measured in a single vessel before percutaneous coronary intervention. This review focuses on the challenges of identifying the presence of CMD in the context of diffuse non-obstructive CAD and obstructive CAD. Furthermore, it is going to discuss the pathophysiology in this complex situation, examine the clinical context in which the interaction of the three components of disease takes place and finally look at non-invasive diagnostic methods relevant for addressing this question.
AB - Diffuse and focal epicardial coronary disease and coronary microvascular abnormalities may exist side-by-side. Identifying the contributions of each of these three players in the coronary circulation is a difficult task. Yet identifying coronary microvascular dysfunction (CMD) as an additional player in patients with coronary artery disease (CAD) may provide explanations of why symptoms may persist frequently following and why global coronary flow reserve may be more prognostically important than fractional flow reserve measured in a single vessel before percutaneous coronary intervention. This review focuses on the challenges of identifying the presence of CMD in the context of diffuse non-obstructive CAD and obstructive CAD. Furthermore, it is going to discuss the pathophysiology in this complex situation, examine the clinical context in which the interaction of the three components of disease takes place and finally look at non-invasive diagnostic methods relevant for addressing this question.
KW - Coronary microvascular dysfunction
KW - Non-obstructive coronary artery disease
KW - Fractional flow reserve
KW - Pathophysiology
KW - Index of microvascular resistance
KW - Obstructive coronary artery disease
KW - Coronary microvascular dysfunction
KW - Non-obstructive coronary artery disease
KW - Fractional flow reserve
KW - Pathophysiology
KW - Index of microvascular resistance
KW - Obstructive coronary artery disease
UR - http://hdl.handle.net/10807/304582
U2 - 10.1093/cvr/cvaa005
DO - 10.1093/cvr/cvaa005
M3 - Article
SN - 0008-6363
VL - 116
SP - 771
EP - 786
JO - Cardiovascular Research
JF - Cardiovascular Research
ER -