Coronary Microvascular Dysfunction
Abstract
:1. Introduction
2. Coronary Microvascular Circulation
2.1. Distribution of Blood Flow
2.2. Heterogeneity of Coronary Microcirculation
2.3. Collaterals
3. Pathophysiology of CMD
3.1. Endothelial Dysfunction
3.2. Autonomic Nervous System
4. Clinical Presentation
4.1. Gender Differences in CMD
4.2. Clinical Classification
5. CMD without Atherosclerosis
6. CMD with Non-Obstructive Atherosclerosis
6.1. CMD in the Development of HFpEF
6.2. Microvascular Disease of the Brain
6.3. CMD in Diabetes
6.4. CMD in Hypertensive Heart Disease
6.5. CMD in Hypertrophic Cardiomyopathy (HCM)
6.6. CMD in Aortic Valve Stenosis
6.7. CMD in Chronic Kidney Disease (CKD)
6.8. CMD in Chronic Inflammatory and Autoimmune Diseases
7. CMD with Obstructive Atherosclerosis
7.1. Epicardial Effects on Microcirculation
7.2. Coronary No-Reflow
7.3. Microvascular Effects on Epicardial Coronary Arteries
8. Diagnosis of CMD
8.1. Invasive Diagnosis
8.2. Non-Invasive Diagnosis
9. Treatment of CMD
10. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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1. Symptoms of myocardial ischemia |
-Effort and/or rest angina |
-Angina equivalents (exertional dyspnea) |
2. Absence of obstructive CAD (<50% diameter reduction or FFR > 0.80) by coronary CTA or invasive angiography |
3. Objective evidence of myocardial ischemia |
-Ischemic ECG changes during chest pain |
-Stress-induced chest pain and/or ischemic ECG changes with or without transient |
or reversible abnormal myocardial perfusion and/or wall motion abnormality |
4. Evidence of impaired coronary microvascular function |
-Impaired coronary flow reserve ≤ 2.0 |
-Coronary microvascular spasm, defined as symptoms and ischemic ECG changes but not epicardial spasm during acetylcholine testing |
-Abnormal coronary microvascular resistance indices (IMR > 25) |
-Coronary slow flow phenomenon, defined as TIMI frame count > 25 |
A. CMD in chronic coronary syndrome |
with non-obstructive chronic coronary syndrome |
with obstructive chronic coronary syndrome |
CMD in acute coronary syndrome (ACS) |
with non-obstructive ACS |
with obstructive ACS |
with coronary no-reflow phenomenon |
CMD following successful revascularization after MI |
B. Group 1. CMD in the absence of obstructive CAD and myocardial disease |
Group 2. CMD in the presence of myocardial disease |
Group 3. CMD in the presence of obstructive CAD |
Group 4. CMD after successful percutaneous coronary intervention |
C. CMD without atherosclerosis |
CMD with non-obstructive atherosclerosis |
CMD with obstructive atherosclerosis |
Clinical Feature | Dysfunction | Diagnostic Criteria |
---|---|---|
Microvascular angina | Impaired coronary vasodilatation | CFR < 2.0 |
Increased microvascular resistance | IMR ≥ 25 units | |
Microvascular spasm | angina symptoms after intracoronary Ach Ischemic ECG changes <90% diameter reduction | |
Vasospastic angina | Epicardial spasm | Angina symptoms after intracoronary Ach Infusion and Ischemic ECG changes with >90% epicardial coronary constriction |
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Vancheri, F.; Longo, G.; Vancheri, S.; Henein, M. Coronary Microvascular Dysfunction. J. Clin. Med. 2020, 9, 2880. https://doi.org/10.3390/jcm9092880
Vancheri F, Longo G, Vancheri S, Henein M. Coronary Microvascular Dysfunction. Journal of Clinical Medicine. 2020; 9(9):2880. https://doi.org/10.3390/jcm9092880
Chicago/Turabian StyleVancheri, Federico, Giovanni Longo, Sergio Vancheri, and Michael Henein. 2020. "Coronary Microvascular Dysfunction" Journal of Clinical Medicine 9, no. 9: 2880. https://doi.org/10.3390/jcm9092880