Author + information
- Received December 14, 2015
- Revision received February 8, 2016
- Accepted February 10, 2016
- Published online April 1, 2016.
- aDepartment of Medicine, University of Texas Medical School and Memorial Hermann Hospital, Houston, Texas
- bWeatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Medical School, Houston, Texas
- ↵∗Reprint requests and correspondence:
Dr. K. Lance Gould, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Medical School, 6431 Fannin, Room 4.256MSB, Houston, Texas 77030.
Microvascular dysfunction or disease is most commonly associated with diffuse epicardial coronary atherosclerosis and endothelial dysfunction, whereas it is less common as a distinct, separate, isolated pathophysiology. The different manifestations of coronary artery disease in women relate in part to their smaller coronary arteries, higher coronary blood flow, and higher endothelial shear stress, which have profound effects on endothelial function and development or resistance to atherosclerosis, its symptomatic presentation, outcomes, and treatment. The complex interactions of focal stenosis, diffuse epicardial atherosclerotic coronary narrowing, and microvascular dysfunction make definitive diagnosis and management difficult by use of standard noninvasive and invasive physiological and anatomic technologies. However, quantitative rest-stress myocardial perfusion, best documented by positron emission tomography, combined with clinical circumstances usually provides a definitive diagnosis to guide management, including vigorous risk factor management and revascularization for patients with physiologically severe epicardial stenosis by quantitative positron emission tomography.
- cardiac PET
- coronary artery disease in women
- endothelial shear stress
- microvascular dysfunction
- quantitative myocardial perfusion imaging
Dr. Gould has received internal funding from the Weatherhead PET Center for Preventing and Reversing Atherosclerosis and was the 510(k) applicant for CFR Quant (K113754) and HeartSee (K143664), software packages for cardiac positron emission tomography image processing and analysis, including absolute flow quantification. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 14, 2015.
- Revision received February 8, 2016.
- Accepted February 10, 2016.
- American College of Cardiology Foundation
- Women Versus Men: Mechanisms Relating Arterial Size, Coronary Blood Flow, Arterial Wall Shear Stress, Fluid Dynamics, Hormones, Clinical Presentation, Outcomes, and Response to Treatment or Procedures
- Quantitative Perfusion Imaging in Women for Microvascular Disease
- Concepts in Quantitative Perfusion Imaging of Microvascular Disease