Author + information
- Received August 6, 2018
- Revision received October 20, 2018
- Accepted November 8, 2018
- Published online April 17, 2019.
- aMallinckrodt Institute of Radiology, Division of Nuclear Medicine, Washington University School of Medicine, Saint Louis, Missouri
- bUniversity of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, Maryland
- ↵∗Address for correspondence:
Dr. Thomas H. Schindler, Mallinckrodt Institute of Radiology-Division of Nuclear Medicine, Washington University in St. Louis, 510 South Kingshighway Boulevard, Campus Box 8223, St. Louis, Missouri 63110.
• Chest pain in patients without obstructive CAD has been appreciated as a frequent clinical problem.
• A substantial portion of these patients may have coronary microvascular dysfunction as potential cause.
• Cardiac PET-, MR- or CT-flow quantification can identify coronary microvascular dysfunction noninvasively.
• Image-guided treatment of coronary microvascular function compared to standard care remains to be investigated.
Chest pain in patients without obstructive coronary artery disease has been realized as a frequent problem encountered in clinical practice. Invasive flow investigations have suggested that up to two-thirds of patients with nonobstructive coronary atherosclerosis may have microvascular dysfunction (MVD). Positron emission tomography myocardial perfusion imaging in conjunction with tracer-kinetic modeling enables the concurrent quantification of myocardial blood flow (MBF) in milliliters per minute per gram of tissue. This allows the assessment of hyperemic MBFs and myocardial flow reserve for the noninvasive identification and characterization of MVD as an important functional substrate for angina symptoms amenable to intensified and individualized medical intervention with nitrates, calcium-channel blockers, statins, angiotensin-converting enzyme inhibitors, and/or angiotensin II type 1 receptor blockers. Recent investigations suggest that cardiac magnetic resonance and computed tomography may also be suitable for the noninvasive detection of MVD. Whether intensified and individualized treatment related improvement or even normalization of hyperemic MBF and/or myocardial flow reserve may lead to a persistent reduction in angina symptoms and/or improved cardiovascular outcome as compared to standard care, deserves further testing in large-scale randomized clinical trials.
- cardiovascular risk factors
- coronary atherosclerosis
- microvascular dysfunction
- myocardial blood flow
- myocardial flow reserve
The recent work was supported by a departmental fund from Washington University (No. 12-3271-93128 to Dr. Schindler), St. Louis, Missouri. Dr. Dilsizian has reported that he has no relationships relevant to the contents of this paper to disclose. Dr. James Udelson served as Guest Editor for this paper.
- Received August 6, 2018.
- Revision received October 20, 2018.
- Accepted November 8, 2018.
- 2019 American College of Cardiology Foundation
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