Coronary microvascular dysfunction: Considerations for diagnosis and treatment

Tjoe, Benita; Barsky, Lili; Wei, Janet; Samuels, Bruce; Azarbal, Babak; Merz, C. Noel Bairey; Shufelt, Chrisandra

doi:10.3949/ccjm.88a.20140

Cited by 21 publications

(17 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients with INOCA report a poor quality of life and recurrent symptoms of angina, require frequent hospital admission and diagnostic interventions, and are a major burden to the health-care system 73 , 79 , 80 . Although the pathophysiology of INOCA is not fully understood, this condition is associated with endothelial dysfunction as reflected by impaired vasodilatation in response to adenosine, acetylcholine and nitroglycerin affecting mainly the microcirculation and, therefore, has a biological basis 81 . In women with MINOCA, multimodality imaging with coronary optical coherence tomography and cardiac MRI identified potential mechanisms of MINOCA in 84.5% of patients, of which 75.5% had myocardial ischaemia and 24.5% had no ischaemia, pointing equally to a biological basis for this condition 82 .…”

Section: Combined Influence Of Sex and Gender On Cvdmentioning

confidence: 99%

Gender medicine: effects of sex and gender on cardiovascular disease manifestation and outcomes

Regitz‐Zagrosek

Gebhard

2022

Nat Rev Cardiol

View full text Add to dashboard Cite

Despite a growing body of evidence, the distinct contributions of biological sex and the sociocultural dimension of gender to the manifestations and outcomes of ischaemic heart disease and heart failure remain unknown. The intertwining of sex-based differences in genetic and hormonal mechanisms with the complex dimension of gender and its different components and determinants that result in different disease phenotypes in women and men needs to be elucidated. The relative contribution of purely biological factors, such as genes and hormones, to cardiovascular phenotypes and outcomes is not yet fully understood. Increasing awareness of the effects of gender has led to efforts to measure gender in retrospective and prospective clinical studies and the development of gender scores. However, the synergistic or opposing effects of sex and gender on cardiovascular traits and on ischaemic heart disease and heart failure mechanisms have not yet been systematically described. Furthermore, specific considerations of sex-related and gender-related factors in gender dysphoria or in heart–brain interactions and their association with cardiovascular disease are still lacking. In this Review, we summarize contemporary evidence on the distinct effects of sex and gender as well as of their interactions on cardiovascular disease and how they favourably or unfavourably influence the pathogenesis, clinical manifestations and treatment responses in patients with ischaemic heart disease or heart failure.

show abstract

Section: Combined Influence Of Sex and Gender On Cvdmentioning

confidence: 99%

Gender medicine: effects of sex and gender on cardiovascular disease manifestation and outcomes

Regitz‐Zagrosek

Gebhard

2022

Nat Rev Cardiol

View full text Add to dashboard Cite

show abstract

“…Positron emission tomography (PET) imaging remains the standard method for estimating CFR, although single-photon emission computed tomography (SPECT), magnetic resonance imaging (MRI), intravascular Doppler ultrasound and echocardiography have been used [ 16 ]. A ratio of <2.0 at maximal hyperemia compared to baseline capacity is considered abnormal [ 17 ]. It is important to note that despite having non-obstructive CAD, patients with CMD are still at an elevated risk for major adverse cardiovascular events [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Multimodality Imaging in the Detection of Ischemic Heart Disease in Women

Gaine

Sharma

Tower‐Rader

et al. 2022

JCDD

View full text Add to dashboard Cite

Women with coronary artery disease tend to have a worse short and long-term prognosis relative to men and the incidence of atherosclerotic cardiovascular disease is increasing. Women are less likely to present with classic anginal symptoms when compared with men and more likely to be misdiagnosed. Several non-invasive imaging modalities are available for diagnosing ischemic heart disease in women and many of these modalities can also assist with prognostication and help to guide management. Selection of the optimal imaging modality to evaluate women with possible ischemic heart disease is a scenario which clinicians often encounter. Earlier modalities such as exercise treadmill testing demonstrate significant performance variation in men and women, while newer modalities such as coronary CT angiography, myocardial perfusion imaging and cardiac magnetic resonance imaging are highly specific and sensitive for the detection of ischemia and coronary artery disease with greater parity between sexes. Individual factors, availability, diagnostic performance, and female-specific considerations such as pregnancy status may influence the decision to select one modality over another. Emerging techniques such as strain rate imaging, CT-myocardial perfusion imaging and cardiac magnetic resonance imaging present additional options for diagnosing ischemia and coronary microvascular dysfunction.

show abstract

“…Gdowski et al published a meta-analysis of 6,631 patients with suspected myocardial ischemia but without coronary artery occlusion, which showed that compared to patients with normal CFRs, CFR decreased the mortality of patients by 3.93 times, whereas the incidence of adverse cardiovascular events increased by 5.16 times ( Gdowski et al, 2020 ). Because CMVD is common in patients with cardiovascular risk factors, CFR measurements should be performed early to determine the presence of CMVD even in people without coronary artery disease to help with early diagnosis and intervention to prevent further progression of CMVD and adverse cardiac events ( Del Buono et al, 2021 ; Tjoe et al, 2021 ; Lopez et al, 2022 ). CMVD has a complex etiology, involves a wide range of people, and lacks standardized and effective means of detection, which causes the systematic prevention and management of coronary heart disease to be difficult and seriously affects the prognosis of patients.…”

Section: Clinical Significance Of Cmvdmentioning

confidence: 99%

Traditional chinese medicine in coronary microvascular disease

et al. 2022

View full text Add to dashboard Cite

Coronary microvascular disease (CMVD) is common in patients with cardiovascular risk factors and is associated with an increased risk of adverse cardiovascular events. Although the study of CMVD in modern medicine is ongoing, there is still no effective treatment for it. Traditional Chinese medicine (TCM) has some clinical advantages based on syndrome differentiation and individualized treatment. In this review, we review the clinical significance, pathogenesis, and current treatments of CMVD and systematically summarize the clinical efficacy and potential action mechanisms of TCM for CMVD. In addition, the scientific problems that need to be solved urgently and the research strategy of TCM for CMVD are described. CMVD has great clinical significance, but there are still many gaps in the related research. This review aims to attract the attention of clinicians to CMVD and promote research on CMVD in TCM.

show abstract

Coronary microvascular dysfunction: Considerations for diagnosis and treatment

Cited by 21 publications

References 57 publications

Gender medicine: effects of sex and gender on cardiovascular disease manifestation and outcomes

Gender medicine: effects of sex and gender on cardiovascular disease manifestation and outcomes

Multimodality Imaging in the Detection of Ischemic Heart Disease in Women

Traditional chinese medicine in coronary microvascular disease

Contact Info

Product

Resources

About