Ischemia in patients with no obstructive coronary artery disease: classification, diagnosis and treatment of coronary microvascular dysfunction

Sucato, Vincenzo; Novo, Giuseppina; Saladino, Antonino; Rubino, Marianna; Caronna, Nicola; Luparelli, Mirko; D’Agostino, Alessandro; Novo, Salvatore; Evola, Salvatore; Galassi, Alfredo R.

doi:10.1097/mca.0000000000000855

Cited by 18 publications

(12 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…109 Hyperinsulinism and hyperglycemia are the main protagonists of MVA and correlate extensively with endothelial damage, neurohormonal dysfunction, and inflammation, as well as oxidative and wall stress. 110-112 Neuropeptide Y (NPY): a peptide endogenous to human coronary arteries, which seems to cause constrictor effects on the coronary microcirculation. NPY can induce transient myocardial ischemia and can play a role in the genesis of angina in patients with MVA.…”

Section: Mixed Mechanisms and Biomarkersmentioning

confidence: 99%

See 1 more Smart Citation

Biomarkers of Coronary Microvascular Dysfunction in Patients With Microvascular Angina: A Narrative Review

et al. 2021

Self Cite

View full text Add to dashboard Cite

The current gold standard for diagnosis of coronary microvascular dysfunction (CMD) in the absence of myocardial diseases, whose clinical manifestation is microvascular angina (MVA), is reactivity testing using adenosine or acetylcholine during coronary angiography. This invasive test can be difficult to perform, expensive, and harmful. The identification of easily obtainable blood biomarkers which reflect the pathophysiology of CMD, characterized by high reliability, precision, accuracy, and accessibility may reduce risks and costs related to invasive procedures and even facilitate the screening and diagnosis of CMD. In this review, we summarized the results of several studies that have investigated the possible relationships between blood biomarkers involved with CMD and MVA. More specifically, we have divided the analyzed biomarkers into 3 different groups, according to the main mechanisms underlying CMD: biomarkers of “endothelial dysfunction,” “vascular inflammation,” and “oxidative stress.” Finally, in the last section of the review, we consider mixed mechanisms and biomarkers which are not included in the 3 major categories mentioned above, but could be involved in the pathogenesis of CMD.

show abstract

Section: Mixed Mechanisms and Biomarkersmentioning

confidence: 99%

“…Hyperinsulinism and hyperglycemia are the main protagonists of MVA and correlate extensively with endothelial damage, neurohormonal dysfunction, and inflammation, as well as oxidative and wall stress. 110-112…”

Section: Mixed Mechanisms and Biomarkersmentioning

confidence: 99%

Biomarkers of Coronary Microvascular Dysfunction in Patients With Microvascular Angina: A Narrative Review

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…An elevated BMI is also strongly linked to an increased mortality rate, according to the largest cohort study with 363,2674 participants (32). Besides microvascular angina, CMD is also involved in several cardiac and systemic diseases; emerging evidence suggests a pathogenic role of cardiovascular risk factors such as diabetes, hypertension, metabolic syndrome, and obesity in the pathogenesis of CMD (33,34). CMD has recently been found to be more common in obese patients.…”

Section: Discussionmentioning

confidence: 99%

Prognostic impact of coronary microvascular dysfunction assessed by caIMR in overweight with chronic coronary syndrome patients

et al. 2022

View full text Add to dashboard Cite

ObjectiveCoronary microvascular dysfunction (CMD) may associate with adverse cardiovascular events in obese patients. Coronary angiography-derived index of microcirculatory resistance (caIMR) is proposed as a less-invasive and pressure-wire-free index to assess CMD. We aimed to investigate the impact of coronary microvascular function assessed by caIMR in patients with overweight and chronic coronary syndrome (CCS).MethodsCCS patients who underwent coronary angiography between 2015 to 2018 were included. Overweight was defined as BMI≥24.0kg/m². Impaired coronary microvascular function was defined as caIMR≥25U. The patients were classified according to BMI and caIMR. The primary endpoint was major adverse cardiac events (MACE). Kaplan-Meier and Cox regression analyses evaluated the association between caIMR and MACE.ResultsTwo hundred and eighty-two CCS patients were enrolled. Among these, 169 (59.93%) were overweight. Impaired coronary microvascular function was higher in overweight patients than in patients with normal weight (49.70% vs. 38.05%; P=0.035). During 35 months of follow-up, 33 MACE had occurred. Among the total CCS population, MACE was higher in patients with high caIMR than in low caIMR (18.11% vs. 6.45%, P=0.003). In subgroups analysis, MACE was higher in overweight patients with high caIMR than low caIMR (20.24% vs. 7.06%, P=0.014), while there were no significant differences in normal-weight patients. Multivariate Cox analysis demonstrated that caIMR≥25 was independently associated with MACE in overweight patients (HR, 2.87; 95% CI, 1.12-7.30; P=0.027) but not in the normal-weight patients. In addition, caIMR showed a significant predictive value for adverse outcomes in overweight patients and provided an incremental prediction when added to a prediction model with BMI.ConclusionsImpaired coronary microvascular function assessed by caIMR was common and is an independent predictor of MACE in overweight patients with CCS.

show abstract

“…Unfortunately, non-invasive MVD-specific detection methods are limited, making the early diagnosis, characterization, and treatment of MVD challenging. For example, in the heart, coronary microvascular dysfunction (CVD) can occur with or without obstructive epicardial coronary artery disease, leading to ischemia and angina [ 8 , 9 , 10 , 11 ]. Imaging techniques, such as coronary flow reserve (CFR), fractional flow reserve (FFR), and index of microcirculatory resistance (IMR), are accepted as measures of myocardial blood flow and even microvascular disease; but are essentially limited to invasive coronary angiography [ 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

In Vivo Imaging of Rat Vascularity with FDG-Labeled Erythrocytes

et al. 2022

View full text Add to dashboard Cite

Microvascular disease is frequently found in major pathologies affecting vital organs, such as the brain, heart, and kidneys. While imaging modalities, such as ultrasound, computed tomography, single photon emission computed tomography, and magnetic resonance imaging, are widely used to visualize vascular abnormalities, the ability to non-invasively assess an organ’s total vasculature, including microvasculature, is often limited or cumbersome. Previously, we have demonstrated proof of concept that non-invasive imaging of the total mouse vasculature can be achieved with 18F-fluorodeoxyglucose (18F-FDG)-labeled human erythrocytes and positron emission tomography/computerized tomography (PET/CT). In this work, we demonstrate that changes in the total vascular volume of the brain and left ventricular myocardium of normal rats can be seen after pharmacological vasodilation using 18F-FDG-labeled rat red blood cells (FDG RBCs) and microPET/CT imaging. FDG RBC PET imaging was also used to approximate the location of myocardial injury in a surgical myocardial infarction rat model. Finally, we show that FDG RBC PET imaging can detect relative differences in the degree of drug-induced intra-myocardial vasodilation between diabetic rats and normal controls. This FDG-labeled RBC PET imaging technique may thus be useful for assessing microvascular disease pathologies and characterizing pharmacological responses in the vascular bed of interest.

show abstract

Ischemia in patients with no obstructive coronary artery disease: classification, diagnosis and treatment of coronary microvascular dysfunction

Cited by 18 publications

References 25 publications

Biomarkers of Coronary Microvascular Dysfunction in Patients With Microvascular Angina: A Narrative Review

Biomarkers of Coronary Microvascular Dysfunction in Patients With Microvascular Angina: A Narrative Review

Prognostic impact of coronary microvascular dysfunction assessed by caIMR in overweight with chronic coronary syndrome patients

In Vivo Imaging of Rat Vascularity with FDG-Labeled Erythrocytes

Contact Info

Product

Resources

About