Microvascular Angina: Diagnosis and Management

Aldiwani, Haider; Mahdai, Suzan; Alhatemi, Ghaith; Merz, C. Noel Bairey

doi:10.15420/ecr.2021.15

Cited by 24 publications

(21 citation statements)

References 107 publications

(171 reference statements)

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“…how much blood flow there is within the specific micro-vessels downstream to the large coronary artery of interest. This could be highly valuable in clinical cardiology as studies have shown that a percentage of patients with coronary heart disease have microvascular disease while their large coronary arteries appears normal during angiographic assessment [35]. Such application could already be used in the clinic with condensation of clinically approved contrast agents.…”

Section: Discussionmentioning

confidence: 99%

Fast and selective super-resolution ultrasound in vivo with sono-switchable nanodroplets

Riemer¹,

Toulemonde²,

Yan³

et al. 2022

Preprint

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Perfusion by the microcirculation is key to the development, maintenance and pathology of tissue. Its measurement with high spatiotemporal resolution is consequently valuable but remains a challenge in deep tissue. Ultrasound Localization Microscopy (ULM) provides very high spatiotemporal resolution but the use of microbubbles requires low contrast agent concentrations, a long acquisition time, and gives little control over the spatial and temporal distribution of the bubbles. The present study is the first to demonstrate Acoustic Wave Sparsely-Activated Localization Microscopy (AWSALM) and fast-AWSALM for in vivo super-resolution ultrasound imaging, offering contrast on demand and vascular selectivity. Three different formulations of sono-switchable contrast agents were tested. We demonstrate their use with ultrasound mechanical indices well within recommended safety limits to enable fast on-demand sparse switching at very high agent concentrations. We produce super-localization maps of the rabbit renal vasculature with acquisition times between 5.5 s and 0.25 s, and an 4-fold improvement in spatial resolution. We present the unique selectivity of AWSALM in visualizing specific vascular branches and downstream microvasculature, and we show super-localized kidney structures in systole and diastole with fast-AWSALM. In conclusion we demonstrate the feasibility of fast and selective measurement of microvascular dynamics in vivo with subwavelength resolution using ultrasound and sono-switchable nanodroplets.

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Section: Discussionmentioning

confidence: 99%

Fast and selective super-resolution ultrasound in vivo with sono-switchable nanodroplets

Riemer¹,

Toulemonde²,

Yan³

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Some reports indicate that structural alterations of the retina are an early marker of concomitant coronary artery disease and of its severity [ 77 , 78 ]. Microvascular angina (MA) is a clinical condition characterized by myocardial ischemia without evidence of obstructive coronary artery disease [ 79 ]. Patients with MA may frequently have microvascular dysfunction, with an associated increased risk of major cardiac events, including myocardial infarction (MI), heart failure with preserved ejection fraction, and stroke [ 80 ].…”

Section: Retinal and Coronary Microcirculationmentioning

confidence: 99%

“…The inward remodeling of coronary arterioles with an increase in WLR and myocardial capillary rarefaction are the abnormalities that characterize structural remodeling of coronary microcirculation [ 83 ]. The increase in minimal myocardial vascular resistance leads to an impairment in blood flow and oxygen supply to the myocardium during stress or exercise [ 79 , 83 ]. CV risk factors (cigarette smoking, hyperlipidemia, high BP, insulin resistant states, and overt diabetes) may cause microcirculation remodeling, alone or in the presence of obstructive atherosclerosis or cardiac remodeling, namely left ventricular hypertrophy [ 83 ].…”

Section: Retinal and Coronary Microcirculationmentioning

confidence: 99%

“…In the absence of obstructive coronary stenosis, MA is diagnosed when at least one of the following conditions are detected: myocardial ischaemia on non-invasive testing; reproducibility of symptoms in association with ECG changes, in the absence of epicardial spasm during coronary function test [ 79 ]. Non-invasive approaches recently proposed for the diagnosis of MA include Transthoracic Doppler Echocardiography (TTDE) with measurements of the maximal diastolic flow at the level of epicardial arteries (left anterior descending artery) during rest, and adenosine/dipyridamole/regadenoson stress with the assessment of the ratio between the peak flow during infusion and the basal flow, known as coronary flow velocity ratio (CFVR) [ 79 ]. In addition, Single Photon Emission Computed Tomography (SPECT) and cardiac Positron Emission Tomography (PET) may identify myocardial perfusion defects suggestive of coronary microvascular abnormalities [ 79 ].…”

Section: Retinal and Coronary Microcirculationmentioning

confidence: 99%

“…Non-invasive approaches recently proposed for the diagnosis of MA include Transthoracic Doppler Echocardiography (TTDE) with measurements of the maximal diastolic flow at the level of epicardial arteries (left anterior descending artery) during rest, and adenosine/dipyridamole/regadenoson stress with the assessment of the ratio between the peak flow during infusion and the basal flow, known as coronary flow velocity ratio (CFVR) [ 79 ]. In addition, Single Photon Emission Computed Tomography (SPECT) and cardiac Positron Emission Tomography (PET) may identify myocardial perfusion defects suggestive of coronary microvascular abnormalities [ 79 ]. Myocardial regional and global perfusion, at rest and during stress, as well as coronary resistance and flow reserve, may be obtained by these techniques [ 84 ].…”

Section: Retinal and Coronary Microcirculationmentioning

confidence: 99%

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Arterial Hypertension and the Hidden Disease of the Eye: Diagnostic Tools and Therapeutic Strategies

et al. 2022

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Hypertension is a major cardiovascular risk factor that is responsible for a heavy burden of morbidity and mortality worldwide. A critical aspect of cardiovascular risk estimation in hypertensive patients depends on the assessment of hypertension-mediated organ damage (HMOD), namely the generalized structural and functional changes in major organs induced by persistently elevated blood pressure values. The vasculature of the eye shares several common structural, functional, and embryological features with that of the heart, brain, and kidney. Since retinal microcirculation offers the unique advantage of being directly accessible to non-invasive and relatively simple investigation tools, there has been considerable interest in the development and modernization of techniques that allow the assessment of the retinal vessels’ structural and functional features in health and disease. With the advent of artificial intelligence and the application of sophisticated physics technologies to human sciences, consistent steps forward have been made in the study of the ocular fundus as a privileged site for diagnostic and prognostic assessment of diverse disease conditions. In this narrative review, we will recapitulate the main ocular imaging techniques that are currently relevant from a clinical and/or research standpoint, with reference to their pathophysiological basis and their possible diagnostic and prognostic relevance. A possible non pharmacological approach to prevent the onset and progression of retinopathy in the presence of hypertension and related cardiovascular risk factors and diseases will also be discussed.

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Coronary microvascular dysfunction assessment: A comparative analysis of procedural aspects

Merdler,

Wallace,

Banerjee

et al. 2024

Cathet Cardio Intervent

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BackgroundFull adoption of coronary microvascular dysfunction (CMD) assessment faces challenges due to its invasive nature and concerns about prolonged procedure time and increased contrast and/or radiation exposure. We compared procedural aspects of CMD invasive assessment to diagnostic left heart catheterization (DLHC) in patients with chest pain who were not found to have obstructive coronary artery disease.MethodsA total of 227 patients in the Coronary Microvascular Disease Registry were compared to 1592 patients who underwent DLHC from August 2021 to November 2023. The two cohorts were compared using propensity‐score matching; primary outcomes were fluoroscopy time and total contrast use.ResultsThe participants' mean age was 64.1 ± 12.6 years. CMD‐assessed patients were more likely to be female (66.5% vs. 45.2%, p < 0.001) and have hypertension (80.2% vs. 44.5%, p < 0.001), history of stroke (11.9% vs. 6.3%, p = 0.002), and history of myocardial infarction (20.3% vs. 7.7%, p < 0.001). CMD assessment was safe, without any reported adverse outcomes. A propensity‐matched analysis showed that patients who underwent CMD assessment had slightly higher median contrast exposure (50 vs. 40 mL, p < 0.001), and slightly longer fluoroscopy time (6.9 vs. 4.7 min, p < 0.001). However, there was no difference in radiation dose (209.3 vs. 219 mGy, p = 0.58) and overall procedure time (31 vs. 29 min, p = 0.37).ConclusionCompared to DLHC, CMD assessment is safe and requires only slightly additional contrast use (10 mL) and slightly longer fluoroscopy time (2 min) without clinical implications. These findings emphasize the favorable safety and feasibility of invasive CMD assessment.

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Microvascular Angina: Diagnosis and Management

Cited by 24 publications

References 107 publications

Fast and selective super-resolution ultrasound in vivo with sono-switchable nanodroplets

Fast and selective super-resolution ultrasound in vivo with sono-switchable nanodroplets

Arterial Hypertension and the Hidden Disease of the Eye: Diagnostic Tools and Therapeutic Strategies

Coronary microvascular dysfunction assessment: A comparative analysis of procedural aspects

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