Noninvasive assessment of coronary microvascular function in women at risk for ischaemic heart disease

Abstract

The primary objective of the current review is to describe the assessment of coronary microvascular function by noninvasive imaging techniques in women at risk for and with ischaemic heart disease (IHD). The search criteria were the analyses of the related bibliography published in PUBMED database. Normal or minimal obstructive coronary artery disease (CAD) at angiography is a common finding in women with signs of ischaemia. Up to 50% of them will have coronary microvascular dysfunction, suggesting that the mechanism of ischaemia may be localised at coronary microcirculation level. Noninvasive measurements of coronary microvascular function can be performed by radionuclide techniques. In particular, positron emission tomography (PET) measures myocardial blood flow (MBF) not only relatively but also in absolute units. Thus, PET offers the possibility to uncover microvascular dysfunction even in patients without obstructive CAD. PET-derived estimates of MBF showed an abnormal coronary microvascular function in women with chest pain and non-obstructive CAD and in women with high-risk conditions for CAD. Interestingly, there is a relationship between an abnormal coronary vascular function and adverse cardiovascular outcomes. In particular, this significant relationship was observed with measurements related to endothelial function. Recent evidence suggests that vascular dysfunction plays a central role as an estimator of outcomes in women at risk for or with IHD. Therefore, assessment of coronary vascular function in these women appears to be of clinical relevance. Whether such evaluation may have an impact to reduce cardiac events needs further investigation.

Digital Assessment of Endothelial Function and Ischemic Heart Disease in Women

“…The design of a new and noninvasive test for the assessment of NOCAD is strongly desirable. Coronary endothelial dysfunction plays an important pathogenic role in NOCAD (7,11,12,27). The present study demonstrated that noninvasive digital assessment of peripheral endothelial function by RH-PAT significantly predicted IHD, particularly NOCAD.…”

“…Furthermore, regarding NOCAD, not only coronary spastic angina, but also microvascular spasm and microcirculatory insufficiency have been shown to be associated with coronary endothelial dysfunction (7,11,12), thus it could be possible to identify all these patients with IHD by physiological examination and evaluating endothelial dysfunction.…”

The Challenges of Prevention, Diagnosis and Treatment of Ischemic Heart Disease in Women

“…These conditions, whether alone or in conglomerate, lead to vascular endothelial injury and increased oxidative stress which further promote coronary atherogenesis [9]. Investigators have theorized that the higher prevalence of left ventricular hypertrophy and obesity in black women results in “microvascular angina” from decreased coronary vascular reserve [68].…”

Exercise electrocardiography detection of coronary artery disease by ST-segment depression/heart rate hysteresis in women: The Finnish Cardiovascular Study

“…The validity of angiography compared to the other methods in women having ischemic signs has been debated. With positron emission tomography (PET) it is possible to measure coronary microvascular functions, and Campisi [24] has observed up to 50% of women with ischemic signs to have dysfunction in coronary microcirculation even though they did not have stenotic coronary arteries according to angiography. In addition, cardiac syndrome X has been suggested to have pathophysiological mechanisms in the endothelial function of coronary microcirculation [25,26].…”