Developments and Controversies in Invasive Diagnosis of Coronary Microvascular Dysfunction in Angina With Nonobstructive Coronary Arteries

IF 6.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL Mayo Clinic proceedings Pub Date : 2024-09-01 DOI:10.1016/j.mayocp.2024.04.022

Kara J. Denby MD , Mohammad Zmaili MD , Sudarshana Datta MD , Thomas Das MD , Stephen Ellis MD , Khaled Ziada MD , Amir Lerman MD , Claire E. Raphael MBBS, PhD

{"title":"Developments and Controversies in Invasive Diagnosis of Coronary Microvascular Dysfunction in Angina With Nonobstructive Coronary Arteries","authors":"Kara J. Denby MD , Mohammad Zmaili MD , Sudarshana Datta MD , Thomas Das MD , Stephen Ellis MD , Khaled Ziada MD , Amir Lerman MD , Claire E. Raphael MBBS, PhD","doi":"10.1016/j.mayocp.2024.04.022","DOIUrl":null,"url":null,"abstract":"<div><p>Approximately half of all coronary angiograms performed for angina do not show obstructive coronary artery disease, and many of these patients have coronary microvascular dysfunction (CMD). Invasive testing for CMD has increased with the advent and wider availability of thermodilution systems. We review CMD pathophysiology and invasive diagnostic testing using the Doppler and thermodilution systems. We report the results of a PubMed search of invasive microvascular testing and discuss limitations of current diagnostic algorithms in the diagnosis of CMD, including controversies regarding the optimal cutoff value for abnormal coronary flow reserve, use of microvascular resistance indices, and options for increasing sensitivity of testing.</p></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"99 9","pages":"Pages 1469-1481"},"PeriodicalIF":6.9000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S002561962400212X/pdfft?md5=6becfa7cb403ba397de5486833ced78b&pid=1-s2.0-S002561962400212X-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Mayo Clinic proceedings","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S002561962400212X","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}

引用次数: 0

Abstract

Approximately half of all coronary angiograms performed for angina do not show obstructive coronary artery disease, and many of these patients have coronary microvascular dysfunction (CMD). Invasive testing for CMD has increased with the advent and wider availability of thermodilution systems. We review CMD pathophysiology and invasive diagnostic testing using the Doppler and thermodilution systems. We report the results of a PubMed search of invasive microvascular testing and discuss limitations of current diagnostic algorithms in the diagnosis of CMD, including controversies regarding the optimal cutoff value for abnormal coronary flow reserve, use of microvascular resistance indices, and options for increasing sensitivity of testing.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

冠状动脉无阻塞性心绞痛患者冠状动脉微血管功能障碍侵入性诊断的发展与争议

在所有因心绞痛而进行的冠状动脉造影检查中，约有一半没有显示阻塞性冠状动脉疾病，其中许多患者存在冠状动脉微血管功能障碍（CMD）。随着热稀释系统的出现和普及，CMD 的侵入性检测也在增加。我们回顾了 CMD 的病理生理学以及使用多普勒和热稀释系统进行的有创诊断测试。我们报告了有关有创微血管检测的 PubMed 搜索结果，并讨论了当前诊断 CMD 算法的局限性，包括有关冠状动脉血流储备异常的最佳临界值、微血管阻力指数的使用以及提高检测灵敏度的方案等方面的争议。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Mayo Clinic proceedings 医学-医学：内科

CiteScore

16.80

自引率

1.10%

发文量

383

审稿时长

37 days

期刊介绍： Mayo Clinic Proceedings is a premier peer-reviewed clinical journal in general medicine. Sponsored by Mayo Clinic, it is one of the most widely read and highly cited scientific publications for physicians. Since 1926, Mayo Clinic Proceedings has continuously published articles that focus on clinical medicine and support the professional and educational needs of its readers. The journal welcomes submissions from authors worldwide and includes Nobel-prize-winning research in its content. With an Impact Factor of 8.9, Mayo Clinic Proceedings is ranked #20 out of 167 journals in the Medicine, General and Internal category, placing it in the top 12% of these journals. It invites manuscripts on clinical and laboratory medicine, health care policy and economics, medical education and ethics, and related topics.