title: Coronary Microvascular Dysfunction, Microvascular Angina, and Management.
abstract: Recent analyses have found that coronary microvascular dysfunction (CMD) portends a poor prognosis in patients with and without obstructive epicardial coronary artery disease (CAD). Chest pain in the absence of epicardial CAD is a common entity. Angina caused by CMD, microvascular angina (MVA), is often indistinguishable from that caused by obstructive epicardial CAD. The recent emergence of noninvasive techniques that can identify CMD, such as stress positron-emission tomography (PET) and cardiovascular magnetic resonance (CMR) myocardial perfusion imaging, allow improved identification of MVA. Using these tools, higher risk patients with MVA can be differentiated from those at lower risk in the heterogeneous population historically labeled as cardiac syndrome X. Likewise, MVA can be diagnosed in those with obstructive epicardial CAD who have persistent angina despite successful revascularization. There is little evidence to support current treatment strategies for MVA and current literature has not clearly defined CMD or whether therapy improves prognosis.
authors.affiliation: Division of Cardiovascular Medicine, University of Virginia Health System, PO Box 800662, Charlottesville, VA, 22908, USA. al2ys@hscmail.mcc.virginia.edu.
authors.forename: Adrián I
authors.initials: AI
authors.lastname: Löffler
authors.affiliation: Division of Cardiovascular Medicine and Radiology, University of Virginia Health System, 1215 Lee Street, Box 800158, Charlottesville, VA, 22908, USA. jbourque@virginia.edu.
authors.forename: Jamieson M
authors.initials: JM
authors.lastname: Bourque
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002637:Chest Pain / Q000209:etiology* / Q000628:therapy; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D003326:Coronary Circulation; D006801:Humans; D017566:Microvascular Angina / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D055414:Myocardial Perfusion Imaging; D009204:Myocardial Revascularization / Q000379:methods; D049268:Positron-Emission Tomography; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012039:Regional Blood Flow
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: Coronary microvascular dysfunction; Microvascular angina; Prognosis; Therapeutics