title: Imaging Microvascular Dysfunction and Mechanisms for Female-Male Differences in CAD.
abstract: Microvascular dysfunction or disease is most commonly associated with diffuse epicardial coronary atherosclerosis and endothelial dysfunction, whereas it is less common as a distinct, separate, isolated pathophysiology. The different manifestations of coronary artery disease in women relate in part to their smaller coronary arteries, higher coronary blood flow, and higher endothelial shear stress, which have profound effects on endothelial function and development or resistance to atherosclerosis, its symptomatic presentation, outcomes, and treatment. The complex interactions of focal stenosis, diffuse epicardial atherosclerotic coronary narrowing, and microvascular dysfunction make definitive diagnosis and management difficult by use of standard noninvasive and invasive physiological and anatomic technologies. However, quantitative rest-stress myocardial perfusion, best documented by positron emission tomography, combined with clinical circumstances usually provides a definitive diagnosis to guide management, including vigorous risk factor management and revascularization for patients with physiologically severe epicardial stenosis by quantitative positron emission tomography.
authors.affiliation: Department of Medicine, University of Texas Medical School and Memorial Hermann Hospital, Houston, Texas.
authors.forename: Monica B
authors.initials: MB
authors.lastname: Patel
authors.affiliation: Department of Medicine, University of Texas Medical School and Memorial Hermann Hospital, Houston, Texas.
authors.forename: Linh P
authors.initials: LP
authors.lastname: Bui
authors.affiliation: Department of Medicine, University of Texas Medical School and Memorial Hermann Hospital, Houston, Texas.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Kirkeeide
authors.affiliation: Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Medical School, Houston, Texas. Electronic address: k.lance.gould@uth.tmc.edu.
authors.forename: K Lance
authors.initials: KL
authors.lastname: Gould
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008833:Microcirculation; D055806:Microvessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors
keywords: cardiac PET; coronary artery disease in women; endothelial shear stress; microvascular dysfunction; quantitative myocardial perfusion imaging