title: Current perspectives in coronary microvascular dysfunction.
abstract: The coronary arterial system consists of large epicardial coronary arteries, pre-arterioles, and arterioles, which together closely regulate CBF. Structural, functional, and extravascular abnormalities of the microcirculation lead to CMD. CMD can present with symptoms suggestive of CAD, often in the absence of significant obstructive epicardial CAD. Conventional invasive angiography does not allow direct visualization of the microcirculation. Invasive indices, such as CBF and CFR, and non-invasive imaging modalities, such as CMR and PET, can be used to quantify absolute MBF and enable a direct and accurate assessment of coronary microvascular function. CMD appears to be more prevalent in women, typically presenting with symptoms of ischemia with unobstructed coronary arteries, and has a relatively unfavorable prognosis. CMD is classified clinically depending on the presence or absence of epicardial CAD, myocardial disease, or iatrogenic causes. Although invasive intracoronary techniques can be used to detect CMD, these cannot provide insight into the mechanisms involved in its pathogenesis. Imaging modalities such as CMR and cardiac PET are becoming indispensable tools in the evaluation of suspected CMD.
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London, St. Thomas' Hospital, London, UK.
authors.forename: Joy S
authors.initials: JS
authors.lastname: Shome
authors.affiliation: Cardiovascular Division, The Rayne Institute, King's College London, St. Thomas' Hospital, London, UK.
authors.forename: Divaka
authors.initials: D
authors.lastname: Perera
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London, St. Thomas' Hospital, London, UK.|Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
authors.forename: Sven
authors.initials: S
authors.lastname: Plein
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London, St. Thomas' Hospital, London, UK.
authors.forename: Amedeo
authors.initials: A
authors.lastname: Chiribiri
mesh_terms: D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003326:Coronary Circulation / Q000502:physiology*; D003952:Diagnostic Imaging / Q000379:methods / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging
keywords: microvascular ischemia