학술논문
Coronary Microvascular Disease in Contemporary Clinical Practice.
Document Type
Academic Journal
Author
Smilowitz NR; Division of Cardiology, Department of Medicine, NYU Langone Health, NY (N.R.S.).; Cardiology Section, Department of Medicine, Veterans Affairs New York Harbor Healthcare System, NY (N.R.S.).; Toleva O; Emory University, Atlanta, GA (O.T.).; Chieffo A; Interventional Cardiology Unit, San Raffaele Hospital, Milan, Italy (A.C.).; Perera D; School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, UK (D.P.).; Guy's and St Thomas' Hospital, London, UK (D.P.).; Berry C; British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK (C.B.).; The West of Scotland Heart and Lung Centre, NHS Golden Jubilee, Glasgow, Scotland, UK (C.B.).
Source
Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 101499602 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1941-7632 (Electronic) Linking ISSN: 19417640 NLM ISO Abbreviation: Circ Cardiovasc Interv Subsets: MEDLINE
Subject
Language
English
Abstract
Coronary microvascular disease (CMD) causes myocardial ischemia in a variety of clinical scenarios. Clinical practice guidelines support routine testing for CMD in patients with ischemia with nonobstructive coronary artery disease. Invasive testing to identify CMD requires Doppler or thermodilution measures of flow to determine the coronary flow reserve and measures of microvascular resistance. Acetylcholine coronary reactivity testing identifies concomitant endothelial dysfunction, microvascular spasm, or epicardial coronary spasm. Comprehensive testing may improve symptoms, quality of life, and patient satisfaction by establishing a diagnosis and guiding-targeted medical therapy and lifestyle measures. Beyond ischemia with nonobstructive coronary artery disease, testing for CMD may play a role in patients with acute myocardial infarction, angina following coronary revascularization, heart failure with preserved ejection fraction, Takotsubo syndrome, and after heart transplantation. Additional education and provider awareness of CMD and its role in cardiovascular disease is needed to improve patient-centered outcomes of ischemic heart disease.
Competing Interests: Disclosures Dr Smilowitz serves on an advisory board for Abbott Vascular. Dr Chieffo receives speaker/consultant fees from Abbott, Abiomed, Boston Scientific, Bionsensor, Medtronc, Menarini, Shock Wave Medical. Dr Perera receives speaker fees/research support from Abbott, Abiomed, Menarini, Philips, Shockwave. Dr Berry is employed by the University of Glasgow, which holds consultancy and research agreements for his work with Abbott Vascular, AstraZeneca, Auxilius Pharma, Boehringer Ingelheim, Causeway Therapeutics, Coroventis, Genentech, GSK, HeartFlow, Menarini, Neovasc, Novartis, Siemens Healthcare, and Valo Health. The other author reports no conflicts.
Competing Interests: Disclosures Dr Smilowitz serves on an advisory board for Abbott Vascular. Dr Chieffo receives speaker/consultant fees from Abbott, Abiomed, Boston Scientific, Bionsensor, Medtronc, Menarini, Shock Wave Medical. Dr Perera receives speaker fees/research support from Abbott, Abiomed, Menarini, Philips, Shockwave. Dr Berry is employed by the University of Glasgow, which holds consultancy and research agreements for his work with Abbott Vascular, AstraZeneca, Auxilius Pharma, Boehringer Ingelheim, Causeway Therapeutics, Coroventis, Genentech, GSK, HeartFlow, Menarini, Neovasc, Novartis, Siemens Healthcare, and Valo Health. The other author reports no conflicts.