Assessing Microvascular Dysfunction in Angina With Unobstructed Coronary Arteries JACC Review Topic of the Week

Coronary microvascular dysfunction is a highly prevalent condition of both structural and functional coronary disorders in patients with angina and nonobstructive coronary artery disease (ANOCA). Current diagnostic modalities to assess microvascular function are related to prognosis, but these modalities have several technical shortcomings and lack the opportunity to determine true coronary blood flow and microvascular resistance. Intracoronary continuous thermodilution assessment of absolute coronary flow (Q) and microvascular resistance (R) was recently shown to be safe and feasible in ANOCA. Further exploration and implementation could lead to a better understanding and treatment of patients with ANOCA. This review discuss the coronary pathophysiology of microvascular dysfunction, provides an overview of noninvasive and invasive diagnostics, and focuses on the novel continuous thermodilution method. Finally, how these measurements of absolute Q and R could be integrated and how this would affect future clinical care are discussed. (J Am Coll Cardiol 2021;78:1471-1479) (c) 2021 by the American College of Cardiology Foundation.

Automated summary

Coronary microvascular dysfunction is a common condition in patients with angina and nonobstructive coronary artery disease, and current diagnostic modalities have technical limitations. Intracoronary continuous thermodilution assessment of absolute coronary flow and microvascular resistance has been proven to be safe and feasible, and further exploration could lead to better understanding and treatment of patients with ANOCA. The review provides insight into the pathophysiology, diagnostics, and novel methods for microvascular dysfunction, and discusses the integration of these measurements into future clinical care.