Coronary Microvascular Disease in Contemporary Clinical Practice

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.

Automated summary

Coronary microvascular disease (CMD) can lead to myocardial ischemia in various clinical scenarios. Routine testing for CMD is supported in patients with ischemia and nonobstructive coronary artery disease. Invasive testing using Doppler or thermodilution measures can determine coronary flow reserve and microvascular resistance. Comprehensive testing can improve symptoms, quality of life, and patient satisfaction by establishing a diagnosis and guiding targeted medical therapy and lifestyle changes. CMD testing may also be useful in other cardiovascular conditions such as acute myocardial infarction, angina after coronary revascularization, heart failure with preserved ejection fraction, Takotsubo syndrome, and after heart transplantation. Educating healthcare providers about CMD is crucial for improving patient-centered outcomes in ischemic heart disease.