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Coronary Microvascular Dysfunction: A Practical Approach to Diagnosis and Management

  • Women and Ischemic Heart Disease (J.M. Peña and F. Lin, Section Editors)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this review is to provide an overview of diagnostic and treatment considerations in patients with coronary microvascular dysfunction (CMD) in the absence of obstructive coronary artery disease (CAD).

Recent Findings

The prevalence of obstructive CAD in unselected patient populations referred for evaluation of angina is less than 10%. A significant proportion of patients with angina and no obstructive CAD have CMD, a condition associated with impaired cardiovascular prognosis. Non-invasive and invasive evaluation of coronary microvascular function is feasible and widely available, yet CMD is underdiagnosed and undertreated. A patient-tailored treatment approach guided by coronary microvascular testing shows promising results for patient-reported outcomes of symptom burden and quality of life.

Summary

Coronary microvascular testing should be considered in angina patients with no obstructive CAD, before other causes of chest pain are explored. A patient-tailored treatment approach guided by a complete evaluation of epicardial anatomy and macro-and microvascular function may help optimize treatment strategy and prevent unnecessary medical interventions. More research is needed to establish the long-term effect of patient-tailored therapies on risk reduction in CMD.

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Authors and Affiliations

  1. Department of Cardiology, North Zealand University Hospital, University of Copenhagen, Dyrehavevej 29, 3400, Hillerød, Denmark

    Daria Frestad Bechsgaard

  2. Department of Cardiology, Bispebjerg University Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark

    Eva Prescott

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  1. Daria Frestad Bechsgaard
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Correspondence to Daria Frestad Bechsgaard.

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This article is part of the Topical Collection on Women and Ischemic Heart Disease

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Bechsgaard, D.F., Prescott, E. Coronary Microvascular Dysfunction: A Practical Approach to Diagnosis and Management. Curr Atheroscler Rep 23, 54 (2021). https://doi.org/10.1007/s11883-021-00947-y

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