Microvascular angina: Assessment of coronary blood flow, flow reserve, and metabolism

Current Cardiology Reports

Volumn 13, Issue 2, 2011, Pages 151-158

  Vesely, Mark R ^a   Dilsizian, Vasken ^b  

^a UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE   (United States)

^b UNIVERSITY OF MARYLAND MEDICAL CENTER   (United States)

Author keywords

Cardiac syndrome X; Coronary artery disease; Coronary flow reserve; Microvascular angina

Indexed keywords

TRACER;

ARTICLE; CLINICAL ASSESSMENT; COMPUTER ASSISTED TOMOGRAPHY; CONTRAST ENHANCEMENT; CORONARY ARTERY BLOOD FLOW; CORONARY FLOW RESERVE; GOLD STANDARD; HEART MUSCLE ISCHEMIA; HEART MUSCLE METABOLISM; HUMAN; INVASIVE PROCEDURE; MICROVASCULATURE; MYOCARDIAL PERFUSION IMAGING; NON INVASIVE PROCEDURE; NUCLEAR MAGNETIC RESONANCE IMAGING; POSITRON EMISSION TOMOGRAPHY; PROGNOSIS; SIGNAL NOISE RATIO; SYNDROME X;

BLOOD FLOW VELOCITY; CORONARY CIRCULATION; HEMODYNAMICS; HUMANS; MICROVASCULAR ANGINA; MICROVESSELS; MYOCARDIAL ISCHEMIA; MYOCARDIAL REPERFUSION; POSITRON-EMISSION TOMOGRAPHY; TOMOGRAPHY, X-RAY COMPUTED;

EID: 79955856333     PISSN: 15233782     EISSN: None     Source Type: Journal    
DOI: 10.1007/s11886-010-0165-y     Document Type: Article

References (67)

1. Diver DJ, Bier JD, Ferreira PE, Sharaf BL, McCabe C, Thompson B, Chaitman B, Williams DO, Braunwald E: Clinical and arteriographic characterization of patients with unstable angina without critical coronary arterial narrowing (from the TIMI-IIIA Trial). Am J Cardiol 1994, 74:531-537. (Pubitemid 24279931)
2. Phibbs B, Fleming T, Ewy GA, Butman S, Ambrose J, Gorlin R, Orme E, Mason J: Frequency of normal coronary arteriograms in three academic medical centers and one community hospital. Am J Cardiol 1988, 62:472-474.
3. Kemp HG, Kronmal RA, Vlietstra RE, Frye RL: Seven year survival of patients with normal or near normal coronary arteriograms: a CASS registry study. J Am Coll Cardiol 1986, 7:479-483. (Pubitemid 16164373)
4. Sharaf BL, Pepine CJ, Kerensky RA, Reis SE, Reichek N, Rogers WJ, Sopko G, Kelsey SF, Holubkov R, Olson M, et al.: Detailed angiographic analysis of women with suspected ischemic chest pain (pilot phase data from the NHLBI-sponsored Women's Ischemia Syndrome Evaluation [WISE] Study Angiographic Core Laboratory). Am J Cardiol 2001, 87:937-941; A933.
5. Panza JA: Myocardial ischemia and the pains of the heart. N Engl J Med 2002, 346:1934-1935.
6. Schelbert H: Anatomy and physiology of coronary blood flow. J Nucl Cardiol 2010, 17:545-554.
7. Likoff W, Segal BL, Kasparian H: Paradox of normal selective coronary arteriograms in patients considered to have unmistakable coronary heart disease. N Engl J Med 1967, 276:1063-1066.
8. Kemp HG, Jr.: Left ventricular function in patients with the anginal syndrome and normal coronary arteriograms. Am J Cardiol 1973, 32:375-376.
9. Cannon RO, Watson RM, Rosing DR, Epstein SE: Angina caused by reduced vasodilator reserve of the small coronary arteries. J Am Coll Cardiol 1983, 1:1359-1373. (Pubitemid 13054121)
10. Lanza GA, Crea F: Primary coronary microvascular dysfunction: clinical presentation, pathophysiology, and management. Circulation 2010, 121:2317-2325.
11. Pepine C, Anderson R, Sharaf B, Reis S, Smith K, Handberg E, Johnson B, Sopko G, Bairey Merz C: Coronary microvascular reactivity to adenosine predicts adverse outcome in women evaluated for suspected ischemia results from the National Heart, Lung and Blood Institute WISE (Women's Ischemia Syndrome Evaluation) study. J Am Coll Cardiol 2010, 55:2825-2832. This investigation demonstrates that invasively assessed decreased CFR (< 2.32) is associated with increased risk of major adverse clinical events, including death, nonfatal myocardial infarction, nonfatal stroke, and heart failure hospitalization. Prediction of events is improved over risk assessment by consideration of CAD severity and other risk conditions and is maintained in patients with chest pain and no obstructive CAD.
12. Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, Jones RH, Kereiakes D, Kupersmith J, Levin TN, et al.: ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction - summary article: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients With Unstable Angina). J Am Coll Cardiol 2002, 40:1366-1374.
13. Modena MG, Bonetti L, Coppi F, Bursi F, Rossi R: Prognostic role of reversible endothelial dysfunction in hypertensive postmenopausal women. J Am Coll Cardiol 2002, 40:505-510. (Pubitemid 34833167)
14. Kaski JC, Rosano G, Gavrielides S, Chen L: Effects of angiotensin-converting enzyme inhibition on exercise-induced angina and ST segment depression in patients with microvascular angina. J Am Coll Cardiol 1994, 23:652-657. (Pubitemid 24074943)
15. Chen JW, Hsu NW, Wu TC, Lin SJ, Chang MS: Long-term angiotensin- converting enzyme inhibition reduces plasma asymmetric dimethylarginine and improves endothelial nitric oxide bioavailability and coronary microvascular function in patients with syndrome X. Am J Cardiol 2002, 90:974-982.
16. Simaitis A, Laucevicius A: [Effect of high doses of atorvastatin on the endothelial function of the coronary arteries]. Medicina (Kaunas) 2003, 39:21-29.
17. Kayikcioglu M, Payzin S, Yavuzgil O, Kultursay H, Can LH, Soydan I: Benefits of statin treatment in cardiac syndrome-X1. Eur Heart J 2003, 24:1999-2005. (Pubitemid 37420446)
18. Houghton JL, Pearson TA, Reed RG, Torosoff MT, Henches NL, Kuhner PA, Philbin EF: Cholesterol lowering with pravastatin improves resistance artery endothelial function: report of six subjects with normal coronary arteriograms. Chest 2000, 118:756-760.
19. Caliskan M, Erdogan D, Gullu H, Topcu S, Ciftci O, Yildirir A, Muderrisoglu H: Effects of atorvastatin on coronary flow reserve in patients with slow coronary flow. Clin Cardiol 2007, 30:475-479. (Pubitemid 47438717)
20. Lanza GA, Stazi F, Colonna G, Pedrotti P, Manzoli A, Crea F, Maseri A: Circadian variation of ischemic threshold in syndrome X. Am J Cardiol 1995, 75:683-686.
21. Bugiardini R, Borghi A, Biagetti L, Puddu P: Comparison of verapamil versus propranolol therapy in syndrome X. Am J Cardiol 1989, 63:286-290. (Pubitemid 19049236)
22. Lanza GA, Manzoli A, Bia E, Crea F, Maseri A: Acute effects of nitrates on exercise testing in patients with syndrome X. Clinical and pathophysiological implications. Circulation 1994, 90:2695-2700.
23. Kaski JC, Cockerill GW: STARR (STudy of Atherosclerosis with Ramipril and Rosiglitazone): is the biggest big enough? J Am Coll Cardiol 2009, 53:2036-2038.
24. Cannon RO, Watson RM, Rosing DR, Epstein SE: Efficacy of calcium channel blocker therapy for angina pectoris resulting from small-vessel coronary artery disease and abnormal vasodilator reserve. Am J Cardiol 1985, 56:242-246. (Pubitemid 15045226)
25. Cannon RO, Quyyumi AA, Mincemoyer R, Stine AM, Gracely RH, Smith WB, Geraci MF, Black BC, Uhde TW, Waclawiw MA: Imipramine in patients with chest pain despite normal coronary angiograms. N Engl J Med 1994, 330:1411-1417. (Pubitemid 24139233)
26. Rosano GM, Peters NS, Lefroy D, Lindsay DC, Sarrel PM, Collins P, Poole-Wilson PA: 17-beta-Estradiol therapy lessens angina in postmenopausal women with syndrome X. J Am Coll Cardiol 1996, 28:1500-1505. (Pubitemid 26391856)
27. Lerman A, Burnett JC, Higano ST, McKinley LJ, Holmes DR: Long-term L-arginine supplementation improves small-vessel coronary endothelial function in humans. Circulation 1998, 97:2123-2128. (Pubitemid 28262119)
28. Fujita H, Yamabe H, Yokoyama M: Effect of L-arginine administration on myocardial thallium-201 perfusion during exercise in patients with angina pectoris and normal coronary angiograms. J Nucl Cardiol 2000, 7:97-102. (Pubitemid 30232673)
29. Dilsizian V: The role of myocardial perfusion imaging in vascular endothelial dysfunction. J Nucl Cardiol 2000, 7:180-184.
30. Elliott PM, Krzyzowska-Dickinson K, Calvino R, Hann C, Kaski JC: Effect of oral aminophylline in patients with angina and normal coronary arteriograms (cardiac syndrome X). Heart 1997, 77:523-526. (Pubitemid 27294690)
31. Bugiardini R, Bairey Merz CN: Angina with "normal" coronary arteries: a changing philosophy. JAMA 2005, 293:477-484.
32. Phan A, Shufelt C, Merz CN: Persistent chest pain and no obstructive coronary artery disease. JAMA 2009, 301:1468-1474.
33. Cannon RO: Microvascular angina and the continuing dilemma of chest pain with normal coronary angiograms. J Am Coll Cardiol 2009, 54:877-885. This manuscript thoroughly reviews the clinical syndrome of microvascular angina, including clinical significance, proposed pathophysiology as well as suggestions for diagnostic and management approaches.
34. Camici P, Rimoldi O: The clinical value of myocardial blood flow measurement. J Nucl Med 2009, 50:1076-1087.
35. Jackson G, Richardson PJ, Atkinson L, Armstrong P, Oram S: Angina with normal coronary arteriograms. Value of coronary sinus lactate estimation in diagnosis and treatment. Br Heart J 1978, 40:976-978.
36. Jackson G, Atkinson L, Clark M, Crook B, Armstrong P, Oram S: Diagnosis of coronary artery disease by estimation of coronary sinus lactate. Br Heart J 1978, 40:979-983. (Pubitemid 9036586)
37. Buffon A, Rigattieri S, Santini SA, Ramazzotti V, Crea F, Giardina B, Maseri A: Myocardial ischemia-reperfusion damage after pacing-induced tachycardia in patients with cardiac syndrome X. Am J Physiol Heart Circ Physiol 2000, 279:H2627-2633.
38. Buchthal SD, den Hollander JA, Merz CN, Rogers WJ, Pepine CJ, Reichek N, Sharaf BL, Reis S, Kelsey SF, Pohost GM: Abnormal myocardial phosphorus-31 nuclear magnetic resonance spectroscopy in women with chest pain but normal coronary angiograms. N Engl J Med 2000, 342:829-835. (Pubitemid 30165205)
39. Dilsizian V, Bateman TM, Bergmann SR, Des Prez R, Magram MY, Goodbody AE, Babich JW, Udelson JE: Metabolic imaging with beta-methyl-p-[(123)I]- iodophenyl-pentadecanoic acid identifies ischemic memory after demand ischemia. Circulation 2005, 112:2169-2174.
40. Taegtmeyer H, Dilsizian V: Imaging myocardial metabolism and ischemic memory. Nat Clin Pract Cardiovasc Med 2008, 5 Suppl 2:S42-48.
41. Chareonthaitawee P, Kaufmann PA, Rimoldi O, Camici PG: Heterogeneity of resting and hyperemic myocardial blood flow in healthy humans. Cardiovasc Res 2001, 50:151-161. (Pubitemid 32244395)
42. Kern MJ, de Bruyne B, Pijls NH: From research to clinical practice: current role of intracoronary physiologically based decision making in the cardiac catheterization laboratory. J Am Coll Cardiol 1997, 30:613-620. (Pubitemid 27397637)
43. Kern MJ: Coronary physiology revisited : practical insights from the cardiac catheterization laboratory. Circulation 2000, 101:1344-1351.
44. Ziadi M, Beanlands R: The clinical utility of assessing myocardial blood flow using positron emission tomography. J Nucl Cardiol 2010, 17:571-581.
45. Doucette JW, Corl PD, Payne HM, Flynn AE, Goto M, Nassi M, Segal J: Validation of a Doppler guide wire for intravascular measurement of coronary artery flow velocity. Circulation 1992, 85:1899-1911.
46. Melikian N, Kearney MT, Thomas MR, De Bruyne B, Shah AM, MacCarthy PA: A simple thermodilution technique to assess coronary endothelium-dependent microvascular function in humans: validation and comparison with coronary flow reserve. Eur Heart J 2007, 28:2188-2194. (Pubitemid 47428940)
47. Seiden SW: Evaluating patients with persistent chest pain and no obstructive coronary artery disease. JAMA 2009, 302:622; author reply 623-624.
48. deKemp RA, Yoshinaga K, Beanlands RS: Will 3-dimensional PET-CT enable the routine quantification of myocardial blood flow? J Nucl Cardiol 2007, 14:380-397.
49. Schelbert HR: Quantification of myocardial blood flow: what is the clinical role? Cardiol Clin 2009, 27:277-289, Table of Contents.
50. Bateman TM, O'Keefe JH, Dong VM, Barnhart C, Ligon RW: Coronary angiographic rates after stress single-photon emission computed tomographic scintigraphy. J Nucl Cardiol 1995, 2:217-223.
51. Husmann L, Wiegand M, Valenta I, Gaemperli O, Schepis T, Siegrist PT, Namdar M, Wyss CA, Alkadhi H, Kaufmann PA: Diagnostic accuracy of myocardial perfusion imaging with single photon emission computed tomography and positron emission tomography: a comparison with coronary angiography. Int J Cardiovasc Imaging 2008, 24:511-518.
52. Nandalur KR, Dwamena BA, Choudhri AF, Nandalur SR, Reddy P, Carlos RC: Diagnostic performance of positron emission tomography in the detection of coronary artery disease: a meta-analysis. Acad Radiol 2008, 15:444-451. (Pubitemid 351375118)
53. Lautamäki R, George RT, Kitagawa K, Higuchi T, Merrill J, Voicu C, DiPaula A, Nekolla SG, Lima JA, Lardo AC, et al.: Rubidium-82 PET-CT for quantitative assessment of myocardial blood flow: validation in a canine model of coronary artery stenosis. Eur J Nucl Med Mol Imaging 2009, 36:576-586.
54. El Fakhri G, Kardan A, Sitek A, Dorbala S, Abi-Hatem N, Lahoud Y, Fischman A, Coughlan M, Yasuda T, Di Carli MF: Reproducibility and accuracy of quantitative myocardial blood flow assessment with (82)Rb PET: comparison with (13)N-ammonia PET. J Nucl Med 2009, 50:1062-1071.
55. Herzog BA, Husmann L, Valenta I, Gaemperli O, Siegrist PT, Tay FM, Burkhard N, Wyss CA, Kaufmann PA: Long-term prognostic value of 13 N-ammonia myocardial perfusion positron emission tomography added value of coronary flow reserve. J Am Coll Cardiol 2009, 54:150-156.
56. Achenbach S, Kramer CM, Zoghbi WA, Dilsizian V: The year in coronary artery disease. JACC Cardiovasc Imaging 2010, 3:1065-1077.
57. Schuleri K, George R, Lardo A: Assessment of coronary blood flow with computed tomography and magnetic resonance imaging. J Nucl Cardiol 2010, 17:582-590. This manuscript reviews the current progress, future outlook as well as strengths and limitations of noninvasive quantitative myocardial perfusion imaging by CT and MRI methodologies.
58. George R, Arbab-Zadeh A, Miller J, Kitagawa K, Chang H, Bluemke D, Becker L, Yousuf O, Texter J, Lardo A, et al.: Adenosine stress 64- and 256-row detector computed tomography angiography and perfusion imaging: a pilot study evaluating the transmural extent of perfusion abnormalities to predict atherosclerosis causingmyocardial ischemia. Circ Cardiovasc Imaging 2009, 2:174-182.
59. Schaefer S, van Tyen R, Saloner D: Evaluation of myocardial perfusion abnormalities with gadolinium-enhanced snapshot MR imaging in humans. Work in progress. Radiology 1992, 185:795-801.
60. Atkinson DJ, Burstein D, Edelman RR: First-pass cardiac perfusion: evaluation with ultrafast MR imaging. Radiology 1990, 174:757-762. (Pubitemid 20089667)
61. Wilke N, Simm C, Zhang J, Ellermann J, Ya X, Merkle H, Path G, Lüdemann H, Bache RJ, Uǧurbil K: Contrast-enhanced first pass myocardial perfusion imaging: correlation between myocardial blood flow in dogs at rest and during hyperemia. Magn Reson Med 1993, 29:485-497. (Pubitemid 23112752)
62. Wilke N, Jerosch-Herold M, Wang Y, Huang Y, Christensen BV, Stillman AE, Ugurbil K, McDonald K, Wilson RF: Myocardial perfusion reserve: assessment with multisection, quantitative, first-pass MR imaging. Radiology 1997, 204:373-384. (Pubitemid 27337482)
63. Fritz-Hansen T, Hove JD, Kofoed KF, Kelbaek H, Larsson HB: Quantification of MRI measured myocardial perfusion reserve in healthy humans: a comparison with positron emission tomography. J Magn Reson Imaging 2008, 27:818-824. (Pubitemid 351508097)
64. Schwitter J, Wacker CM, van Rossum AC, Lombardi M, Al-Saadi N, Ahlstrom H, Dill T, Larsson HB, Flamm SD, Marquardt M, et al.: MR-IMPACT: comparison of perfusioncardiac magnetic resonance with single-photon emission computed tomography for the detection of coronary artery disease in a multicentre, multivendor, randomized trial. Eur Heart J 2008, 29:480-489. (Pubitemid 351264187)
65. Jahnke C, Nagel E, Gebker R, Kokocinski T, Kelle S, Manka R, Fleck E, Paetsch I: Prognostic value of cardiac magnetic resonance stress tests: adenosine stress perfusion and dobutamine stress wall motion imaging. Circulation 2007, 115:1769-1776. (Pubitemid 46648614)
66. Doyle M, Weinberg N, Pohost G, Bairey Merz C, Shaw L, Sopko G, Fuisz A, Rogers W, Walsh E, Johnson B, et al.: Prognostic value of global MR myocardial perfusion imaging in women with suspected myocardial ischemia and no obstructive coronary disease: results from the NHLBI-sponsored WISE (Women's Ischemia Syndrome Evaluation) study. JACC Cardiovasc Imaging 2010, 3:1030-1036.
67. Nagel E, Lima J, George R, Kramer C: Newer methods for noninvasive assessment of myocardial perfusion: cardiac magnetic resonance or cardiac computed tomography? JACC Cardiovasc Imaging 2009, 2:656-660.