Coronary microvascular disease: diagnostic evaluation

Abstract

The diagnosis of coronary microvascular disease (CMD) is vital in a subset of patients with symptoms of myocardial ischemia. The typical ischemic findings on resting electrocardiogram and echocardiogram are uncommon or absent in CMD. Therefore, a high clinical suspicion is essential. We aim to review the invasive and non-invasive diagnostic testing for CMD. The goal is to assess the endothelial dysfunction related to vasoconstriction or reduced coronary blood flow reserve. Non-invasive testing includes resting electrocardiogram, exercise electrocardiogram, transthoracic color Doppler echocardiography, myocardial contrast echocardiography, positron emission tomography, and cardiac magnetic resonance imaging. Comprehensive invasive assessment includes coronary angiography followed by fractional functional flow reserve assessment, coronary flow reserve testing with intravenous acetylcholine with or without intravenous adenosine.

Keywords

Coronary microvascular dysfunction / intracoronary acetylcholine / intracoronary adenosine / coronary flow velocity / coronary flow reserve / myocardial contrast echocardiography / positron emission tomography / cardiac magnetic resonance

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