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Diagnosis of coronary microvascular dysfunction in the clinic

Research output: Contribution to journalReviewpeer-review

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  1. Genome-wide association study on coronary artery disease in type 1 diabetes suggests beta-defensin 127 as a risk locus

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  3. Genome-wide association study identifies locus at chromosome 2q32.1 associated with syncope and collapse

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  4. Genetic associations and regulation of expression indicate an independent role for 14q32 snoRNAs in Human Cardiovascular Disease

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  1. Vital exhaustion in women with chest pain and no obstructive coronary artery disease: the iPOWER study

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  2. Screening for Potential Familial Hypercholesterolaemia in General Practice: an observational study on prevalence and management

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  3. Impaired coronary flow velocity reserve is associated with cardiovascular risk factors but not with angina symptoms

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  • Peter Ong
  • Basmah Safdar
  • Andreas Seitz
  • Astrid Hubert
  • John F Beltrame
  • Eva Prescott
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The coronary microcirculation plays a pivotal role in the regulation of coronary blood flow and cardiac metabolism. It can adapt to acute and chronic pathologic conditions such as coronary thrombosis or long-standing hypertension. Due to the fact that the coronary microcirculation cannot be visualized in human beings in vivo, its assessment remains challenging. Thus, the clinical importance of the coronary microcirculation is still often underestimated or even neglected. Depending on the clinical condition of the respective patient, several non-invasive (e.g. transthoracic Doppler-echocardiography assessing coronary flow velocity reserve, cardiac magnetic resonance imaging, positron emission tomography) and invasive methods (e.g. assessment of coronary flow reserve (CFR) and microvascular resistance (MVR) using adenosine, microvascular coronary spasm with acetylcholine) have been established for the assessment of coronary microvascular function. Individual patient characteristics, but certainly also local availability, methodical expertise and costs will influence which methods are being used for the diagnostic work-up (non-invasive and/or invasive assessment) in a patient with recurrent symptoms and suspected coronary microvascular dysfunction. Recently, the combined invasive assessment of coronary vasoconstrictor as well as vasodilator abnormalities has been titled interventional diagnostic procedure (IDP). It involves intracoronary acetylcholine testing for the detection of coronary spasm as well as CFR and MVR assessment in response to adenosine using a dedicated wire. Currently, the IDP represents the most comprehensive coronary vasomotor assessment. Studies using the IDP to better characterize the endotypes observed will hopefully facilitate development of tailored and effective treatments.

Original languageEnglish
JournalCardiovascular Research
Volume116
Issue number4
Pages (from-to)841-855
Number of pages15
ISSN0008-6363
DOIs
Publication statusPublished - 1 Mar 2020

    Research areas

  • Cardiac Catheterization, Cardiac Imaging Techniques, Coronary Circulation, Coronary Vessels/diagnostic imaging, Humans, Microcirculation, Microvessels/diagnostic imaging, Myocardial Ischemia/diagnosis, Predictive Value of Tests, Prognosis, Vasoconstriction, Vasodilatation, Diagnosis, Coronary microvascular dysfunction

ID: 61665009