Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan 6;21(1):5.
doi: 10.1186/s12880-020-00535-7.

Evaluation of non-invasive imaging parameters in coronary microvascular disease: a systematic review

F Groepenhoff #  1   2 , R G M Klaassen #  1 , G B Valstar  1 , S H Bots  1 , N C Onland-Moret  3 , H M Den Ruijter  1 , T Leiner  4 , A L M Eikendal  5
Affiliations

Evaluation of non-invasive imaging parameters in coronary microvascular disease: a systematic review

F Groepenhoff et al. BMC Med Imaging. .

Erratum in

Abstract

Background: Coronary microvascular dysfunction (CMD) is an important underlying cause of angina pectoris. Currently, no diagnostic tool is available to directly visualize the coronary microvasculature. Invasive microvascular reactivity testing is the diagnostic standard for CMD, but several non-invasive imaging techniques are being evaluated. However, evidence on reported non-invasive parameters and cut-off values is limited. Thus, we aimed to provide an overview of reported non-invasive parameters and corresponding cut-off values for CMD.

Methods: Pubmed and EMBASE databases were systematically searched for studies enrolling patients with angina pectoris without obstructed coronary arteries, investigating at least one non-invasive imaging technique to quantify CMD. Methodological quality assessment of included studies was performed using QUADAS-2.

Results: Thirty-seven studies were included. Ten cardiac magnetic resonance studies reported MPRI and nine positron emission tomography (PET) and transthoracic echocardiography (TTE) studies reported CFR. Mean MPRI ranged from 1.47 ± 0.36 to 2.01 ± 0.41 in patients and from 1.50 ± 0.47 to 2.68 ± 0.49 in controls without CMD. Reported mean CFR in PET and TTE ranged from 1.39 ± 0.31 to 2.85 ± 1.35 and 1.69 ± 0.40 to 2.40 ± 0.40 for patients, and 2.68 ± 0.83 to 4.32 ± 1.78 and 2.65 ± 0.65 to 3.31 ± 1.10 for controls, respectively.

Conclusions: This systematic review summarized current evidence on reported parameters and cut-off values to diagnose CMD for various non-invasive imaging modalities. In current clinical practice, CMD is generally diagnosed with a CFR less than 2.0. However, due to heterogeneity in methodology and reporting of outcome measures, outcomes could not be compared and no definite reference values could be provided.

Keywords: Coronary flow reserve; Coronary microvascular dysfunction; Myocardial perfusion reserve; Non-invasive imaging; Reference values.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart study design. RCT randomized controlled trial
Fig. 2
Fig. 2
Overview of study outcomes presented as mean ± SD in patients and controls for MPRI by CMR (a), CFR by PET (b) and CFR by TTE (c). For CMR. Error bars are not shown for some studies as some only assessed patient or control subjects. Studies with multiple patient or control groups are indicated by numbers. CFR coronary flow reserve, CMR cardiac magnetic resonance imaging, MPRI myocardial perfusion reserve index, PET positron emission tomography, TTE transthoracic echocardiography
See this image and copyright information in PMC

References

    1. Patel MR, Peterson ED, Dai D, Brennan JM, Redberg RF, Anderson HV, Brindis RG, Douglas PS. Low diagnostic yield of elective coronary angiography. N Engl J Med. 2010;362:886–895. doi: 10.1056/NEJMoa0907272. - DOI - PMC - PubMed
    1. Chen C, Wei J, AlBadri A, Zarrini P, Bairey Merz C. Coronary microvascular dysfunction—epidemiology, pathogenesis, prognosis, diagnosis, risk factors and therapy. Circ J. 2016;81:3–11. doi: 10.1253/circj.CJ-16-1002. - DOI - PMC - PubMed
    1. Sara JD, Widmer RJ, Matsuzawa Y, Lennon RJ, Lerman LO, Lerman A. Prevalence of coronary microvascular dysfunction among patients with chest pain and nonobstructive coronary artery disease. JACC Cardiovasc Interv. 2015;8:1445–1453. doi: 10.1016/j.jcin.2015.06.017. - DOI - PubMed
    1. Camici PG, Crea F. Coronary microvascular dysfunction. N Engl J Med. 2007;356:830–840. doi: 10.1056/NEJMra061889. - DOI - PubMed
    1. Dean J, Dela CS, Mehta PK, Merz CNB. Coronary microvascular dysfunction: sex-specific risk, diagnosis, and therapy. Nat Rev Cardiol. 2015;12:406–414. doi: 10.1038/nrcardio.2015.72. - DOI - PubMed

Publication types