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Review
. 2021 Apr 23;10(9):1848.
doi: 10.3390/jcm10091848.

Coronary Microvascular Dysfunction: PET, CMR and CT Assessment

Elisabetta Tonet  1 , Graziella Pompei  1 , Evelina Faragasso  2 , Alberto Cossu  3 , Rita Pavasini  1 , Giulia Passarini  1 , Matteo Tebaldi  1 , Gianluca Campo  1
Affiliations
Review

Coronary Microvascular Dysfunction: PET, CMR and CT Assessment

Elisabetta Tonet et al. J Clin Med. .

Abstract

Microvascular dysfunction is responsible for chest pain in various kinds of patients, including those with obstructive coronary artery disease and persistent symptoms despite revascularization, or those with myocardial disease without coronary stenosis. Its diagnosis can be performed with an advanced imaging technique such as positron emission tomography, which represents the gold standard for diagnosing microvascular abnormalities. In recent years, cardiovascular magnetic resonance and cardiac computed tomography have demonstrated to be emerging modalities for microcirculation assessment. The identification of microvascular disease represents a fundamental step in the characterization of patients with chest pain and no epicardial coronary disease: its identification is important to manage medical strategies and improve prognosis. The present overview summarizes the main techniques and current evidence of these advanced imaging strategies in assessing microvascular dysfunction and, if present, their relationship with invasive evaluation.

Keywords: angina; cardiac computer tomography; cardiac magnetic resonance; microvascular dysfunction; positron emission tomography.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart for the diagnosis of microvascular angina according to current criteria. CAD = coronary artery disease; CT = computed tomography.
Figure 2
Figure 2
Mechanisms of microvascular dysfunction.
Figure 3
Figure 3
Cardiac Magnetic Resonance (CMR) evaluation of microvascular dysfunction in a patient with effort angina without obstructive coronary artery disease. Invasive coronary angiography shows epicardial coronary artery without obstructive disease. CMR sequences show three ventricular slices (basal, mid-ventricular, apical slices) during rest, stress and late gadolinium enhancement (LGE) protocols. Stress CMR is performed with adenosine administration (140 mcg/Kg/min for 3–6 min). Comparing rest and stress CMR sequences, there is a severe and diffuse hypoperfusion in the stress images, showed by a widely hypointense myocardium (green arrows): this pattern is consistent with microvascular dysfunction. LGE images show no myocardial fibrosis. CMR Sequences: Saturation recovery gradient echo pulse sequences for rest and stress images; Inversion recovery gradient echo sequences for LGE images.
Figure 4
Figure 4
CMR assessment of microvascular dysfunction in a young patient with Danon disease. CMR analysis includes sequences for the visualization of epicardial coronary arteries, rest and stress protocols and LGE images of three ventricular slices (basal, mid-ventricular, apical slices). Stress CMR is performed by adenosine administration (140 mcg/Kg/min for 3–6 min). Comparing rest and stress images, a diffuse subendocardial hypoperfusion (green arrows) due to microvascular dysfunction can be noted. LGE images show no ischemic pattern. CMR Sequences: Free-breathing diaphragmatic 3D navigator BFTE Whole heart non contrast sequences for coronary arteries images, Saturation recovery gradient echo pulse sequences for rest and stress images, and Inversion recovery gradient echo sequences for LGE images.
See this image and copyright information in PMC

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