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Review
. 2021 Jun;38(6):993-1001.
doi: 10.1111/echo.15059. Epub 2021 May 5.

Echocardiographic assessment of coronary microvascular dysfunction: Basic concepts, technical aspects, and clinical settings

Andreina Carbone  1 , Antonello D'Andrea  2 , Simona Sperlongano  2 , Ercole Tagliamonte  2 , Giulia Elena Mandoli  3 , Ciro Santoro  4 , Vincenzo Evola  5 , Francesco Bandera  6   7 , Doralisa Morrone  8 , Alessandro Malagoli  9 , Flavio D'Ascenzi  3 , Eduardo Bossone  10 , Matteo Cameli  3 ; Echocardiography study group of the Italian Society of Cardiology
Affiliations
Review

Echocardiographic assessment of coronary microvascular dysfunction: Basic concepts, technical aspects, and clinical settings

Andreina Carbone et al. Echocardiography. 2021 Jun.

Abstract

Coronary flow reserve is the capacity of the coronary circulation to augment the blood flow in response an increase in myocardial metabolic demands and has a powerful prognostic significance in different clinical situations. It might assess with invasive and noninvasive technique. Transthoracic echocardiography Doppler is an emerging diagnostic technique, noninvasive, highly feasible, safe for patient and physician, without radiation, and able to detect macrovascular and microvascular anomalies in the coronary circulation. This review aims to describe the benefit and limits of echocardiographic assessment of coronary flow reserve.

Keywords: Doppler echocardiography; coronary flow reserve; coronary microvascular dysfunction; coronary physiology; microcirculation.

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Figures

FIGURE 1
FIGURE 1
Color Doppler images of the distal left anterior descending coronary artery (LAD) and interventricular posterior coronary artery (IVP). The modified apical 4‐chamber (A) and 2‐chamber (B) positions, with cranial angulation of the transducer and a Nyquist limit of 20‐67 cm/s, allow optimal identification of the diastolic coronary flow. LV = left ventricle; RV = right ventricle; LA = left atrium
FIGURE 2
FIGURE 2
an example of normal coronary flow reserve in a healthy subject. Velocity patterns are registered by pulsed‐wave Doppler. Resting laminar peak diastolic velocity in normal coronary artery is from 0.21 ± 0.08 m/s to 0.28 ± 0.09 m/s, and the velocity will not exceed 1 m/s even in case of its three‐ fourfold increase in the stenosis site. CFR is expressed as the ratio of coronary flow velocity under maximal vasodilatation to coronary flow velocity at rest. In this case, the basal peak diastolic flow velocity is normal, and it increases more than 2 times after dipyridamole, and therefore, CFR is normal. LV = left ventricle; Vp(d) = velocity peak (diastolic); CFVR = coronary flow velocity ratio
FIGURE 3
FIGURE 3
impaired CFR in an HCM patient with normal epicardial coronary arteries. Basal increased coronary flow with high peak diastolic flow velocity in distal LAD at rest; after dipyridamole, the increase of peak diastolic flow velocity is slight, and CFR is equal to 1.2. Vp(d)= velocity peak (diastolic)
See this image and copyright information in PMC

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