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Coronary Vasomotion Abnormalities pp 119–137Cite as

Diagnosis of Coronary Microvascular Dysfunction

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Abstract

Coronary microvascular dysfunction (CMD) has emerged as a third potential mechanism of myocardial ischemia in addition to coronary atherosclerotic disease (CAD) and epicardial coronary artery spasm. Since several studies indicated that CMD could be associated with increased risk of cardiovascular events, it is important to make correct diagnosis and assessment of CMD. However, in contrast with epicardial coronary arteries, the coronary microcirculation cannot be directly visualized in vivo with coronary angiography or intracoronary imaging technique. Although there are several non-invasive (e.g. transthoracic Doppler echocardiography, positron emission tomography, cardiac magnetic resonance imaging) and invasive (e.g. assessment of coronary flow reserve and microvascular resistance using adenosine, microvascular coronary spasm with acetylcholine) approaches for the evaluation of coronary microvascular function, all of them have several limitations. Currently, the interventional diagnostic procedure, which consists of acetylcholine testing for the detection of coronary spasm as well as coronary flow reserve and microvascular resistance assessment in response to adenosine using a coronary pressure–temperature sensor guidewire, could represent the most comprehensive coronary vasomotor evaluation. Furthermore, several biomarkers have recently attracted much attention as a diagnostic tool for CMD. Especially, plasma concentration of serotonin may be a novel biomarker to dissect CMD from epicardial coronary artery spasm. Correct diagnosis of the underlying cause of angina should enable us to stratify the treatment for distinct disorders, including CMD, vasospastic angina, and non-cardiac chest pain.

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  1. Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan

    Jun Takahashi & Hiroaki Shimokawa

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    Hiroaki Shimokawa

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Takahashi, J., Shimokawa, H. (2021). Diagnosis of Coronary Microvascular Dysfunction. In: Shimokawa, H. (eds) Coronary Vasomotion Abnormalities. Springer, Singapore. https://doi.org/10.1007/978-981-15-7594-5_7

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