Non-invasive quantification of coronary vascular dysfunction for diagnosis and management of coronary artery disease

Excerpt

The last several decades have seen significant advances in the evaluation and treatment of coronary artery disease. Multiple non-invasive methods for the diagnosis of coronary atherosclerosis have matured and are in wide clinical practice. Improving risk factors and primary1,2 and secondary prevention strategies3 have resulted in a decline in cardiac mortality and myocardial infarction.4,5 The focus of these diagnostic methods and treatment strategies has been on the identification and treatment of atherosclerotic lesions of the epicardial coronary arteries, particularly obstructive, ischemia causing lesions. While there is no doubt that this approach has been tremendously successful, it must be noted the coronary arterial circulation extends from large epicardial conduit arteries through resistance arterioles (i.e., the microvasculature) to the intra-myocardial capillary bed. Dysfunction of the microvasculature and pre-obstructive disease of the epicardial arteries can not only cause typical anginal symptoms but also may be harbingers of adverse prognosis. In the following paragraphs, we will discuss current approaches to the quantification of coronary vascular function and the evidence supporting its potential diagnostic and prognostic implications with a particular focus on ischemic heart disease. …