Baweja Paramdeep, Sweeney Michael J, López-Candales Angel
Cardiovascular Medicine, University of Missouri Kansas City, Kansas City, USA.
Cureus. 2021 Sep 6;13(9):e17763. doi: 10.7759/cureus.17763. eCollection 2021 Sep.
Identification of ischemia remains critical when assessing individuals presenting with atypical symptoms or in patients with known coronary artery disease (CAD). Several imaging modalities are currently available to attain this diagnostic goal. Unfortunately, not all case presentations are straightforward, particularly when microvascular dysfunction (MVD) is the cause of symptoms in the absence of identifiable epicardial luminal stenosis. Specifically, in such cases, current imaging guidelines do not include stress echocardiography (SE) as a recommended tool when assessing these patients. We present three cases that highlight the utility of SE for identifying MVD and provide mechanistic explanations. We believe that SE should not be completely discarded as an inadequate testing modality; we highlight the potential utility of this imaging modality not only in diagnosing CAD and pre-surgical evaluation of patients but also in identifying patients with MVD.
在评估出现非典型症状的个体或已知患有冠状动脉疾病（CAD）的患者时，识别缺血情况仍然至关重要。目前有几种成像方式可用于实现这一诊断目标。不幸的是，并非所有病例表现都很直接，特别是当微血管功能障碍（MVD）是在没有可识别的心外膜管腔狭窄的情况下导致症状的原因时。具体而言，在这种情况下，当前的成像指南在评估这些患者时并未将负荷超声心动图（SE）列为推荐工具。我们展示了三个病例，突出了SE在识别MVD方面的效用并提供了机制解释。我们认为，SE不应作为一种不充分的检测方式而被完全摒弃；我们强调这种成像方式不仅在诊断CAD和患者术前评估中具有潜在效用，而且在识别患有MVD的患者方面也具有潜在效用。
