Denby Kara J, Zmaili Mohammad, Datta Sudarshana, Das Thomas, Ellis Stephen, Ziada Khaled, Lerman Amir, Raphael Claire E
Department of Cardiovascular Medicine, Saint Alphonsus Regional Medical Center, Boise, ID.
Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH.
Mayo Clin Proc. 2024 Sep;99(9):1469-1481. doi: 10.1016/j.mayocp.2024.04.022.
Approximately half of all coronary angiograms performed for angina do not show obstructive coronary artery disease, and many of these patients have coronary microvascular dysfunction (CMD). Invasive testing for CMD has increased with the advent and wider availability of thermodilution systems. We review CMD pathophysiology and invasive diagnostic testing using the Doppler and thermodilution systems. We report the results of a PubMed search of invasive microvascular testing and discuss limitations of current diagnostic algorithms in the diagnosis of CMD, including controversies regarding the optimal cutoff value for abnormal coronary flow reserve, use of microvascular resistance indices, and options for increasing sensitivity of testing.
因心绞痛进行的冠状动脉造影中，约半数未显示阻塞性冠状动脉疾病，其中许多患者存在冠状动脉微血管功能障碍（CMD）。随着热稀释系统的出现及更广泛应用，针对CMD的有创检测有所增加。我们回顾了CMD的病理生理学以及使用多普勒和热稀释系统进行的有创诊断检测。我们报告了PubMed中关于有创微血管检测的搜索结果，并讨论了当前诊断算法在CMD诊断中的局限性，包括冠状动脉血流储备异常的最佳临界值、微血管阻力指数的使用以及提高检测敏感性的方法等方面的争议。
