Stable microvascular angina: Instrumental evaluation of coronary microvascular dysfunction with coronary angiography and myocardial scintigraphy

Abstract

Stable microvascular angina (SMVA) describes a framework in which episodes of angina are exclusively or predominantly related to exertion. During diagnostic investigation, physician notices findings compatible with myocardial ischemia, normal coronary arteries on angiography, absence of any other specific cardiac disease (e.g., variant angina, cardiomyopathy, and valvular disease) [1,2]. The aim of this study is to demonstrate that myocardial ischemia in patients without epicardial artery stenosis, evaluated with nuclear imaging, correlates with alterations of coronary microcirculation. These alterations were evaluated by angiography indices like TIMI Frame Count (TFC), Myocardial Blush Grade (MBG) and Total Myocardial Blush Score (TMBS). We studied ninety-six patients who came to the emergency room for angina from January 2007 to May 2011. After that they were hospitalized to our institution. In this retrospective study, inclusion criteria are the presence of stable angina, the presence of positive stress test, and coronary arteries free from stenosis at coronary angiography. All patients underwent to myocardial scintigraphy and coronary angiography. Significantly, we excluded patients who had positive biomarkers for myocardial infarction when they arrived to the Emergency Room or during hospitalization. Besides, we considered neither those patients who had the mild increase after coronary angiography, nor those pa

Coronary microvascular dysfunction in diabetes mellitus

“… 103 TFC, similar to total myocardial blush score, represents the sum of three major epicardial artery scores and is useful for coronary microcirculation assessment. 104 …”