International standardization of diagnostic criteria for microvascular angina

Ong, Peter; Camici, Paolo G.; Beltrame, John F.; Crea, Filippo; Shimokawa, Hiroaki; Sechtem, Udo; Kaski, Juan Carlos; Merz, C. Noel Bairey

doi:10.1016/j.ijcard.2017.08.068

Cited by 571 publications

(602 citation statements)

References 37 publications

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“…Pueden ser de utilidad las pruebas de reserva de flujo coronario para el estudio de la enfermedad de la microvasculatura (8,14) . El diagnóstico de disfunción de flujo coronario puede ser determinado por cualquiera de los siguientes criterios: 1) reserva de flujo coronario < 2,0 en respuesta a un estímulo vasodilatador como adenosina; 2) evidencia de espasmo microvascular diagnosticado durante prueba provocadora de espasmo: dolor torácico y cambios sugestivos de isquemia en el ECG inducidos por provocación de acetilcolina en ausencia de espasmo epicárdico (reducción del diámetro > 75%), o 3) flujo coronario deteriorado medido con recuento de cuadros TIMI (Thrombolysis in Myocardial Infarction) corregida (15,34,35) .…”

Section: Espasmo Microvascularunclassified

Infarto agudo de miocardio sin lesiones coronarias obstructivas - MINOCA: un enigma para el cardiólogo clínico

Ache¹,

Guamán

Viñole

et al. 2020

Rev.Urug.Cardiol.

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ResumenEl infarto agudo de miocardio sin lesiones coronarias obstructivas (MINOCA) es una afección recientemente definida en la práctica cardiológica. Su diagnóstico se basa en la angiografía coronaria, que da inicio a un proceso de búsqueda etiológica muchas veces complejo, pero con importancia pronóstica y terapéutica. Existen diferentes mecanismos involucrados en los MINOCA, que se plantean una vez excluidas la embolia pulmonar, la miocarditis y el síndrome de takotsubo. Se reconoce un patrón epicárdico de MINOCA presente en los casos de disrupción de placa, disección, vasoespasmo, y, eventualmente, embolismo coronario; y un patrón microvascular en casos de espasmo microvascular y embolia coronaria de pequeños vasos. Varias herramientas son útiles en su estudio: ecocardiografía, ventriculografía izquierda, técnicas de imagen intravascular, estudio del flujo coronario y resonancia magnética cardíaca, entre otras. Su uso debe ser guiado por el juicio clínico, y si bien no hay un algoritmo claramente establecido, incorporar todas las herramientas disponibles puede determinar la causa definitiva en algunos pacientes. La presente revisión pretende acercar al cardiólogo clínico información útil para su práctica habitual. SummaryAcute Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) is a recently defined condition in cardiology practice. The diagnosis starts with coronary angiography that is the beginning of an etiological research process, often complex, but with prognostic and therapeutic importance for each etiology. There are different mechanisms involved in MINOCA, which are posed once pulmonary embolism, myocarditis and takotsubo cardiomyopathy are excluded. It is described an epicardial pattern of MINOCA in cases of plaque disruption, dissection, vasospasm, and eventually coronary embolism; and a microvascular pattern in cases of microvascular spasm and small vessel coronary embolism. Several tools are useful in its study, such as echocardiography, left ventriculography, intravascular imaging techniques, study of coronary flow, and cardiac magnetic resonance, among others. Its use should be guided by clinical criteria. Despite there is no clearly established algorithm in our current practice, it is necessary to incorporate all available tools to approach the definitive MINOCA etiology whenever is possible. The aim of this review is to bring useful information to the clinical cardiologist for his daily practice.

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Section: Espasmo Microvascularunclassified

Infarto agudo de miocardio sin lesiones coronarias obstructivas - MINOCA: un enigma para el cardiólogo clínico

Ache¹,

Guamán

Viñole

et al. 2020

Rev.Urug.Cardiol.

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“…CMD is associated with a series of functional and structural changes in the resistance vessels of the heart that lead to absolute decreases in blood flow and ischemia [12]. The clinical manifestations of CMD are indistinguishable from those of typical angina pectoris, and its equivalents, or other forms of "atypical chest" pain [13]. Clinical evaluation has a very insensitive diagnostic ability, so confirmation is reliant on a variety of non-invasive and invasive tests-either used solely or in combination.…”

Section: Coronary Microvascular Disease (Cmd)mentioning

confidence: 99%

Invasive Evaluation of the Microvasculature in Acute Myocardial Infarction: Coronary Flow Reserve versus the Index of Microcirculatory Resistance

Clarke

Kennedy

Lau

et al. 2019

JCM

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Acute myocardial infarction (AMI) is one of the most common causes of death in both the developed and developing world. It has high associated morbidity despite prompt institution of recommended therapy. The focus over the last few decades in ST-segment elevation AMI has been on timely reperfusion of the epicardial vessel. However, microvascular consequences after reperfusion, such as microvascular obstruction (MVO), are equally reliable predictors of outcome. The attention on the microcirculation has meant that traditional angiographic/anatomic methods are insufficient. We searched PubMed and the Cochrane database for English-language studies published between January 2000 and November 2019 that investigated the use of invasive physiologic tools in AMI. Based on these results, we provide a comprehensive review regarding the role for the invasive evaluation of the microcirculation in AMI, with specific emphasis on coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR).

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“…The current recommendation for diagnosis and treatment is based upon expert opinions formulated by the international Coronary Vasomotion Disorders International Study Group (COVADIS) [7]. It is conceivable that this proposal will lead to official ESC/ACC/AHA guidelines.…”

mentioning

confidence: 99%

Gender differences: it’s time for a rational approach

Piek

2019

Neth Heart J

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International standardization of diagnostic criteria for microvascular angina

Cited by 571 publications

References 37 publications

Infarto agudo de miocardio sin lesiones coronarias obstructivas - MINOCA: un enigma para el cardiólogo clínico

Infarto agudo de miocardio sin lesiones coronarias obstructivas - MINOCA: un enigma para el cardiólogo clínico

Invasive Evaluation of the Microvasculature in Acute Myocardial Infarction: Coronary Flow Reserve versus the Index of Microcirculatory Resistance

Gender differences: it’s time for a rational approach

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