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Trends Cardiovasc Med. 2015 Feb;25(2):98-103. doi: 10.1016/j.tcm.2014.09.013. Epub 2014 Nov 7.

Microvascular coronary dysfunction and ischemic heart disease: where are we in 2014?

Author information

1
Division of Cardiovascular Medicine, University of Florida, 1600 SW Archer Road, PO Box 100277, Gainesville, FL 32610-0277.
2
Division of Cardiovascular Medicine, University of Florida, 1600 SW Archer Road, PO Box 100277, Gainesville, FL 32610-0277. Electronic address: carl.pepine@medicine.ufl.edu.

Abstract

Many patients with angina and signs of myocardial ischemia on stress testing have no significant obstructive epicardial coronary disease. There are many potential coronary and non-coronary mechanisms for ischemia without obstructive epicardial coronary disease, and prominent among these is coronary microvascular and/or endothelial dysfunction. Patients with coronary microvascular and/or endothelial dysfunction are often at increased risk of adverse cardiovascular events, including ischemic events and heart failure despite preserved ventricular systolic function. In this article, we will review the diagnosis and treatment of coronary microvascular and endothelial dysfunction, discuss their potential contribution to heart failure with preserved ejection fraction, and highlight recent advances in the evaluation of atherosclerotic morphology in these patients, many of whom have non-obstructive epicardial disease.

PMID:
25454903
PMCID:
PMC4336803
DOI:
10.1016/j.tcm.2014.09.013
[Indexed for MEDLINE]
Free PMC Article

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