JNC: Role of nuclear cardiology in diagnosis and risk stratification of coronary microvascular disease (July/August 2023)-JNC: Role of nuclear cardiology in diagnosis and risk stratification of coronary microvascular disease

JNC: Role of nuclear cardiology in diagnosis and risk stratification of coronary microvascular disease

Pdf Summary

Coronary microvascular disease (CMD) plays a significant role in the symptoms and prognosis of coronary artery disease (CAD), nonischemic cardiomyopathies, and heart failure. Coronary flow reserve (CFR) measured with positron emission tomography/computed tomography (PET/CT) can aid in the diagnosis and risk stratification of CMD. Reduced CFR in patients with INOCA (ischemia with nonobstructive CAD) identifies a high-risk group that may benefit from specific management strategies. However, the use of PET/CT for CFR measurement is limited by cost and availability. Single-photon emission tomography (SPECT) is a feasible alternative for CFR measurement and would increase the availability and utilization of CFR. Patients with CMD can be identified by reduced CFR and selected for specific therapies. CMD also contributes to symptoms and adverse outcomes in patients with obesity, diabetes mellitus, metabolic syndrome, and chronic kidney disease. SPECT measurement of CFR with solid-state cameras is emerging and has good diagnostic accuracy and prognostic value. The diagnostic accuracy and prognostic value of SPECT measurement of CFR need to be further established in specific patient populations. Overall, the utilization of CFR measurements with PET/CT or SPECT has the potential to improve risk stratification and guide personalized therapies for patients with CMD. Further research is needed to evaluate the effectiveness of these approaches in clinical trials and compare them to standard care.

Keywords

Coronary microvascular disease

CMD

coronary artery disease

CAD

coronary flow reserve

CFR

PET/CT

SPECT

risk stratification

personalized therapies