The link between myocardial ischemia and obstructive atherosclerosisof the epicardial coronary arteries is well established, andcoronary angiography has demonstrated a relationship betweenthe severity and extent of coronary artery disease (CAD) andsurvival. In the past two decades, however, a number of studieshave reported that abnormalities in the function and structureof the coronary microcirculation occur in many clinical conditions.In some instances these abnormalities represent epiphenomena,whereas in others they represent important markers of risk ormay even contribute to the pathogenesis of myocardial ischemia,thus becoming therapeutic targets.1
Functional Anatomy of the Coronary Arterial System
Classification of Coronary Microvascular Dysfunction
Microvascular Dysfunction without CAD or Myocardial Diseases
Cigarette Smoking
Hyperlipidemia
Diabetes
Microvascular Angina
Microvascular Dysfunction with Myocardial Diseases
Primary (Genetic) Cardiomyopathies
Hypertrophic Cardiomyopathy
Dilated Cardiomyopathy
Secondary Cardiomyopathies
Arterial Hypertension
Aortic Stenosis
Infiltrative Heart Disease
Microvascular Dysfunction with Obstructive CAD
Stable CAD
Acute Coronary Syndromes without ST-Segment Elevation
Acute Myocardial Infarction with ST-Segment Elevation
Iatrogenic Coronary Microvascular Dysfunction
Conclusions
Source Information
From the Medical Research Council Clinical Sciences Centre and National Heart and Lung Institute, Imperial College, London (P.G.C.); and the Institute of Cardiology, Catholic University, Rome (F.C.).
Address reprint requests to Dr. Camici at the Medical Research Council Clinical Sciences Centre, Hammersmith Hospital, Du Cane Rd., London W12 0NN, United Kingdom, or at paolo.camici@csc.mrc.ac.uk.
Rubinshtein, R., Yang, E. H., Rihal, C. S., Prasad, A., Lennon, R. J., Best, P. J., Lerman, L. O., Lerman, A.
(2009). Coronary microcirculatory vasodilator function in relation to risk factors among patients without obstructive coronary disease and low to intermediate Framingham score. Eur Heart J
0: ehp459v1-ehp459
[Abstract][Full Text]
Lin, J., Zhu, X., Chade, A. R., Jordan, K. L., Lavi, R., Daghini, E., Gibson, M. E., Guglielmotti, A., Lerman, A., Lerman, L. O.
(2009). Monocyte Chemoattractant Proteins Mediate Myocardial Microvascular Dysfunction in Swine Renovascular Hypertension. Arterioscler. Thromb. Vasc. Bio.
29: 1810-1816
[Abstract][Full Text]
Escaned, J., Flores, A., Garcia-Pavia, P., Segovia, J., Jimenez, J., Aragoncillo, P., Salas, C., Alfonso, F., Hernandez, R., Angiolillo, D. J., Jimenez-Quevedo, P., Banuelos, C., Alonso-Pulpon, L., Macaya, C.
(2009). Assessment of Microcirculatory Remodeling With Intracoronary Flow Velocity and Pressure Measurements: Validation With Endomyocardial Sampling in Cardiac Allografts. Circulation
120: 1561-1568
[Abstract][Full Text]
Ganz, P., Hsue, P. Y.
(2009). Assessment of Structural Disease in the Coronary Microvasculature. Circulation
120: 1555-1557
[Full Text]
McGeechan, K., Liew, G., Macaskill, P., Irwig, L., Klein, R., Klein, B. E.K., Wang, J. J., Mitchell, P., Vingerling, J. R., deJong, P. T.V.M., Witteman, J. C.M., Breteler, M. M.B., Shaw, J., Zimmet, P., Wong, T. Y.
(2009). Meta-analysis: Retinal Vessel Caliber and Risk for Coronary Heart Disease. ANN INTERN MED
151: 404-413
[Abstract][Full Text]
Fischer-Rasokat, U., Assmus, B., Seeger, F. H., Honold, J., Leistner, D., Fichtlscherer, S., Schachinger, V., Tonn, T., Martin, H., Dimmeler, S., Zeiher, A. M.
(2009). A Pilot Trial to Assess Potential Effects of Selective Intracoronary Bone Marrow-Derived Progenitor Cell Infusion in Patients With Nonischemic Dilated Cardiomyopathy: Final 1-Year Results of the Transplantation of Progenitor Cells and Functional Regeneration Enhancement Pilot Trial in Patients With Nonischemic Dilated Cardiomyopathy. Circ Heart Fail
2: 417-423
[Abstract][Full Text]
Bagi, Z.
(2009). Mechanisms of coronary microvascular adaptation to obesity. Am. J. Physiol. Regul. Integr. Comp. Physiol.
297: R556-R567
[Abstract][Full Text]
Cortigiani, L, Rigo, F, Sicari, R, Gherardi, S, Bovenzi, F, Picano, E
(2009). Prognostic correlates of combined coronary flow reserve assessment on left anterior descending and right coronary artery in patients with negative stress echocardiography by wall motion criteria. Heart
95: 1423-1428
[Abstract][Full Text]
Maron, M. S., Olivotto, I., Maron, B. J., Prasad, S. K., Cecchi, F., Udelson, J. E., Camici, P. G.
(2009). The case for myocardial ischemia in hypertrophic cardiomyopathy.. J Am Coll Cardiol
54: 866-875
[Abstract][Full Text]
Sattler, K. J.E., Herrmann, J., Yun, S., Lehmann, N., Wang, Z., Heusch, G., Sack, S., Erbel, R., Levkau, B.
(2009). High high-density lipoprotein-cholesterol reduces risk and extent of percutaneous coronary intervention-related myocardial infarction and improves long-term outcome in patients undergoing elective percutaneous coronary intervention. Eur Heart J
30: 1894-1902
[Abstract][Full Text]
Recio-Mayoral, A., Mason, J. C., Kaski, J. C., Rubens, M. B., Harari, O. A., Camici, P. G.
(2009). Chronic inflammation and coronary microvascular dysfunction in patients without risk factors for coronary artery disease. Eur Heart J
30: 1837-1843
[Abstract][Full Text]
Zhu, X.-Y., Daghini, E., Chade, A. R., Versari, D., Krier, J. D., Textor, K. B., Lerman, A., Lerman, L. O.
(2009). Myocardial microvascular function during acute coronary artery stenosis: effect of hypertension and hypercholesterolaemia. Cardiovasc Res
83: 371-380
[Abstract][Full Text]
Herzog, B. A., Husmann, L., Valenta, I., Gaemperli, O., Siegrist, P. T., Tay, F. M., Burkhard, N., Wyss, C. A., Kaufmann, P. A.
(2009). Long-Term Prognostic Value of (13)N-Ammonia Myocardial Perfusion Positron Emission Tomography Added Value of Coronary Flow Reserve.. J Am Coll Cardiol
54: 150-156
[Abstract][Full Text]
Beanlands, R. S.B., Ziadi, M. C., Williams, K.
(2009). Quantification of Myocardial Flow Reserve Using Positron Emission Imaging The Journey to Clinical Use.. J Am Coll Cardiol
54: 157-159
[Full Text]
Camici, P. G., Rimoldi, O. E.
(2009). The Clinical Value of Myocardial Blood Flow Measurement. JNM
50: 1076-1087
[Abstract][Full Text]
Camici, P. G.
(2009). Absolute Figures Are Better Than Percentages. J Am Coll Cardiol Img
2: 759-760
[Full Text]
Delcour, K. S., Khaja, A., Chockalingam, A., Kuppuswamy, S., Dresser, T.
(2009). Outcomes in Patients With Abnormal Myocardial Perfusion Imaging and Normal Coronary Angiogram. ANGIOLOGY
60: 318-321
[Abstract]
Goette, A., Bukowska, A., Dobrev, D., Pfeiffenberger, J., Morawietz, H., Strugala, D., Wiswedel, I., Rohl, F.-W., Wolke, C., Bergmann, S., Bramlage, P., Ravens, U., Lendeckel, U.
(2009). Acute atrial tachyarrhythmia induces angiotensin II type 1 receptor-mediated oxidative stress and microvascular flow abnormalities in the ventricles. Eur Heart J
30: 1411-1420
[Abstract][Full Text]
Aboukhoudir, F., Rekik, S., Andrieu, S., Cheggour, S., Pansieri, M., Metge, M., Barnay, P., Faugier, J. P., Schouvey, S., Quaino, G., Unal, C., Gonzalez, S., Hirsch, J. L.
(2009). Coronary artery spasm and dobutamine stress echocardiography. Eur J Echocardiogr
10: 556-561
[Abstract][Full Text]
Seddon, M., Melikian, N., Dworakowski, R., Shabeeh, H., Jiang, B., Byrne, J., Casadei, B., Chowienczyk, P., Shah, A. M.
(2009). Effects of Neuronal Nitric Oxide Synthase on Human Coronary Artery Diameter and Blood Flow In Vivo. Circulation
119: 2656-2662
[Abstract][Full Text]
Beller, G. A., Watson, D. D.
(2009). A Welcomed New Myocardial Perfusion Imaging Agent for Positron Emission Tomography. Circulation
119: 2299-2301
[Full Text]
Cheung, N., Rogers, S., Mosley, T. H., Klein, R., Couper, D., Wong, T. Y.
(2009). Vital Exhaustion and Retinal Microvascular Changes in Cardiovascular Disease: Atherosclerosis Risk in Communities Study. Psychosom. Med.
71: 308-312
[Abstract][Full Text]
(2009). Padua University: The role it has played in the History of Medicine and Cardiology and its position today. Eur Heart J
30: 629-635
[Full Text]
Camici, P. G., Rimoldi, O. E.
(2009). A Novel 18F-Labeled Tracer for the Quantification of Myocardial Blood Flow and Infarct Size With Positron-Emission Tomography: Another Way to Avoid the Need of an On-Site Cyclotron. Circ Cardiovasc Imaging
2: 75-76
[Full Text]
Koleganova, N., Piecha, G., Ritz, E., Gross, M.-L.
(2009). Calcitriol ameliorates capillary deficit and fibrosis of the heart in subtotally nephrectomized rats. Nephrol Dial Transplant
24: 778-787
[Abstract][Full Text]
Hiss, F. C., Lascala, T. F., Maciel, B. C., Marin-Neto, J. A., Simoes, M. V.
(2009). Changes in myocardial perfusion correlate with deterioration of left ventricular systolic function in chronic Chagas' cardiomyopathy.. J Am Coll Cardiol Img
2: 164-172
[Abstract][Full Text]
Schwartz, R. G., Wexler, O.
(2009). Early identification and monitoring progression of Chagas' cardiomyopathy with SPECT myocardial perfusion imaging.. J Am Coll Cardiol Img
2: 173-175
[Full Text]
Tio, R. A., Dabeshlim, A., Siebelink, H.-M. J., de Sutter, J., Hillege, H. L., Zeebregts, C. J., Dierckx, R. A.J.O., van Veldhuisen, D. J., Zijlstra, F., Slart, R. H.J.A.
(2009). Comparison Between the Prognostic Value of Left Ventricular Function and Myocardial Perfusion Reserve in Patients with Ischemic Heart Disease. JNM
50: 214-219
[Abstract][Full Text]
Neglia, D., L'Abbate, A.
(2009). Myocardial Perfusion Reserve in Ischemic Heart Disease. JNM
50: 175-177
[Full Text]
Cambronero, F., Marin, F., Roldan, V., Hernandez-Romero, D., Valdes, M., Lip, G. Y.H.
(2009). Biomarkers of pathophysiology in hypertrophic cardiomyopathy: implications for clinical management and prognosis. Eur Heart J
0: ehn538v1-13
[Abstract][Full Text]
Crea, F., Camici, P. G., De Caterina, R., Lanza, G. A.
(2009). CHAPTER 17 Chronic Ischaemic Heart Disease. ESC Textbook of Cardiovascular Medicine
2: med-9780199566990-chapter-med-9780199566990-chapter
[Abstract][Full Text]
Heinonen, I., Nesterov, S. V., Liukko, K., Kemppainen, J., Nagren, K., Luotolahti, M., Virsu, P., Oikonen, V., Nuutila, P., Kujala, U. M., Kainulainen, H., Boushel, R., Knuuti, J., Kalliokoski, K. K.
(2008). Myocardial blood flow and adenosine A2A receptor density in endurance athletes and untrained men. J. Physiol.
586: 5193-5202
[Abstract][Full Text]
Pries, A. R., Habazettl, H., Ambrosio, G., Hansen, P. R., Kaski, J. C., Schachinger, V., Tillmanns, H., Vassalli, G., Tritto, I., Weis, M., de Wit, C., Bugiardini, R.
(2008). A review of methods for assessment of coronary microvascular disease in both clinical and experimental settings. Cardiovasc Res
80: 165-174
[Abstract][Full Text]
Camici, P. G
(2008). Coronary Microvascular Dysfunction in Patients with Cardiomyopathies. Circ Heart Fail
1: 150-152
[Full Text]
Hadjiloizou, N., Davies, J. E., Malik, I. S., Aguado-Sierra, J., Willson, K., Foale, R. A., Parker, K. H., Hughes, A. D., Francis, D. P., Mayet, J.
(2008). Differences in cardiac microcirculatory wave patterns between the proximal left mainstem and proximal right coronary artery. Am. J. Physiol. Heart Circ. Physiol.
295: H1198-H1205
[Abstract][Full Text]
Levy, B. I., Schiffrin, E. L., Mourad, J.-J., Agostini, D., Vicaut, E., Safar, M. E., Struijker-Boudier, H. A.J.
(2008). Impaired Tissue Perfusion: A Pathology Common to Hypertension, Obesity, and Diabetes Mellitus. Circulation
118: 968-976
[Full Text]
Sotgia, B., Sciagra, R., Olivotto, I., Casolo, G., Rega, L., Betti, I., Pupi, A., Camici, P. G., Cecchi, F.
(2008). Spatial Relationship Between Coronary Microvascular Dysfunction and Delayed Contrast Enhancement in Patients with Hypertrophic Cardiomyopathy. JNM
49: 1090-1096
[Abstract][Full Text]
Stangl, V., Witzel, V., Baumann, G., Stangl, K.
(2008). Current diagnostic concepts to detect coronary artery disease in women. Eur Heart J
29: 707-717
[Abstract][Full Text]
Fearon, W. F., Shah, M., Ng, M., Brinton, T., Wilson, A., Tremmel, J. A., Schnittger, I., Lee, D. P., Vagelos, R. H., Fitzgerald, P. J., Yock, P. G., Yeung, A. C.
(2008). Predictive value of the index of microcirculatory resistance in patients with ST-segment elevation myocardial infarction.. J Am Coll Cardiol
51: 560-565
[Abstract][Full Text]
Knaapen, P., Germans, T., Camici, P. G., Rimoldi, O. E., ten Cate, F. J., ten Berg, J. M., Dijkmans, P. A., Boellaard, R., van Dockum, W. G., Gotte, M. J. W., Twisk, J. W. R., van Rossum, A. C., Lammertsma, A. A., Visser, F. C.
(2008). Determinants of coronary microvascular dysfunction in symptomatic hypertrophic cardiomyopathy. Am. J. Physiol. Heart Circ. Physiol.
294: H986-H993
[Abstract][Full Text]
Lanza, G. A., Buffon, A., Sestito, A., Natale, L., Sgueglia, G. A., Galiuto, L., Infusino, F., Mariani, L., Centola, A., Crea, F.
(2008). Relation between stress-induced myocardial perfusion defects on cardiovascular magnetic resonance and coronary microvascular dysfunction in patients with cardiac syndrome X.. J Am Coll Cardiol
51: 466-472
[Abstract][Full Text]
McIntyre, C. W., Burton, J. O., Selby, N. M., Leccisotti, L., Korsheed, S., Baker, C. S.R., Camici, P. G.
(2008). Hemodialysis-Induced Cardiac Dysfunction Is Associated with an Acute Reduction in Global and Segmental Myocardial Blood Flow. CJASN
3: 19-26
[Abstract][Full Text]
Naoumova, R. P., Kindler, H., Leccisotti, L., Mongillo, M., Khan, M. T., Neuwirth, C., Seed, M., Holvoet, P., Betteridge, J., Camici, P. G.
(2007). Pioglitazone Improves Myocardial Blood Flow and Glucose Utilization in Nondiabetic Patients With Combined Hyperlipidemia: A Randomized, Double-Blind, Placebo-Controlled Study. J Am Coll Cardiol
50: 2051-2058
[Abstract][Full Text]
van't Veer, M., van Straten, B., vande Vosse, F., Pijls, N.
(2007). Influence of orientation of bi-leaflet valve prostheses on coronary perfusion pressure in humans. ICVTS
6: 588-592
[Abstract][Full Text]
Marques, K. M., Knaapen, P., Boellaard, R., Westerhof, N., Lammertsma, A. A., Visser, C. A., Visser, F. C.
(2007). Hyperaemic microvascular resistance is not increased in viable myocardium after chronic myocardial infarction. Eur Heart J
28: 2320-2325
[Abstract][Full Text]
Erbs, S., Linke, A., Schachinger, V., Assmus, B., Thiele, H., Diederich, K.-W., Hoffmann, C., Dimmeler, S., Tonn, T., Hambrecht, R., Zeiher, A. M., Schuler, G.
(2007). Restoration of Microvascular Function in the Infarct-Related Artery by Intracoronary Transplantation of Bone Marrow Progenitor Cells in Patients With Acute Myocardial Infarction: The Doppler Substudy of the Reinfusion of Enriched Progenitor Cells and Infarct Remodeling in Acute Myocardial Infarction (REPAIR-AMI) Trial. Circulation
116: 366-374
[Abstract][Full Text]
Futterman, L. G., Lemberg, L.
(2007). The Leukocyte Count, A Measure and Predictor of Coronary Events. Am J Crit Care
16: 401-404
[Full Text]
Camici, P. G.
(2007). Is the chest pain in cardiac syndrome X due to subendocardial ischaemia?. Eur Heart J
28: 1539-1540
[Full Text]
Duran, J. R. III, Taffet, G., Camici, P. G., Crea, F.
(2007). Coronary Microvascular Dysfunction. NEJM
356: 2324-2325
[Full Text]