We mourn the untimely passing of Dr. Amir Lerman, from the Mayo Clinic in Rochester, MN, who was an original member of the MVN. His tireless work and research in the field of coronary physiology established a cornerstone upon which programs such as the MVN can exist, thrive, and now must move forward without him. We send our condolences to his family, Mayo Clinic colleagues, and the entire physiology community.
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Why Does Coronary Microvascular Dysfunction Matter? Up to 50% of patients with chest pain who are referred for cardiac catheterization / coronary angiography do not have obstructive disease of the major coronary arteries. This syndrome is termed ANOCA. Coronary microvascular dysfunction is one of the possible causes (or "endotypes") of ANOCA.
Goals:
Community: Build a community of clinicians dedicated to the diagnosis and management of CMD.
Dialogue: Create forums for knowledge sharing and idea generation based on unmet needs.
Alignment: Develop common language, terminology, and approaches to the diagnosis and management of CMD.
Advancement: Advance care through research, registries, scientific statements and guidelines.
Outcomes: Expand access to care, ensure accurate diagnoses, and advance treatment options to improve clinical outcomes and patient quality of life..
Practice Changing Featured Research:
Coronary Sinus Reducer Improves Angina, Quality of Life, and Coronary Flow Reserve in Microvascular Dysfunction. Tryon D, Corban MT, Alkhouli M, Prasad A, Raphael CE, Rihal CS, Reeder GS, Lewis B, Albers D, Gulati R, Lerman A. JACC Cardiovasc Interv. 2024 Oct 23:S1936-8798(24)01202-0. PMID: 39520443
This Phase II trial evaluated the coronary sinus (CS) Reducer as a potential treatment for refractory angina in 30 ANOCA patients with CMD, defined by reduced coronary flow reserve (CFR ≤2.5) and/or an abnormal coronary blood flow (CBF) response to acetylcholine. At 120 days post-implantation, patients with endothelium-independent CMD showed a significant improvement in CFR (from 2.1 to 2.7, P = 0.0011), while those with endothelium-dependent CMD experienced improved CBF response (-11.0% to 11.5%, P = 0.042). Patients demonstrated substantial symptom improvement by Canadian Cardiovascular Society (CCS) angina class (median reduction from 4.0 to 2.0, P < 0.001) and quality of life, as measured by the Seattle Angina Questionnaire (P < 0.006 for all domains). These findings suggest the CS Reducer significantly enhances coronary microvascular function, alleviates angina, and improves quality of life, offering a promising therapy for CMD in ANOCA patients..
Angiographic Coronary Slow Flow Is Not a Valid Surgate for Invasively Diagnosed Coronary Microvascular Dysfunction. Mayer M, Allan T, Harkin KL, Loftspring E, Saffari SE, Reynolds HR, Paul J, Kalathiya R, Shah AP, Nathan S, McCarthy MC, Smilowitz NR, Miner SES, Blair J. JACC Cardiovasc Interv. 2024 Apr 8;17(7):920-929. doi: 10.1016/j.jcin.2024.02.025. PMID: 38599696
The aim of this study was to investigate relationships between cTFC and invasive CFT for CMD. Coronary slow flow was weakly associated with results of invasive CFT and should not be used as a surrogate for the invasive diagnosis of CMD.
Rethinking False Positive Exercise Electrocardiographic Stress Tests by Assessing Coronary Microvascular Function. Sinha A, Dutta U, Demir OM, De Silva K, Ellis H, Belford S, Ogden M, Li Kam Wa M, Morgan HP, Shah AM, Chiribiri A, Webb AJ, Marber M, Rahman H, Perera D. J Am Coll Cardiol. 2024 Jan 16;83(2):291-299. doi: 10.1016/j.jacc.2023.10.034. PMID: 38199706
In patients with ANOCA, ischemia on EST was highly specific of an underlying ischemic substrate. These findings challenge the traditional belief that EST has a high false positive rate.
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