The following are key points to remember from this state-of-the-art review on cardiovascular imaging in microvascular dysfunction:

1. The understanding of microvascular dysfunction without evidence of epicardial coronary artery disease is far less in comparison with that of obstructive epicardial coronary artery disease.
2. A primary limitation in the past has been the lack of noninvasive methods of detecting and quantifying microvascular dysfunction.
3. “Microvascular dysfunction” is a broad term; in the absence of obstructive coronary disease, it includes any pathology that may disrupt the microvasculature, including endothelial dysfunction, coronary spasm, inflammation, and atherosclerosis.
4. A number of imaging methods are presently available to measure myocardial blood flow in the setting of microvascular dysfunction.
5. Positron emission tomography (PET) has the most clinical and prognostic data compared with the other modalities, but cardiac magnetic resonance (CMR)-derived myocardial blood flow measures are being increasingly used to assess clinical utility and response to treatment.
6. A few algorithms have been proposed in the clinical evaluation of microvascular angina and diagnosis of microvascular dysfunction, with the use of PET as the diagnostic imaging modality for the evaluation of perfusion abnormalities and myocardial blood flow quantification.
7. CMR measures of myocardial blood flow remain in the research realm and are not yet fully vetted for clinical use.
8. Clinically, the type of imaging modality used should depend on local availability of the technology, as well as risk/benefit analysis and cost to the patient.
9. Additional studies are currently examining integrative imaging approaches and regional versus global myocardial perfusion reserve assessments, which show promise for improving measurement precision.
10. Our current understanding of mechanisms and therapy for microvascular dysfunction is significantly less than that for obstructive epicardial disease, but advances in cardiac imaging may soon allow improved identification and treatment of this disease.

Clinical Topics: Noninvasive Imaging, Prevention, Stable Ischemic Heart Disease, Atherosclerotic Disease (CAD/PAD), Computed Tomography, Magnetic Resonance Imaging, Nuclear Imaging, Chronic Angina

Keywords: Atherosclerosis, Cardiac Imaging Techniques, Coronary Artery Disease, Diagnostic Imaging, Coronary Vasospasm, Inflammation, Magnetic Resonance Imaging, Microvascular Angina, Microvessels, Myocardial Ischemia, Myocardial Perfusion Imaging, Positron-Emission Tomography, Secondary Prevention

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