Chinese Expert Consensus on the Diagnosis and Treatment of Coronary Microvascular Diseases (2023 Edition)

Overview

Journal MedComm (2020)

Specialty Health Services

Date 2023 Dec 20

PMID 38116064

Authors

Wenqiang Chen

Mei Ni

He Huang

Hongliang Cong

Xianghua Fu

Wei Gao

Yuejin Yang

Mengyue Yu

Xiantao Song

Meilin Liu

Zuyi Yuan

Bo Zhang

Zhaohui Wang

Yan Wang

Yundai Chen

Cheng Zhang

Yun Zhang

Affiliations

Soon will be listed here.

Abstract

Since the four working groups of the Chinese Society of Cardiology issued first expert consensus on coronary microvascular diseases (CMVD) in 2017, international consensus documents on CMVD have increased rapidly. Although some of these documents made preliminary recommendations for the diagnosis and treatment of CMVD, they did not provide classification of recommendations and levels of evidence. In order to summarize recent progress in the field of CMVD, standardize the methods and procedures of diagnosis and treatment, and identify the scientific questions for future research, the four working groups of the Chinese Society of Cardiology updated the 2017 version of the Chinese expert consensus on CMVD and adopted a series of measures to ensure the quality of this document. The current consensus has raised a new classification of CMVD, summarized new epidemiological findings for different types of CMVD, analyzed key pathological and molecular mechanisms, evaluated classical and novel diagnostic technologies, recommended diagnostic pathways and criteria, and therapeutic strategies and medications, for patients with CMVD. In view of the current progress and knowledge gaps of CMVD, future directions were proposed. It is hoped that this expert consensus will further expedite the research progress of CMVD in both basic and clinical scenarios.

Citing Articles

Advances in the diagnosis and management of post-percutaneous coronary intervention coronary microvascular dysfunction: Insights into pathophysiology and metabolic risk interactions.

Tang N, Li K, Li H, Zhang Q, Hao J, Qi C World J Cardiol. 2025; 17(2):103950.

PMID: 40061275 PMC: 11886395. DOI: 10.4330/wjc.v17.i2.103950.

Analysis of Metabolic Risk Factors for Microcirculation Disorders Post-Percutaneous Coronary Intervention and Predictive Model Construction: A Study on Patients with Unstable Angina.

Li K, Liu S, Wang J, Liu Z, Qi C Rev Cardiovasc Med. 2025; 26(1):25739.

PMID: 39867198 PMC: 11759962. DOI: 10.31083/RCM25739.

Spectrum of Non-Obstructive Coronary Artery Disease and Its Relationship with Atrial Fibrillation.

Oancea A, Morariu P, Buburuz A, Miftode I, Miftode R, Mitu O J Clin Med. 2024; 13(16).

PMID: 39201063 PMC: 11355151. DOI: 10.3390/jcm13164921.

Effect of enhanced external counterpulsation on coronary microcirculation dysfunction (CMD) in patients with coronary artery disease (EECP-CMD II): study protocol of a single-centre, open-label, parallel group, randomised controlled trial.

Cao F, Liu Y, Wei W, Liang J BMJ Open. 2024; 14(8):e086901.

PMID: 39182936 PMC: 11404164. DOI: 10.1136/bmjopen-2024-086901.

Inflammation and coronary microvascular disease: relationship, mechanism and treatment.

Guo Z, Yang Z, Song Z, Li Z, Xiao Y, Zhang Y Front Cardiovasc Med. 2024; 11:1280734.

PMID: 38836066 PMC: 11148780. DOI: 10.3389/fcvm.2024.1280734.

References

Schepis T, Gaemperli O, Treyer V, Valenta I, Burger C, Koepfli P . Absolute quantification of myocardial blood flow with 13N-ammonia and 3-dimensional PET. J Nucl Med. 2007; 48(11):1783-9. DOI: 10.2967/jnumed.107.044099. View

Mejia-Renteria H, Travieso A, Matias-Guiu J, Yus M, Espejo-Paeres C, Finocchiaro F . Coronary microvascular dysfunction is associated with impaired cognitive function: the Cerebral-Coronary Connection study (C3 study). Eur Heart J. 2022; 44(2):113-125. PMC: 9825810. DOI: 10.1093/eurheartj/ehac521. View

Dorbala S, Vangala D, Bruyere Jr J, Quarta C, Kruger J, Padera R . Coronary microvascular dysfunction is related to abnormalities in myocardial structure and function in cardiac amyloidosis. JACC Heart Fail. 2014; 2(4):358-67. PMC: 4127145. DOI: 10.1016/j.jchf.2014.03.009. View

Shah N, Cheezum M, Veeranna V, Horgan S, Taqueti V, Murthy V . Ranolazine in Symptomatic Diabetic Patients Without Obstructive Coronary Artery Disease: Impact on Microvascular and Diastolic Function. J Am Heart Assoc. 2017; 6(5). PMC: 5524071. DOI: 10.1161/JAHA.116.005027. View

Beltrame J, Turner S, Leslie S, Solomon P, Freedman S, Horowitz J . The angiographic and clinical benefits of mibefradil in the coronary slow flow phenomenon. J Am Coll Cardiol. 2004; 44(1):57-62. DOI: 10.1016/j.jacc.2004.03.055. View

Yang J, Obokata M, Reddy Y, Redfield M, Lerman A, Borlaug B . Endothelium-dependent and independent coronary microvascular dysfunction in patients with heart failure with preserved ejection fraction. Eur J Heart Fail. 2019; 22(3):432-441. DOI: 10.1002/ejhf.1671. View

Niccoli G, Montone R, Ibanez B, Thiele H, Crea F, Heusch G . Optimized Treatment of ST-Elevation Myocardial Infarction. Circ Res. 2019; 125(2):245-258. DOI: 10.1161/CIRCRESAHA.119.315344. View

Manfrini O, Morrell C, Das R, Barth J, Hall A, Gale C . Effects of angiotensin-converting enzyme inhibitors and beta blockers on clinical outcomes in patients with and without coronary artery obstructions at angiography (from a Register-Based Cohort Study on Acute Coronary Syndromes). Am J Cardiol. 2014; 113(10):1628-33. DOI: 10.1016/j.amjcard.2014.02.015. View

Bove K, Nilsson M, Pedersen L, Mikkelsen N, Suhrs H, Astrup A . Comprehensive treatment of microvascular angina in overweight women - a randomized controlled pilot trial. PLoS One. 2020; 15(11):e0240722. PMC: 7644075. DOI: 10.1371/journal.pone.0240722. View

10.

Zhou J, Xu J, Cheng A, Li P, Chen B, Sun S . Effect of nicorandil treatment adjunctive to percutaneous coronary intervention in patients with acute myocardial infarction: a systematic review and meta-analysis. J Int Med Res. 2020; 48(11):300060520967856. PMC: 7708727. DOI: 10.1177/0300060520967856. View

11.

Ma Q, Ma Y, Wang X, Li S, Yu T, Duan W . Intracoronary compared with intravenous bolus tirofiban on the microvascular obstruction in patients with STEMI undergoing PCI: a cardiac MR study. Int J Cardiovasc Imaging. 2020; 36(6):1121-1132. DOI: 10.1007/s10554-020-01800-0. View

12.

Vant Hof A, Berg J, Heestermans T, Dill T, Funck R, van Werkum W . Prehospital initiation of tirofiban in patients with ST-elevation myocardial infarction undergoing primary angioplasty (On-TIME 2): a multicentre, double-blind, randomised controlled trial. Lancet. 2008; 372(9638):537-46. DOI: 10.1016/S0140-6736(08)61235-0. View

13.

Jansen T, Konst R, Elias-Smale S, van den Oord S, Ong P, De Vos A . Assessing Microvascular Dysfunction in Angina With Unobstructed Coronary Arteries: JACC Review Topic of the Week. J Am Coll Cardiol. 2021; 78(14):1471-1479. DOI: 10.1016/j.jacc.2021.08.028. View

14.

Montone R, Rinaldi R, Del Buono M, Gurgoglione F, La Vecchia G, Russo M . Safety and prognostic relevance of acetylcholine testing in patients with stable myocardial ischaemia or myocardial infarction and non-obstructive coronary arteries. EuroIntervention. 2022; 18(8):e666-e676. PMC: 10241282. DOI: 10.4244/EIJ-D-21-00971. View

15.

Bulluck H, Foin N, Cabrera-Fuentes H, Yeo K, Wong A, Fam J . Index of Microvascular Resistance and Microvascular Obstruction in Patients With Acute Myocardial Infarction. JACC Cardiovasc Interv. 2016; 9(20):2172-2174. DOI: 10.1016/j.jcin.2016.08.018. View

16.

Asal N, Wojciak K . Effect of cilostazol in treating diabetes-associated microvascular complications. Endocrine. 2017; 56(2):240-244. DOI: 10.1007/s12020-017-1279-4. View

17.

Ibanez B, James S, Agewall S, Antunes M, Bucciarelli-Ducci C, Bueno H . 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European.... Eur Heart J. 2017; 39(2):119-177. DOI: 10.1093/eurheartj/ehx393. View

18.

Vegsundvag J, Holte E, Wiseth R, Hegbom K, Hole T . Coronary flow velocity reserve in the three main coronary arteries assessed with transthoracic Doppler: a comparative study with quantitative coronary angiography. J Am Soc Echocardiogr. 2011; 24(7):758-67. DOI: 10.1016/j.echo.2011.03.010. View

19.

Chow C, Jolly S, Rao-Melacini P, Fox K, Anand S, Yusuf S . Association of diet, exercise, and smoking modification with risk of early cardiovascular events after acute coronary syndromes. Circulation. 2010; 121(6):750-8. DOI: 10.1161/CIRCULATIONAHA.109.891523. View

20.

Camici P, Gloekler S, Levy B, Skalidis E, Tagliamonte E, Vardas P . Ivabradine in chronic stable angina: Effects by and beyond heart rate reduction. Int J Cardiol. 2016; 215:1-6. DOI: 10.1016/j.ijcard.2016.04.001. View