PET for Detection and Reporting Coronary Microvascular Dysfunction: A JACC: Cardiovascular Imaging Expert Panel Statement.

Schindler, Thomas H; Fearon, William F; Pelletier-Galarneau, Matthieu; Ambrosio, Giuseppe; Sechtem, Udo; Ruddy, Terrence D; Patel, Krishna K; Bhatt, Deepak L; Bateman, Timothy M; Gewirtz, Henry; Shirani, Jamshid; Knuuti, Juhani; Gropler, Robert J; Chareonthaitawee, Panithaya; Slart, Riemer H J A; Windecker, Stephan; Kaufmann, Philipp A; Abraham, Maria R; Taqueti, Viviany R; Ford, Thomas J; ... (2023). PET for Detection and Reporting Coronary Microvascular Dysfunction: A JACC: Cardiovascular Imaging Expert Panel Statement. JACC. Cardiovascular imaging, 16(4), pp. 536-548. Elsevier 10.1016/j.jcmg.2022.12.015

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Angina pectoris and dyspnea in patients with normal or nonobstructive coronary vessels remains a diagnostic challenge. Invasive coronary angiography may identify up to 60% of patients with nonobstructive coronary artery disease (CAD), of whom nearly two-thirds may, in fact, have coronary microvascular dysfunction (CMD) that may account for their symptoms. Positron emission tomography (PET) determined absolute quantitative myocardial blood flow (MBF) at rest and during hyperemic vasodilation with subsequent derivation of myocardial flow reserve (MFR) affords the noninvasive detection and delineation of CMD. Individualized or intensified medical therapies with nitrates, calcium-channel blockers, statins, angiotensin-converting enzyme inhibitors, angiotensin II type 1-receptor blockers, beta-blockers, ivabradine, or ranolazine may improve symptoms, quality of life, and outcome in these patients. Standardized diagnosis and reporting criteria for ischemic symptoms caused by CMD are critical for optimized and individualized treatment decisions in such patients. In this respect, it was proposed by the cardiovascular council leadership of the Society of Nuclear Medicine and Molecular Imaging to convene thoughtful leaders from around the world to serve as an independent expert panel to develop standardized diagnosis, nomenclature and nosology, and cardiac PET reporting criteria for CMD. This consensus document aims to provide an overview of the pathophysiology and clinical evidence of CMD, its invasive and noninvasive assessment, standardization of PET-determined MBFs and MFR into "classical" (predominantly related to hyperemic MBFs) and "endogen" (predominantly related to resting MBF) normal coronary microvascular function or CMD that may be critical for diagnosis of microvascular angina, subsequent patient care, and outcome of clinical CMD trials.

Item Type:

Journal Article (Review Article)


04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Windecker, Stephan


600 Technology > 610 Medicine & health








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Date Deposited:

08 Mar 2023 09:37

Last Modified:

07 Apr 2023 00:15

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Uncontrolled Keywords:

coronary artery disease coronary circulation coronary flow reserve microvascular dysfunction myocardial blood flow myocardial perfusion imaging positron emission tomography




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