Do the physiological indexes of coronary artery and the microcirculation indexes of coronary artery have to be evaluated separately? Just as the two indicators are used to evaluate two completely separated things, there is an insurmountable gap between them. But in fact, the large coronary vessels and coronary microcirculation are closely connected.
Hi Li,
Microvascular disease may occur without significant epicardial coronary artery stenosis.
As a result, tests such as myocardial perfusion studies employing nuclear medicine techniques, stress echocardiography and stress cardiac MR imaging studies to non-invasively assess for ischemia caused by intermediate coronary lesions. Additionally, many of these techniques cannot distinguish between ischemia caused by epicardial coronary artery disease and microvascular dysfunction.
In comparison, an invasive coronary angiography is technique that aims to display an image of large(r) luminal narrowing /stenoses of the major epicardial coronary artery or (ies). Particularly in case of pronounced stenosis (graded severity), angiography is an adequate technique for evaluating of a coronary stenosis however, the degree to which it is the cause of myocardial ischemia and also evaluate the coronary microcirculation, angiography is however not adequate method, due to size of the vessels (simply put, they are too small to be visualized and graded).
There are techniques used for each e.g., Coronary Flow (Velocity) Reserve, Fractional Flow Reserve, Instantaneous Wave-free Ratio, Index of Microcirculatory Resistance and its combinations (these are invasive based techniques),
There are also non-invasive techniques mentioned earlier and combinations. The best is to read review article and separate them later on. Here is e.g., of review that might help you
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5633718/
Hope this helps,
Filip
Hello Li Liang
There is just a small thing to add onto the excellent answer by Filip Konecny and that is ti day that while those non invasive techniques mentioned cannot distinguish between macro and micro vascular changes, they are useful and important and informative for deciding necessity of treatment .
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