Why the study?
Chronic coronary syndromes with non-obstructive coronary artery disease are relatively frequent with an unfavorable prognosis, yet coronary microvascular dysfunction remains difficult to grasp despite current advances.
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Design
Review
Does not support routine clinical adoption of dynamic SPECT for CMD; leaves open its diagnostic role pending prospective validation.
Recentn doporuen postupy Evropsk kardiologick spolenosti (ESC) z roku 2024 tkajc se chronickch koronrnch syndrom (chronic coronary syndromes, CCS) zahrnuj vedle standardn problematiky CCS na podklad obstruktivn formy koronrn nemoci (nejastji ischemick choroba srden [ICHS], vzcn vrozen anomlie koronrnch tepen a svalov mstky) tak problematiku CCS na podklad neobstruktivn formy koronrnch arteri/neobstruktivn formy koronrn nemoci (non-obstructive coronary arteries/non-obstructive coronary artery diseases [NOCA/NOCAD]). Hlavnm dvodem aktuln zvenho zjmu o CCS s NOCA/NOCAD jsou patrn nedvn data dokumentujc jejich relativn ast vskyt i jejich relativn nepznivou prognzu, kter kontrastuj s pvodnmi pedpoklady odborn veejnosti. Typickm znakem CCS pi NOCA/NOCAD je normln, nebo tm normln koronarogram. Autoi se v dalm textu zamili na koronrn mikrovaskulrn dysfunkci (coronary microvascular dysfunction [CMD]), kter reprezentuje NOCA/NOCAD na mikrovaskulrn rovni koronrnho eit. Pina CMD me bt strukturln, funkn nebo smen (remodelace, endoteliln dysfunkce, abnormln vazodilatace, mikrovaskulrn vazospasmus). Pes souasn pokroky zstv problematika CMD obtn uchopiteln. Proto jsou dal vzkumy v tto oblasti douc. Slibnou metodou pro diagnostiku CMD se zd bt dynamick jednofotonov pozitronov emisn vpoetn tomografie (SPECT) myokardu (D-SPECT) s CZT (kadmium-zinek-tellurid) kamerami.
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Pumprla et al. (2025) studied this question.
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