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Subendocardial ischemia: does CMD really exist?

Cardiovasc Revasc Med

January 2025

Weatherhead PET Imaging Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX, United States of America.

Patients with angina but without obstructive epicardial coronary disease still require a specific mechanistic diagnosis to enable targeted treatment. The overarching term "coronary microvascular dysfunction" (CMD) has been applied broadly - but is it correct? We present a series of case examples culminating a systematic exploration of our large clinical database to distinguish among four categories of coronary pathophysiology. First, by far the largest group of "no stenosis angina" patients exhibits subendocardial ischemia during intact flow through diffuse epicardial disease during dipyridamole vasodilator stress.

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Immune checkpoint inhibitor (ICI) therapy is a cornerstone treatment for many cancers, but it can induce severe immunotoxicity, including acute interstitial nephritis (AIN). Currently, kidney biopsy is required to differentiate ICI-AIN from other causes of acute kidney injury (AKI). However, this invasive approach can lead to morbidity, delayed glucocorticoid treatment for patients with AIN, and unnecessarily prolonged suspension of ICI therapy in non-AIN patients.

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CUOB (co-existent underactive overactive bladder) syndrome is a clinical entity that embraces storage and emptying symptoms, not strictly correlated with urodynamic findings. We assessed the differences between patients diagnosed with CUOB with/without cystocele. The study group was allocated from 2000 women who underwent urodynamic studies between 2008 and 2016.

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: Vestibular symptoms can severely affect patients with vestibular schwannomas (VSs). Studies assessing vestibular symptoms beyond clinical routine assessment in patients with VS treated by stereotactic radiosurgery (SRS) are scarce. Therefore, we employed the standardized questionnaire Dizziness Handicap Inventory (DHI) to systematically evaluate vestibular symptoms prior to and after SRS.

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In the year 2019, a highly virulent coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged, precipitating the outbreak of the illness known as coronavirus disease 2019 (COVID-19). The commonly employed reverse transcription polymerase chain reaction (RT-qPCR) methodology serves to estimate the viral load in each patient's sample by employing a standard curve. However, it is imperative to recognize that this technique exhibits limitations with respect to clinical diagnosis and therapeutic applications, since an advancement of the conventional polymerase chain reaction methods, digital polymerase chain reaction (digital PCR or DDPCR), enables the direct quantification and clonal amplification of nucleic acid strands.

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