Thread by @CoronaryDoc

9/19
#Tweetorial #CMD #ACC21

#CMD shares similar RFs w epicardial atherosclerosis (traditional ASCVD RFs) & is associated with several biomarkers of inflammation, oxidative stress & coagulation

🔗futuremedicine.com/doi/10.2217/fc…
🔗sciencedirect.com/science/articl…
🔗atherosclerosis-journal.com/article/S0021-…

10/19
#Tweetorial #CMD #ACC21

There is significant overlap between #CMD & epicardial disease

Large number of patients w/ #CMD also have epicardial atherosclerosis (obstructive or non-obstructive) & epicardial endothelial dysfunction

🔗onlinelibrary.wiley.com/doi/abs/10.100…

11/19
#Tweetorial #CMD #ACC21

In our IVUS study:
✅ Most patients with #CMD had significant plaque burden
✅ Patients with #CMD had higher plaque burden & more diffuse atherosclerosis as compared to patients w/o CMD

🔗jacc.org/doi/full/10.10…

12/19
#Tweetorial #CMD #ACC21

In our IVUS study & a study from @MayoClinicCV, #CMD (endo-dependent/independent) was associated with features of high-risk (vulnerable) plaque

🔗atherosclerosis-journal.com/article/S0021-…
🔗eurointervention.pcronline.com/article/associ…

13/19
#Tweetorial #CMD #ACC21

#CMD Clinical Phenotypes:

1⃣ #CMD w/o obst CAD or myocardial disease
2⃣ #CMD w/ myocardial disease
3⃣ #CMD w/ obs CAD
4⃣ Iatrogenic #CMD

🔗nature.com/articles/nrcar…

14/19
#Tweetorial #CMD #ACC21

#CMD is highly prevalent in patients w/ angina and/or signs of ischemia referred for coronary evaluation (in presence or absence of obstructive CAD)

@VTaqMD
🔗jacc.org/doi/10.1016/j.…

15/19
#Tweetorial #CMD #ACC21

Several clinical studies showed poor prognosis for #CMD (abnl invasive/non-invasive CFR) regardless of sex

@venkmurthy @ahmedalbadrimd
🔗ahajournals.org/doi/full/10.11…
🔗jacc.org/doi/full/10.10…

16/19
#Tweetorial #CMD #ACC21

In meta-analysis of 5K patients
#CMD (abnl invasive/non-invasive CFR) associated with
4x ⬆ in mortality
5x ⬆ in MACE

🔗ahajournals.org/doi/full/10.11…

17/19
#Tweetorial #CMD #ACC21

#CMD is diagnosed by non-invasive & invasive imaging tools

Guidelines + reviews:
@ChrisKramerMD @wfearonmd @DrArgyle
🔗link.springer.com/article/10.100…
🔗jacc.org/doi/abs/10.101…
🔗ahajournals.org/doi/full/10.11…
🔗eurointervention.pcronline.com/article/the-fu…

18/19
#Tweetorial #CMD #ACC21

Based on 👆 strong body of evidence, @escardio recently included recommendations for diagnosis + treatment of #CMD:

IIa – Invasive CFR/IMR
IIb – Invasive endothelial function by Ach
IIb – Non-invasive imaging/testing

🔗academic.oup.com/eurheartj/arti…

19/19
#Tweetorial #CMD #ACC21

What I hope you learned from this #CMD #Tweetorial 👇