The coronary microcirculation plays a pivotal role in the regulation of coronary blood flow and cardiac metabolism. It can adapt to acute and chronic pathologic conditions such as coronary thrombosis or long-standing hypertension. Due to the fact that the coronary microcirculation cannot be visualized in human beings, in vivo its assessment remains challenging. Thus, the clinical importance of the coronary microcirculation is still often underestimated or even neglected. Depending on the clinical condition of the respective patient, several non-invasive (e.g. transthoracic Doppler-echocardiography assessing coronary flow velocity reserve, cardiac magnetic resonance imaging, positron emission tomography) and invasive methods (e.g. assessment of coronary flow reserve and microvascular resistance using adenosine, microvascular coronary spasm with acetylcholine) have been established for the assessment of coronary microvascular function. Individual patient characteristics, but certainly also local availability, methodical expertise and costs will influence which methods are being used for the diagnostic work-up (non-invasive and/or invasive assessment) in a patient with recurrent symptoms and suspected coronary microvascular dysfunction. Recently, the combined invasive assessment of coronary vasoconstrictor as well as vasodilator abnormalities has been titled interventional diagnostic procedure (IDP). It involves intracoronary acetylcholine testing for the detection of coronary spasm as well as coronary flow reserve and microvascular resistance assessment in response to adenosine using a dedicated wire. Currently, the IDP represents the most comprehensive coronary vasomotor assessment. Studies using the IDP to better characterize the endotypes observed will hopefully facilitate development of tailored and effective treatments.

中文翻译：

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在临床中诊断冠状动脉微血管功能障碍。

冠状动脉微循环在冠状动脉血流量和心脏代谢的调节中起关键作用。它可以适应急性和慢性病理状况，例如冠状动脉血栓形成或长期存在的高血压。由于冠状动脉微循环在人类中不可见，因此在体内对其评估仍然具有挑战性。因此，冠状动脉微循环的临床重要性仍然经常被低估甚至忽略。根据各自患者的临床情况，几种非侵入性方法（例如，经胸多普勒超声心动图评估冠状动脉血流速度储备，心脏磁共振成像，正电子发射断层扫描）和侵入性方法（例如，使用腺苷评估冠状动脉血流储备和微血管阻力） ，已经建立了具有乙酰胆碱的微血管冠状痉挛）以评估冠状动脉微血管功能。个别患者的特征，当然还有当地的可获得性，方法学的专业知识和成本，将影响正在复发的症状和可疑的冠状动脉微血管功能障碍的患者中用于诊断检查（非侵入性和/或侵入性评估）的方法。最近，冠状血管收缩剂和血管扩张剂异常的联合侵入性评估已被称为介入诊断程序（IDP）。它涉及冠状动脉内乙酰胆碱测试，用于检测冠状动脉痉挛以及使用专用导线响应腺苷对冠状动脉血流储备和微血管阻力的评估。目前，IDP代表了最全面的冠状动脉血管舒缩评估。使用IDP更好地表征观察到的内型的研究有望促进定制和有效治疗的发展。