PET Unmasks CMD: The Hidden Risk Behind Normal Perfusion | JACC Baran

Hosts Mitsuaki Sawano, MD, Satoshi Shoji, MD, and Kentaro Ejiri, MD, welcome Yoshito Kadoya, MD, PhD (University of British Columbia / St. Paul’s Hospital) to discuss his JACC: Cardiovascular Imaging study, “PET-Based Coronary Microvascular Dysfunction Phenotypes and Outcomes in Patients With Normal Myocardial Perfusion.” Among 3,317 patients with normal relative perfusion on cardiac PET, the study examined four phenotypes defined by myocardial flow reserve and stress myocardial blood flow. Both classical CMD and endogen CMD were associated with higher long-term cardiovascular risk, suggesting that reduced MFR may remain clinically meaningful even when stress myocardial blood flow is preserved. The episode explores how PET can phenotype coronary microvascular dysfunction, differences between invasive and noninvasive approaches to CMD, and Dr. Kadoya’s cardiac imaging training and career in Canada.