{
  "abstract": "Background Coronary microvascular dysfunction (CMD) is an underdiagnosed cause of angina. Rubidium-82 PET allows assessment of myocardial blood flow and myocardial flow reserve (MFR), but how these findings translate into clinical management remains unclear.Methods We retrospectively reviewed 10,125 rubidium-82 PET scans performed between 2020 and 2025. Of these, 171 (1.7%) reported possible or definite CMD with reduced MFR, categorised into microvascular angina, epicardial coronary disease, renal transplant, and cardiomyopathy subgroups. Downstream outcomes focused on the microvascular angina cohort.Results Age was 67.9 years, 56.7% female, BMI 31 kg/m2, LVEF 60%, global MFR 1.38, and stress MBF 1.37. Angina was present in 78.9%, ischaemia in 15.8%, and infarction in 4.7%. Only 5.3% of PET requests queried CMD. Severe MFR reduction was present in 85.4%; 63.2% were reported as possible and 36.8% definite CMD. Microvascular angina was the largest subgroup (49.1%), followed by epicardial coronary disease (29.2%), renal transplant (18.1%), and cardiomyopathy (5.3%). CTCA was performed in 22.2% and angiography in 33.9%, of whom 17.2% underwent PCI. In the microvascular angina cohort, 86.9% had pure CMD without ischaemia or infarction. PET findings were documented in 65.5% of post-scan letters and CMD mentioned in 63.1%. Targeted therapy was recorded in 32.1%. Following PET, 37.3% were discharged, 28.6% re-presented to ED with angina, and 3.6% were referred to interventional cardiology (figure 1).Conclusion Rubidium-82 PET identifies an important CMD cohort, but downstream care needs improvement. Documentation, targeted treatment, specialist referral, and follow-up were low. A standardised post-PET pathway could improve CMD recognition, treatment, and management. In this retrospective study of rubidium-82 PET scans reporting coronary microvascular dysfunction, which of the following best describes the downstream management of the microvascular angina cohort?A. The majority received targeted medical therapy and specialist follow-upB. Most were referred to interventional cardiology for further evaluationC. Documentation, targeted treatment, and referral rates were consistently highD. Despite frequent ED re-presentation, targeted therapy was recorded in fewer than a third of patients (correct)Abstract 12 Figure 1E. PET findings were documented in fewer than half of post-scan letters",
  "authors": [
    {
      "affiliations": [
        "Barts Health NHS Trust"
      ],
      "name": "Alaswad Shakh"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust"
      ],
      "name": "Sara Elsaadany"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust"
      ],
      "name": "Iffat Zahan"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust"
      ],
      "name": "Leon Menezes"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust"
      ],
      "name": "George Collins"
    }
  ],
  "title": "12 Coronary microvascular dysfunction on rubidium-82 PET: findings and downstream clinical management",
  "uid": "dbdb3e81-1b3d-581b-87e1-c69ebe4df89a"
}