Coronary Microvascular Dysfunction Program

What Sets Us Apart

Part of the Interventional Cardiology Center of Excellence, our team includes board-certified cardiologists, interventional cardiologists, and other medical professionals who have been trained to accurately diagnose and treat Coronary Microvascular Dysfunction (CMD) as recommended by guidelines from leading national and international cardiovascular societies.

Volume & Quality

Tampa General Hospital established the CMD program in November 2022, and was the first site on the west coast of Florida to launch a dedicated CMD program. We are now the highest volume center for CMD diagnosis and therapy in the state of Florida and top three in the nation, and routinely track our quality with pre- and post- diagnosis assessment of patient symptoms.

Advanced Technology & Research

Tampa General Hospital is committed to being a world-class academic health system rooted in innovative technologies, clinical research, and education. As part of our CMD diagnosis, we also routinely test for Vasospastic Angina with the use of intracoronary acetylcholine, a study not routinely performed in all institutions as part of CMD assessment. Additionally, we are part of the Discover INOCA study, a registry evaluating the natural history, diagnosis, and treatment course of patients diagnosed with CMD. Through our clinical research initiatives, our team is defining the future management of CMD.

Risk Factors for Coronary Microvascular Dysfunction

Hypertension
Dyslipidemia
Diabetes
Obesity
Tobacco use
Females are at higher risk, however, CMD is also prevalent in men

Symptoms of Coronary Microvascular Dysfunction

Chest pain or tightness/angina
Neck/shoulder/arm/back pain
Shortness of Breath
Fatigue

Diagnosis of Coronary Microvascular Dysfunction

At Tampa General Hospital, our team uses a more detailed patient evaluation that is not typical at many facilities.

Diagnosing CMD can be difficult at first, but our team always starts with a history and physical exam to rule out symptoms of myocardial ischemia or another underlying condition with either your primary care provider or cardiologist. Once more common medical conditions are ruled out, a CMD assessment can begin.

The diagnosis of CMD is accomplished by the use of the Coroventis‡ CoroFlow‡ Cardiovascular System, which is an advanced platform to measure physiological indices: fractional flow reserve (FFR) and resting full-cycle ratio (RFR) to assess flow through epicardial (larger) vessels, and coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) to assess flow through the microcirculation (smaller vessels).

The CoroFlow‡ Cardiovascular System can calculate and display hemodynamic measurements in both epicardial vessels and coronary microvasculature. 50-65% of patients with angina with non-obstructive coronary artery disease (NOCAD) are believed to have Coronary Microvascular Dysfunction (CMD). Our goal is to give patients a clear diagnosis of CMD and take the first step to improve their quality of life.

Treatment Options for Coronary Microvascular Dysfunction

After diagnosis, we are committed to providing personalized medical therapy and working with each patient to develop a treatment plan that meets their specific needs and goals. Patients with abnormal findings on their CMD study are followed up in our CMD Medical Clinic to tailor their therapy.

Lifestyle Changes

Smoking cessation
Exercise/cardiac rehabilitation
Nutrition
Weight management
Stress reduction

Risk Factor Management

Diabetes
High cholesterol
High blood pressure

Medications

Some patients may require medications in addition to lifestyle and risk factor management to treat symptoms, reduce recurrent events, and improve quality of life. Most patients with CMD have some degree of dysfunction of the vascular lining of the small vessels of the heart and benefit from medications including statins and angiotensin converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB). A combination of medications may also be trialed to help maximally dilate the micro vessels including beta blockers and calcium channel blockers. For patients who demonstrate vasospastic angina, the use of nitrate therapy in conjunction with calcium channel blocker therapy may be very effective. Individualized treatment regimens are key and our team at TGH is geared to help find the best treatment for you.

Clinical Trials

Physicians in the CMD Program are national leaders in the field of cardiac disease and thus have access to industry- and physician-sponsored clinical trials as mentioned above. Our role in the Discover INOCA study and some of our own research efforts will help define the diagnostic and treatment approaches to CMD management for future patients.

Our Leadership Team

Our nationally recognized multidisciplinary system of care ensures comprehensive patient evaluations and the best possible care.

This is achieved under the collaborative leadership and teamwork of:

Dr. Samip Vasaiwala, MD, MSc, FACC
Associate Professor, USF Health Morsani College of Medicine
Coronary Programs Director, TGH Heart & Vascular Institute

Dr. Fadi Matar, MD, FACC, FSCAI
TGH Cath Lab Director
Associate Professor, USF Health Morsani College of Medicine

Daniela Crousillat, Director of TGH Cardio-Obstetrics Dr. Daniela Crousillat, MD
Assistant Professor of Medicine, USF Health Morsani College of Medicine