Tag: coronary microvascular dysfunction

Research

Coronary Microvascular Dysfunction and Vasospastic Angina—Pathophysiology, Diagnosis and Management Strategies

Coronary artery disease is one of the leading public health problems in the world in terms of mortality and economic burden from the disease. Traditionally, the focus of research and clinical pathways leading to the diagnosis and treatment of coronary artery disease was on the more common variant of the disease resulting from atherosclerosis in the epicardial coronary arteries. However, coronary microvasculature, representing the vast majority of the total heart circulation, has the greatest influence on overall coronary resistance and, therefore, blood flow. Coronary microvascular dysfunction (CMD), characterized by structural or functional abnormalities in the microvasculature, significantly impacts myocardial perfusion. Endothelial dysfunction results in inadequate coronary dilation during exercise or spontaneous spasm in the microvasculature or epicardial arteries.

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Research

Coronary function testing vs angiography alone to guide treatment of...

Introduction

The diagnostic and therapeutic approach for patients with chronic coronary syndromes (CCS) is evolving from a simplistic approach focused on diagnosis and treatment of obstructive epicardial coronary artery disease (CAD) to include a comprehensive assessment of the functional status of the coronary circulation to assess causes of angina with non-obstructive coronary arteries (ANOCA).

ANOCA is present […]

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Research

Current Evidence-Based Treatment of Angina With Nonobstructive Coronary Arteries (ANOCA)

Although the techniques for coronary function testing (CFT) were largely developed more than 30 years ago, consensus on the specific diagnostic criteria and endotypes is still lacking. Furthermore, the management of patients with angina with nonobstructive coronary arteries (ANOCA) is challenging for most cardiologists. These patients are often a burden to the health care system due to recurrent presentations to the emergency room, repeated coronary angiography, and lack of improvement in their anginal symptoms even after being properly diagnosed with CFT.

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Research

Skeletal muscle adiposity, coronary microvascular dysfunction, and adverse cardiovascular outcomes

Skeletal muscle (SM) fat infiltration, or intermuscular adipose tissue (IMAT), reflects muscle quality and is associated with inflammation, a key determinant in cardiometabolic disease. Coronary flow reserve (CFR), a marker of coronary microvascular dysfunction (CMD), is independently associated with body mass index (BMI), inflammation and risk of heart failure, myocardial infarction, and death. The relationship between SM quality, CMD, and cardiovascular outcomes is not known.

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Research

Diagnostic Yield and Clinical Utility of Coronary Angiography Versus Coronary...

Approximately 50% of women referred for invasive coronary angiography have angina and nonobstructive coronary arteries, which includes coronary microvascular dysfunction, vasospastic angina, and other vasomotor disorders. We sought to determine the real‐world diagnostic yield of invasive coronary angiography and coronary function testing in women with angina and nonobstructive coronary arteries.

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Research

Evaluating Ischemic Heart Disease in Women: Focus on Angina With...

Ischemic heart disease (IHD) is common in women, and cardiovascular disease is a leading cause of morbidity and mortality. While obstructive coronary artery disease is the most common form of IHD, millions of women suffer from angina with nonobstructive coronary arteries (ANOCA), an umbrella term encompassing multiple nonatherosclerotic disorders of the coronary tree.

The underlying pathology leading to ischemia in these syndromes may be challenging to diagnose, leaving many women without a diagnosis despite persistent symptoms that impact quality of life and adversely affect long-term cardiovascular prognosis. In the last decade, there have been significant advances in the recognition and diagnostic evaluation of ANOCA.

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Research

Multivessel Coronary Function Testing Increases Diagnostic Yield in Patients With...

Invasive CFT is the gold standard for diagnosing coronary vasomotor dysfunction in patients with ANOCA. Most institutions recommend only testing the left coronary circulation. Therefore, it is unknown whether testing multiple coronary territories would increase diagnostic yield.

The aim of this study was to evaluate the diagnostic yield of multivessel, compared with single-vessel, invasive coronary function testing (CFT) in patients with angina and nonobstructive coronary arteries (ANOCA).

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Research

Rethinking False Positive Exercise Electrocardiographic Stress Tests by Assessing Coronary...

Exercise electrocardiographic stress testing (EST) has historically been validated against the demonstration of obstructive coronary artery disease. However, myocardial ischemia can occur because of coronary microvascular dysfunction (CMD) in the absence of obstructive coronary artery disease.

The aim of this study was to assess the specificity of EST to detect an ischemic substrate against the reference standard of coronary endothelium-independent and endothelium-dependent microvascular function in patients with angina with nonobstructive coronary arteries (ANOCA).

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Research

JCS/CVIT/JCC 2023 guideline focused update on diagnosis and treatment of...

In 2008, the Guidelines for diagnosis and treatment of patients with vasospastic angina (coronary spastic angina) were developed by the Japanese Circulation Society, and the revised version was published in 2013. Since then, new findings from various fields such as coronary microvascular dysfunction (CMD), biomarkers, imaging, physiological functions, and genes have accumulated.

Furthermore, together with the spread of emergency coronary angiography (CAG) for acute coronary syndrome (ACS) and the development of diagnostic techniques using high-sensitive troponin, the new concepts of myocardial infarction with non-obstructive coronary arteries (MINOCA) and ischemia with non-obstructive coronary artery disease (INOCA) have been proposed.

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Research

Coronary Microvascular Spasm: Clinical Presentation and Diagnosis

Professor Maseri pioneered the research and treatment of coronary vasomotion abnormalities represented by coronary vasospasm and coronary microvascular dysfunction (CMD).

These mechanisms can cause myocardial ischaemia even in the absence of obstructive coronary artery disease, and have been appreciated as an important aetiology and therapeutic target with major clinical implications in patients with ischaemia with non-obstructive coronary artery disease (INOCA). Coronary microvascular spasm is one of the key mechanisms responsible for myocardial ischaemia in patients with INOCA.

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Research

Design and rationale of the NetherLands registry of invasive Coronary...

Angina without angiographic evidence of obstructive coronary artery disease (ANOCA) is a highly prevalent condition with insufficient pathophysiological knowledge and lack of evidence-based medical therapies. This affects ANOCA patients prognosis, their healthcare utilization and quality of life.

In current guidelines, performing a coronary function test (CFT) is recommended to identify a specific vasomotor dysfunction endotype. The NetherLands registry of invasive Coronary vasomotor Function testing (NL-CFT) has been designed to collect data on ANOCA patients undergoing CFT in the Netherlands.

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Real Patient Stories

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Dima’s story

March 3rd, 2021 was the day that changed everything. At 55, I had a busy counselling practice and a few other projects on the go. The pandemic was causing anxiety for many of my clients and in my private life. I had a lot of stress of my own: there were safety issues in the building where I lived, and I was looking for a new apt. Despite this, I thought I was handling it well. I was fairly healthy, I walked daily, ate well, meditated and didn’t smoke or drink.

I started to experience heavy fatigue towards the end of 2020 but told myself it was normal considering all that was going on in the world.

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Sinéad’s story

My first episode caught me completely off guard on a Sunday morning in 2014. I was an active, healthy 35-year-old mother of 3. It felt like what I imagined having a heart attack would feel like. After a minute or two it stopped as suddenly as it had started and I got out of bed to start my day, I had experienced palpitations before and brushed it off as a once off.

I had about 8 more episodes before lunch time and made a deal with myself that if it continued, I would call an ambulance. I was a busy mum and didn’t want to be ‘dramatic’! It resolved by 2 p.m.

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Jennifer’s story

Hello! My name is Jennifer, a 41-year-old mother of 5 and a nurse. My husband and I have been married nearly 15 years. Before I share my story, I’d like to share that I had never been on any medications other than Lexapro for mild depression and anxiety. I did not have heart problems or even high blood pressure. December 9, 2023, was the beginning of a life changing event leading to the diagnosis of Coronary Artery Spasm, also known as Prinzmetal Angina.

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CORONARY VASOSPASMMICROVASCULAR ANGINA

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