Normal coronary arteries: clinical implications and further classification

Area of Science:

• Cardiology
• Vascular Biology
• Diagnostic Imaging

Background:

• Chest pain with normal coronary arteries is a complex condition with various underlying cardiac issues.
• Standard coronary angiography (lumenology) is limited as it cannot assess vessel walls, plaque characteristics, or outward remodeling.
• Early atherosclerosis, endothelial dysfunction, and impaired coronary flow reserve are often undetected by angiography.

Purpose of the Study:

• To highlight the limitations of coronary angiography in diagnosing early atherosclerosis.
• To emphasize the need for advanced imaging and functional assessments.
• To advocate for research into improved diagnostic and therapeutic strategies for patients with normal angiography.

Main Methods:

• Review of available clinical studies and imaging techniques.
• Intravascular ultrasound imaging to assess vessel wall and plaque.
• Coronary flow reserve and endothelial function testing.

Main Results:

• Many patients with chest pain and normal angiography show evidence of early atherosclerosis via intravascular ultrasound.
• Reduced coronary flow reserve and endothelial dysfunction are common findings.
• Patients with normal angiography have shown recurrent coronary events in long-term follow-up.

Conclusions:

• Early atherosclerosis is a significant, often undiagnosed, cause of chest pain despite normal coronary angiography.
• Advanced imaging and functional tests are crucial for accurate diagnosis.
• Further research is warranted to improve diagnosis and treatment, potentially improving outcomes for these patients.