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Coronary Microvascular Dysfunction, Microvascular Angina, and Management

Adrián I Löffler1, Jamieson M Bourque2

  • 1Division of Cardiovascular Medicine, University of Virginia Health System, PO Box 800662, Charlottesville, VA, 22908, USA. al2ys@hscmail.mcc.virginia.edu.

Current Cardiology Reports
|December 24, 2015
PubMed

Insights

Coronary microvascular dysfunction (CMD) indicates poor prognosis in patients with or without coronary artery disease (CAD). New noninvasive imaging techniques help identify microvascular angina (MVA), aiding risk stratification.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Imaging

Background:

  • Coronary microvascular dysfunction (CMD) is increasingly recognized as a significant predictor of adverse outcomes in patients with and without obstructive epicardial coronary artery disease (CAD).
  • Microvascular angina (MVA), resulting from CMD, presents clinically with chest pain that is often indistinguishable from angina caused by epicardial CAD.
  • The historical diagnosis of cardiac syndrome X encompasses a heterogeneous group of patients, many of whom likely have underlying MVA.

Purpose of the Study:

  • To review the diagnostic capabilities of emerging noninvasive imaging techniques for identifying CMD and MVA.
  • To discuss the clinical implications of MVA in patients with and without obstructive CAD.
  • To highlight the current limitations in understanding and treating MVA.

Main Methods:

  • Review of recent analyses and literature on coronary microvascular dysfunction and microvascular angina.
  • Discussion of noninvasive imaging modalities including stress positron-emission tomography (PET) and cardiovascular magnetic resonance (CMR) myocardial perfusion imaging.
  • Analysis of patient populations previously categorized under cardiac syndrome X and those with persistent angina post-revascularization.

Main Results:

  • Noninvasive imaging techniques like stress PET and CMR myocardial perfusion imaging enable improved identification of MVA.
  • These tools allow differentiation of higher-risk from lower-risk patients within the MVA population, including those historically labeled as cardiac syndrome X.
  • MVA can also be diagnosed in patients with obstructive epicardial CAD experiencing persistent angina after revascularization.

Conclusions:

  • Emerging noninvasive imaging significantly enhances the diagnosis of microvascular angina (MVA).
  • Improved diagnostic capabilities allow for better risk stratification in patients with MVA.
  • Further research is needed to establish evidence-based treatment strategies and clarify the prognostic impact of MVA therapies.

Keywords:
Coronary microvascular dysfunctionMicrovascular anginaPrognosisTherapeutics

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