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Updated: Feb 17, 2026
Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
Published on: August 17, 2022
[Coronary microvascular dysfunction: past, present, and future of an evolving disease]
Vincenzo Sucato1, Salvatore Evola1, Giuseppina Novo1
1U.O.C. Cardiologia, Dipartimento Biomedico di Medicina Interna e Specialistica (DiBiMIS), A.O.U.P. Paolo Giaccone, Università degli Studi, Palermo.
Insights
Coronary microvascular dysfunction (CMVD) causes angina in 10-30% of patients with normal coronary arteries. This condition, termed leading microvascular angina, presents unique challenges in diagnosis and treatment.
Area of Science:
- Cardiology
- Vascular Biology
- Internal Medicine
Background:
- Coronary atherosclerosis is a primary cause of myocardial ischemia.
- 10-30% of angina patients exhibit normal coronary arteries on angiography.
- Coronary microvascular dysfunction (CMVD) is increasingly recognized as a cause of symptoms in these patients.
Purpose of the Study:
- To differentiate and define leading microvascular angina (LMVA) as a distinct clinical entity.
- To explore the pathogenesis and risk factors associated with CMVD in patients with normal coronary arteries.
- To review current understanding of endothelial function alterations in LMVA.
Main Methods:
- Review of existing literature on coronary microcirculation and angina.
- Analysis of studies investigating CMVD in patients with angiographically normal coronary arteries.
- Examination of emerging evidence on risk factors and endothelial dysfunction.
Main Results:
- CMVD can cause angina symptoms independently of obstructive coronary artery disease.
- Leading microvascular angina is defined as CMVD being the sole cause of symptoms.
- Specific risk factors and endothelial alterations are being identified, though uncertainties remain.
Conclusions:
- Coronary microvascular dysfunction is a significant cause of angina in patients with normal coronary arteries.
- Leading microvascular angina represents a distinct clinical syndrome requiring further investigation.
- Pathogenesis, therapeutic strategies, and prognostic factors for LMVA are areas of ongoing research and debate.
Abstract:
Coronary atherosclerosis is the main cause of myocardial ischemia. Nevertheless 10-30% of patients with angina has angiographically normal coronary arteries. In the last 30 years, several studies showed that in these patients the symptoms can be caused by dysfunction of the coronary microcirculation. Coronary microvascular dysfunction (CMVD) occurring in patients affected by specific cardiac or systemic diseases may be due to mechanisms of the underlying disease. On the other hand, in several patients affected by angina with angiographically normal coronary arteries, there is no specific disease, and CMVD only is responsible for the clinical picture. This condition can be defined as leading microvascular angina in order to distinguish it from other forms of microvascular angina where CMVD is related to the presence of a specific disease. As regards pathogenesis, there are still many uncertainties, though evidence suggesting a role for certain risk factors rather than others is gradually emerging, along with the demonstration of new alterations of endothelial function. Also as regards therapy, and prognosis above all, the debate is still open.
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