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NONOBSTRUCTIVE CORONARY ARTERY DISEASE - CLINICAL RELEVANCE, DIAGNOSIS, MANAGEMENT AND PROPOSAL OF NEW
Zorin Makarović1, Sandra Makarović1, Ines Bilić-Ćurčić1
11Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Cardiology, Osijek University Hospital Centre, Osijek, Croatia; 3Department of Pharmacology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Department of Nuclear Medicine and Radiation Protection, Osijek University Hospital Centre, Osijek, Croatia.
Insights
Nonobstructive coronary artery disease (non-CAD) affects many, particularly women, and carries significant mortality risks. Understanding its mechanisms is crucial for diagnosis and treatment.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Nonobstructive coronary artery disease (non-CAD) is increasingly diagnosed, especially in women undergoing coronary angiography.
- The prevalence of non-CAD is rising due to expanded indications for angiography in patients with angina.
- Recent findings indicate a higher mortality risk associated with non-CAD, challenging previous perceptions of its benign prognosis.
Purpose of the Study:
- To address the elusive definition and diagnostic challenges of non-CAD.
- To explore the pathophysiological mechanisms underlying non-CAD.
- To propose a novel classification system for non-CAD to aid diagnosis and treatment.
Main Methods:
- Review of large clinical trials and existing literature on non-CAD.
- Analysis of diagnostic challenges, including exclusion-based diagnosis.
- Examination of proposed pathophysiological hypotheses (ischemic and non-ischemic).
Main Results:
- Non-CAD is a significant clinical entity with a substantial impact on patient outcomes.
- Current diagnostic and treatment strategies for non-CAD face considerable challenges.
- Two primary hypotheses, ischemic (microvascular dysfunction) and non-ischemic (altered pain perception), attempt to explain non-CAD mechanisms.
Conclusions:
- A new classification system for non-CAD is proposed, categorizing it into Type I (ischemic) and Type II (non-ischemic) based on the predominant mechanism.
- This classification aims to improve understanding, facilitate earlier diagnosis, and guide more effective treatment strategies for non-CAD.
- Accurate diagnosis and management of non-CAD are critical due to its associated increased mortality risk.
Abstract:
- New data gathered from large clinical trials indicate that nonobstructive coronary artery disease (non-CAD) is a clinical entity that should not be ignored. It is estimated that 50% of female population undergoing coronarography are diagnosed with non-CAD. There is also an increase in the prevalence of non-CAD in both genders, which is probably due to gradual expanding of clinical indications for angiography in patients with angina. Furthermore, considering the increased mortality risk established recently, a prognosis of non-CAD is not benign as previously thought. However, the concept and definition of non-CAD remains elusive causing difficulties in diagnosis and treatment. One of the major shortcomings is the exclusion-based diagnosis of non-CAD. Furthermore, treatment of non-CAD still presents a great challenge and optimal therapy is yet to be determined. There are two major hypotheses explaining the pathophysiological mechanisms of non-CAD, i.e. ischemic hypothesis based on abnormal microvascular dysfunction and non-ischemic one based on altered pain perception. This review encompasses a broader spectrum of pathophysiological mechanisms of non-CAD, and proposes a new way of classification based on the major disorder involved: type I (ischemic mechanisms) and type II (non-ischemic mechanisms), depending on which mechanism predominates. Hopefully, this would provide new insights in the understanding of this disorder, thus leading to accurate and early diagnosis and successful treatment, especially considering the increased mortality risk in these patients.
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