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Ischemia in patients with no obstructive coronary artery disease: classification, diagnosis and treatment of coronary

Vincenzo Sucato1, Giuseppina Novo, Antonino Saladino

  • 1Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) 'G. D'Alessandro', University Hospital Paolo Giaccone, University of Palermo, Palermo, Italy.

Coronary Artery Disease
|February 20, 2020
PubMed

Insights

Coronary microvascular dysfunction impacts many, causing angina and limiting life quality. Recent updates refine its classification and the definition of ischemia in non-obstructive coronary artery disease, improving diagnosis and management.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Criteria

Background:

  • Coronary microvascular dysfunction (CMD) affects a large patient population, often leading to angina symptoms and reduced quality of life.
  • Despite a generally good prognosis, persistent symptoms significantly impair daily activities for affected individuals.
  • Previous understanding of cardiac X syndrome and ischemia in non-obstructive coronary artery disease has been advanced by recent updates.

Purpose of the Study:

  • To summarize recent advancements in the classification and definition of coronary microvascular dysfunction.
  • To highlight updated diagnostic criteria for microvascular angina and vasospastic angina.
  • To provide a comprehensive overview of the latest understanding of ischemia in patients with non-obstructive coronary artery disease.

Main Methods:

  • Literature review of recent studies and guidelines on coronary microvascular dysfunction.
  • Analysis of the 2017 updated classification and definition of microvascular dysfunction and ischemia.
  • Focus on diagnostic criteria for microvascular and vasospastic angina.

Main Results:

  • A new classification for microvascular dysfunction was established in 2017.
  • An improved definition of ischemia in patients with non-obstructive coronary artery disease is now available.
  • Updated diagnostic criteria for microvascular and vasospastic angina have been proposed.

Conclusions:

  • Recent updates provide a refined framework for understanding and diagnosing coronary microvascular dysfunction.
  • The new definitions improve upon previous work, such as Kemp's description of cardiac X syndrome.
  • These advancements are crucial for better managing patients suffering from angina due to microvascular issues.

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