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Updated: Oct 10, 2025

Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
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Ischemia and no obstructive coronary arteries in patients with stable ischemic heart disease

Puja K Mehta1, Odayme Quesada2, Ahmed Al-Badri1

  • 1Emory Women's Heart Center, Division of Cardiology, Emory University, Atlanta, GA, United States of America.

International Journal of Cardiology
|December 13, 2021
PubMed

Insights

Patients with ischemia with no obstructive coronary artery disease (INOCA) face risks despite clear arteries. Early diagnosis of coronary microvascular dysfunction (CMD) is crucial for managing INOCA symptoms and improving outcomes.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Imaging

Background:

  • A significant number of patients with suspected obstructive coronary artery disease (CAD) are diagnosed with ischemia with no obstructive coronary artery disease (INOCA).
  • INOCA patients face elevated risks for adverse cardiovascular events, recurrent chest pain, and reduced quality of life.
  • Coronary microvascular dysfunction (CMD) is a key contributor to adverse outcomes in INOCA, involving both endothelium-dependent and independent mechanisms.

Purpose of the Study:

  • To review current diagnostic methods for identifying functional abnormalities in INOCA.
  • To discuss treatment strategies for epicardial and/or microvascular dysfunction in INOCA patients.
  • To highlight the importance of functional testing in INOCA management.

Main Methods:

  • Review of current literature on diagnostic testing for INOCA.
  • Analysis of non-invasive and invasive functional testing approaches.
  • Examination of therapeutic interventions for CMD and epicardial dysfunction.

Main Results:

  • Traditional diagnostic tests often overlook functional abnormalities in INOCA.
  • Functional testing is essential for detecting coronary epicardial and microvascular dysfunction in INOCA.
  • CMD plays a significant role in the pathophysiology and adverse outcomes associated with INOCA.

Conclusions:

  • Patients with INOCA and persistent angina require functional assessment to detect epicardial and microvascular dysfunction.
  • Targeted treatment strategies for CMD are vital for improving patient outcomes.
  • Further research into diagnostic and therapeutic approaches for INOCA is warranted.

Keywords:
AtherosclerosisCoronary artery diseaseFunctional imagingIschemic heart disease

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