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Updated: Sep 20, 2025
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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
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Phenotype-based management of coronary microvascular dysfunction
Daniel Tze Yee Ang1, Colin Berry1, Juan-Carlos Kaski2
1British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
Summary
Many patients with ischemia symptoms lack obstructive coronary artery disease (INOCA). Coronary microvascular dysfunction (CMD) affects two-thirds, necessitating phenotype-based management for improved prognosis and quality of life.
Area of Science:
- Cardiology
- Vascular Biology
- Precision Medicine
Background:
- 40-70% of patients with ischemia symptoms undergoing coronary angiography have no obstructive coronary artery disease (INOCA).
- Coronary microvascular dysfunction (CMD) is diagnosed in approximately two-thirds of these patients, linked to adverse outcomes.
- Four distinct CMD phenotypes exist, each requiring tailored therapeutic strategies.
Purpose of the Study:
- To present a contemporary, phenotype-based management approach for patients with INOCA.
- To highlight the importance of identifying and stratifying patients with coronary microvascular dysfunction.
- To emphasize the role of precision medicine in managing INOCA.
Main Methods:
- Utilizing diagnostic criteria from the Coronary Vasomotor Disorders International Study Group (COVADIS).
- Employing invasive and non-invasive modalities for coronary function testing.
- Applying the 'functional angiography' concept to guide stratified medical therapy, as advocated by the CorMicA study.
Main Results:
- Identification of four clinical phenotypes of INOCA: microvascular angina, vasospastic angina, mixed, and non-cardiac symptoms.
- Demonstration that CMD is a prevalent condition in INOCA patients, associated with poor prognosis.
- Evidence supporting phenotype-based management for improved patient outcomes.
Conclusions:
- Phenotype-based management of INOCA, particularly CMD, is crucial for improving prognosis, symptom burden, and quality of life.
- Tailored therapies, considering individual patient phenotypes and risk factors, are essential.
- Precision medicine approaches offer a promising strategy for optimizing care in INOCA patients.
Keywords:
CADMicrovascular dysfunctiondiagnostic and prognostic applicationmyocardial blood flowmyocardial ischemia and infarctionvasodilatorsMore Related Videos
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