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Updated: Sep 20, 2025

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function

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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.

Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
|June 7, 2022
PubMed

Insights

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 infarctionvasodilators

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