[Coronary microvascular disease, vasospastic angina].

Area of Science:

• Cardiology
• Vascular Medicine
• Diagnostic Imaging

Background:

• Angina and myocardial ischemia often occur without obstructive epicardial coronary artery disease.
• These symptoms are frequently caused by microvascular coronary artery disease or coronary vasospasm.
• These conditions significantly impact patient quality of life, prognosis, and healthcare resource utilization.

Purpose of the Study:

• To review the epidemiology, prognosis, and pathomechanisms of microvascular coronary artery disease and vasospastic angina.
• To provide a technical analysis of invasive diagnostic modalities for these conditions.
• To discuss current and emerging pharmacologic treatment strategies.

Main Methods:

• Review of recent publications and consensus documents.
• Detailed technical analysis of invasive coronary thermodilution and provocation tests.
• Summary of diagnostic criteria and parameters of microvascular function.

Main Results:

• Invasive diagnostics objectively elucidate the pathomechanisms of microvascular dysfunction and vasospasm.
• Established diagnostic criteria allow for the identification of patients who benefit from specific therapies.
• Systematic application of diagnostic workup improves patient outcomes.

Conclusions:

• Microvascular coronary artery disease and vasospastic angina are significant causes of angina.
• Invasive diagnostic techniques are crucial for accurate diagnosis and understanding of pathomechanisms.
• Targeted medical therapies based on precise diagnosis can improve quality of life and prognosis.