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Challenges in diagnosing coronary microvascular dysfunction and coronary vasospasm
Sonya Burgess1, F Aaysha Cader2, Martha Gulati3
1Department of Cardiology, Nepean Hospital, Sydney, Australia; University of Sydney, NSW, Australia.
Insights
Chronic coronary syndromes (CCS) involve angina with nonobstructive coronary arteries (ANOCA) or ischemia with nonobstructive coronary arteries (INOCA). This review addresses diagnostic challenges in coronary microvascular dysfunction and vasospastic disease within ANOCA-INOCA patients.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Chronic coronary syndromes (CCS) encompass angina with nonobstructive coronary arteries (ANOCA) and ischemia with nonobstructive coronary arteries (INOCA).
- ANOCA-INOCA is a common diagnosis in patients presenting with angina or ischemia despite the absence of obstructive coronary artery disease (CAD) on imaging.
- Coronary microvascular dysfunction (CMD) and vasospastic disease are increasingly recognized as significant contributors to ANOCA-INOCA.
Purpose of the Study:
- To review current diagnostic challenges for coronary microvascular dysfunction (CMD) and vasospastic disease.
- To highlight recent guideline updates and ongoing controversies in the diagnosis of ANOCA-INOCA.
- To underscore the importance of investigating and treating CMD and vasospastic angina (VSA) in patients with CCS.
Main Methods:
- Literature review focusing on contemporary challenges in diagnosing CMD and VSA.
- Analysis of recent guideline changes relevant to ANOCA-INOCA.
- Discussion of current controversies in the field.
Main Results:
- Diagnostic difficulties persist for CMD and vasospastic disease in the context of ANOCA-INOCA.
- Recent guidelines offer updated perspectives but controversies remain.
- CMD and VSA are frequently overlooked, under-investigated, and undertreated entities.
Conclusions:
- Accurate diagnosis of CMD and vasospastic disease is crucial for managing ANOCA-INOCA patients.
- Further research and standardized diagnostic approaches are needed.
- Addressing CMD and VSA can improve outcomes for patients with chronic coronary syndromes.
Abstract:
Chronic coronary syndromes (CCS) include 2 overlapping subgroups of patients - those with angina with nonobstructive coronary arteries (ANOCA), or ischaemia with non-obstructive coronary arteries (INOCA). A diagnosis of ANOCA-INOCA, is common and should be considered where angina is present and/or ischaemia is found on functional imaging in the absence of obstructive coronary artery disease (CAD) on coronary computed tomography angiography (CCTA) or invasive coronary angiography (ICA) (Ford and Berry, 2019). This review aims to provide an overview of contemporary challenges in the diagnosis of coronary microvascular dysfunction (CMD) and vasospastic disease, with a focus on recent guideline changes and current controversies. CMD and vasospastic angina (VSA) are increasingly acknowledged as an important and frequently overlooked, under investigated, and undertreated entities that contribute to ANOCA-INOCA (Samuels et al., 2023; Kunadian et al., 2020; Ford and Berry, 2019; Burgess and Mamas, 2024).
