Related Experiment Video

Updated: Sep 9, 2025

Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
08:35

Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction

Published on: August 17, 2022

2.5K

Chest pain patterns and coronary microvascular function in non-obstructive coronary artery disease

Kai Nogami1, Yoshihisa Kanaji2, Takumi Toya3

  • 1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
|September 1, 2025
PubMed

Insights

Patients with exertional chest pain (CP) and coronary microvascular dysfunction (CMD) have worse microvascular function. Endothelium-independent CMD significantly impacts prognosis in exertional CP patients, suggesting targeted treatments.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Imaging

Background:

  • Coronary microvascular dysfunction (CMD) is a primary cause of chest pain (CP) in patients with angina and non-obstructive coronary arteries (ANOCA).
  • The precise relationship between CMD patterns and CP characteristics in ANOCA patients remains unclear.

Purpose of the Study:

  • To investigate the association between CMD and distinct CP patterns (exertional vs. resting) in ANOCA patients.
  • To evaluate the prognostic significance of these associations.

Main Methods:

  • 1,264 ANOCA patients underwent coronary reactivity testing.
  • Chest pain patterns were categorized as exertional, resting, or both.
  • Endothelium-dependent and -independent CMD were assessed using intracoronary acetylcholine and adenosine infusion, respectively.

Main Results:

  • Exertional CP patients exhibited lower coronary flow reserve (CFR) and higher rates of endothelium-independent CMD compared to resting CP patients.
  • A significantly blunted coronary blood flow (CBF) response to acetylcholine was observed in exertional CP patients.
  • Endothelium-independent CMD was linked to increased mortality risk in exertional CP patients but not in resting CP patients over a 7-year follow-up.

Conclusions:

  • Exertional CP in ANOCA patients is associated with poorer microvascular function compared to resting CP.
  • Endothelium-independent CMD carries significant prognostic implications for patients with exertional CP.
  • Targeted therapeutic strategies for CMD may be particularly beneficial for ANOCA patients experiencing exertional CP.
Abstract

More Related Videos

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function10:28

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

Published on: March 15, 2022

5.2K
Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders06:39

Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders

Published on: August 18, 2016

15.9K

Related Concept Videos

Angina III: Clinical Manifestations and Assessment01:29

Angina III: Clinical Manifestations and Assessment

Angina manifests as chest pain, tightness, or squeezing discomfort typically located behind the breastbone. It can radiate to the neck, jaw, shoulders, and inner aspects of the upper arms, most commonly the left arm. Patients may experience shortness of breath, fatigue, profuse sweating, dizziness, indigestion, heartburn, palpitations, anxiety, and vomiting as accompanying symptoms. This pain often lasts a few minutes and is triggered by physical exertion, emotional stress, heavy meals, or cold...
25
Coronary Artery Disease III: Clinical Manifestations01:30

Coronary Artery Disease III: Clinical Manifestations

Coronary Artery Disease (CAD) is a primary health risk worldwide, leading to significant morbidity and mortality. The condition arises from the buildup of atherosclerotic plaques within the coronary arteries, resulting in diminished blood supply to the heart muscle.The clinical manifestations of CAD vary widely, from asymptomatic stages to severe, life-threatening conditions. Understanding these manifestations is crucial for early diagnosis and effective management.Angina Pectoris: The Warning...
31
Angina I: Introduction01:30

Angina I: Introduction

Definition and Symptoms: Angina (angina pectoris) is chest pain or discomfort caused by myocardial ischemia, which occurs when the heart muscle receives insufficient oxygen-rich blood. It typically manifests as pressing, squeezing, or crushing sensations in the chest and may radiate to the shoulders, arms, neck, jaw, or back.Primary Cause: In a healthy state, the coronary arteries can dilate (widen) to increase blood flow and meet the increased oxygen demand during physical activity or...
35
Angina II: Classification01:27

Angina II: Classification

Angina, also known as angina pectoris, is a chest pain resulting from diminished blood flow to the heart muscle and is often a symptom of coronary artery disease. Angina presents several variants with distinctive attributes, etiologies, and therapeutic approaches. The main types of angina include stable, unstable, variant (Prinzmetal's), microvascular, intractable, and silent ischemia.Stable angina is caused by atherosclerosis, which leads to the formation of plaques that narrow the coronary...
38
Coronary Artery Disease V: Interprofessional Care01:27

Coronary Artery Disease V: Interprofessional Care

Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
30
Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations01:19

Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations

The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
45