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.
Summary
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.
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