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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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The clinical utility of assessing coronary vasomotor dysfunction in angina with nonobstructive coronary artery

Kai Nogami1, Lilach O Lerman1,2, Amir Lerman1

  • 1Department of Cardiovascular Medicine.

Current Opinion in Cardiology
|September 1, 2025
PubMed

Insights

Coronary vascular dysfunction (CVDys) in angina with no obstructive coronary artery disease (ANOCA) is linked to worse outcomes. Comprehensive assessment using coronary reactivity testing (CRT) aids risk stratification for major adverse cardiovascular events.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Clinical Research

Background:

  • Coronary vascular dysfunction (CVDys) contributes to angina in patients with no obstructive coronary artery disease (ANOCA).
  • Understanding the prognostic implications of different CVDys subtypes is crucial for patient management.
  • Recent large-scale studies provide new insights into CVDys in ANOCA.

Purpose of the Study:

  • To review the current understanding of CVDys in ANOCA.
  • To discuss findings from a comprehensive study on CVDys subtypes and prognosis.
  • To explore future research and clinical practice directions.

Main Methods:

  • Review of current literature on CVDys in ANOCA.
  • Analysis of recent large-scale study findings on CVDys subtypes.
  • Assessment of coronary reactivity testing (CRT) for evaluating CVDys.

Main Results:

  • CVDys involves impaired vasoconstriction/vasodilation in epicardial or microvascular coronary arteries.
  • Endothelium-dependent epicardial and both microvascular dysfunction types are associated with worse prognosis in ANOCA.
  • Microvascular function (endothelium-dependent and -independent) is an independent predictor of major adverse cardiovascular events.

Conclusions:

  • Evidence for the prognostic impact of CVDys in ANOCA is growing.
  • Effective treatment strategies for CVDys in ANOCA are still needed.
  • Future research should focus on CRT-guided interventions to improve clinical outcomes.
Abstract

Keywords:
angina and nonobstructive coronary arteriescoronary reactivity testingcoronary vasomotor dysfunctionendothelium functionmicrovascular dysfunction

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