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Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
Published on: August 17, 2022
Future Perspectives and Unmet Needs in Ischemia with Non-obstructive Coronary Arteries
Giulia Botti1, Giandomenico Mancini2, Giovanni Vitale3
1Vita-Salute San Raffaele University, Via Olgettina, Milan, Italy; IRCCS Ospedale San Raffaele, Milan, Italy.
Abstract:
Ischemia and angina with non-obstructive coronary arteries (INOCA/ANOCA) have evolved into a defined clinical entity, with invasive coronary functional testing now guideline-recommended to establish the underlying endotypes. Yet diagnostic progress has outpaced pathophysiological understanding and therapeutic development. This article examines the principal unmet needs across INOCA/ANOCA: the observational nature of current registries; the unresolved molecular basis, natural history and overlap of the microvascular and vasospastic endotypes; persistent underdiagnosis and unstandardized invasive physiology; the absence of validated non-invasive tools and biomarkers; and the lack of endotype-targeted therapies proven to improve outcomes. Addressing these gaps is essential to advance mechanism-based personalized care.
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