Assessing Microcirculation in Coronary Artery Disease

Ischemic heart disease is a leading cause of death worldwide. Usually, it is attributed to atherosclerosis of epicardial coronary arteries. However, around half of patients with ischemic heart disease do not present this pathophysiology. Ischemia with no obstructive coronary arteries, also known as INOCA, can be caused by mechanisms such as microvascular angina or epicardial coronary spasm. There are Doppler and thermodilution methods to measure coronary flow for the diagnosis and management of ischemia. Although there are limitations to each of these techniques, assessing coronary microcirculation holds great potential in future management of coronary artery disease. However, more research is required into understanding the optimal therapies needed for differing cardiac disease states, to allow for a more precise, individualised approach.

This review by Pruthi S et al. aimed to discuss the assessment of microcirculation in coronary artery disease, specifically discussing INOCA, ischemia with no obstructive coronary arteries.

Key learnings:

Greater understanding the pathophysiology, diagnosis, and treatment of CMD holds promise to improve clinical outcomes of patients with ischaemic heart disease. who undergo invasive coronary angiography do not have obstructive epicardial coronary artery disease.