Sucato et al acknowledge that invasive methods used in CMD screening are difficult to perform, expensive, and risky for the patient. Their article reviews the diversity of blood markers associated with CMD pathophysiology whose non-invasive identification could serve as an alternative in CMD, and thus MVA, diagnosis. These markers can be divided into three groups: biomarkers of endothelial dysfunction, vascular inflammation and oxidative stress.
Endothelial dysfunction biomarkers that may play a role in MVA pathophysiology include angiogenic factors, endothelins, platelets and endocan. Both the latter and changes in plasma levels of angiogenic factors should be studied in future research in order to confirm their status as an indicator of endothelial dysfunction and as a common predictor of MVA.
C-reactive proteins, cell adhesion molecules, inflammatory cytokines, monocyte to high density lipoprotein-cholesterol ratio (MHR) and heat-shock proteins are all biomarkers of vascular inflammation, while superoxide free radicals, mononuclear cells, nitric oxide synthetic pathway and lymphocyte DNA damage represent biomarkers of oxidative stress. The detection of these markers could be vital in the diagnosis of CMD and apprehension of MVA pathophysiology, and thus replace the costly invasive methods currently used. Take-home message: Identifying blood markers of CMD, a non-invasive approach, could be more effective and less costly for the patient and their physician than currently-used invasive methods used to diagnose MVA. Biomarkers are divided into three categories: those of endothelial dysfunction, vascular inflammation and oxidative stress. Further research should be conducted on the already promising value of CMD-specific biomarkers in the differentiation between patients with epicardial CAD, CMD, and without any coronary flow abnormalities.