Coronary microvascular angina: a review

Out of the patients who undergo coronary angiography due to angina and myocardial ischemia, up to 70% do not have obstructive coronary disease. For many, coronary microvascular angina as a cause of dysfunctional coronary microcirculation is often the reason behind this. This dysfunction is associated with poor prognosis, as well as poor quality of life due to difficult symptoms, increased rates of hospital admissions and common invasive exams. Endothelial nitric oxide is believed to have a role in modulating myocardial blood flow. Overall, coronary microvascular dysfunction has two endotypes: structural, where inflammation or atherosclerosis are related to its cause, and functional, where vasomotor disorders cause an alteration to vasodilator substances. The gold standard for diagnosis is invasive methods such as cardiac PET, although there are non-invasive tests available too. This dysfunction lacks a proper understanding of correct treatment due to a lack of randomised trials.

This review by Spione F et al aimed to discuss coronary microvascular dysfunction, considering causes, diagnosis and treatment.

Key learnings

Despite the existence of non-invasive tests, invasive diagnostic tests are currently the most reliable for assessing this condition. However, it is important to continue improving and researching these diagnostic methods to improve quality of life for the patients. Furthermore, more research is required into understanding the best paths of treatment and management of coronary microvascular angina.