TY - JOUR
T1 - Ischemia and no obstructive coronary arteries in patients with stable ischemic heart disease
AU - Mehta, Puja K.
AU - Quesada, Odayme
AU - Al-Badri, Ahmed
AU - Fleg, Jerome L.
AU - Volgman, Annabelle Santos
AU - Pepine, Carl J.
AU - Merz, C. Noel Bairey
AU - Shaw, Leslee J.
N1 - Publisher Copyright:
© 2021 Elsevier B.V.
PY - 2022/2/1
Y1 - 2022/2/1
N2 - A large proportion of patients with suspected obstructive coronary artery disease (CAD) is found to have ischemia with no obstructive coronary artery disease (INOCA). Based on current evidence, these patients are at increased risk of adverse cardiovascular events, even though they have no obstructive CAD. Importantly, INOCA is associated with recurrent clinical presentations with chest pain, impaired functional capacity, reduced health-related quality of life, and high healthcare costs. Underlying coronary microvascular dysfunction (CMD), through endothelium-dependent and independent mechanisms contribute to these adverse outcomes in INOCA. While non-invasive and invasive diagnostic testing has typically focused on identification of obstructive CAD in symptomatic patients, functional testing to detect coronary epicardial and microvascular dysfunction should be considered in those with INOCA who have persistent angina. Current diagnostic methods to clarify functional abnormalities and treatment strategies for epicardial and/or microvascular dysfunction in INOCA are reviewed.
AB - A large proportion of patients with suspected obstructive coronary artery disease (CAD) is found to have ischemia with no obstructive coronary artery disease (INOCA). Based on current evidence, these patients are at increased risk of adverse cardiovascular events, even though they have no obstructive CAD. Importantly, INOCA is associated with recurrent clinical presentations with chest pain, impaired functional capacity, reduced health-related quality of life, and high healthcare costs. Underlying coronary microvascular dysfunction (CMD), through endothelium-dependent and independent mechanisms contribute to these adverse outcomes in INOCA. While non-invasive and invasive diagnostic testing has typically focused on identification of obstructive CAD in symptomatic patients, functional testing to detect coronary epicardial and microvascular dysfunction should be considered in those with INOCA who have persistent angina. Current diagnostic methods to clarify functional abnormalities and treatment strategies for epicardial and/or microvascular dysfunction in INOCA are reviewed.
KW - Atherosclerosis
KW - Coronary artery disease
KW - Functional imaging
KW - Ischemic heart disease
UR - http://www.scopus.com/inward/record.url?scp=85121732485&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2021.12.013
DO - 10.1016/j.ijcard.2021.12.013
M3 - Article
C2 - 34902504
AN - SCOPUS:85121732485
SN - 0167-5273
VL - 348
SP - 1
EP - 8
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -