Ischemia and no obstructive coronary arteries in patients with stable ischemic heart disease

Puja K. Mehta, Odayme Quesada, Ahmed Al-Badri, Jerome L. Fleg, Annabelle Santos Volgman, Carl J. Pepine, C. Noel Bairey Merz, Leslee J. Shaw

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalInternational Journal of Cardiology
Volume348
DOIs
StatePublished - 1 Feb 2022
Externally publishedYes

Keywords

  • Atherosclerosis
  • Coronary artery disease
  • Functional imaging
  • Ischemic heart disease

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