scholarly journals Non-pharmacological Treatment of Refractory Angina and Microvascular Angina

Biomedicines ◽  
2020 ◽  
Vol 8 (8) ◽  
pp. 285
Author(s):  
Kudrat Rakhimov ◽  
Tommaso Gori
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Microvascular Dysfunction ◽  
Refractory Angina ◽  
Microvascular Angina ◽  
Novel Technologies ◽  
Number Of Patients ◽  
Recent Developments ◽  
Wide Clinical Application ◽  
Artery Disease

Refractory angina (RA) is defined as debilitating anginal symptoms despite the optimal guideline-directed combination of medical, percutaneous, and surgical therapies. Often referred to as “no option”, these patients represent a significant unmet clinical need for healthcare institutions. Due to the ageing of the population, and increased survival from coronary artery disease, the number of patients with RA is expected to rise exponentially. Despite the developments of novel technologies for the treatment of RA, none of them found wide clinical application (to date). Microvascular dysfunction, alone or in combination with epicardial coronary disease, is thought to contribute significantly to refractory angina. However, most of the techniques developed to improve RA symptoms have not been tested specifically on patients with microvascular dysfunction. This review discusses the recent developments in the treatment of RA, and gives some perspectives on the future of these techniques.

The coronary microcirculation and coronary microvascular dysfunction

2021 ◽  
pp. 18-21
Author(s):  
Romana Herscovici ◽  
C. Noel Bairey Merz
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Signs And Symptoms ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Microvascular Angina ◽  
Cardiac Syndrome ◽  
Artery Disease

The role of revascularization in the treatment of obstructive coronary artery disease is well established, and its impact on improving survival has been proven. Nevertheless, patients with signs and symptoms considered of cardiac origin but with no obstructive coronary artery disease on coronary angiography are increasingly seen. Initially described as a ‘paradox’ or cardiac syndrome X and subsequently defined as microvascular angina, angina-like chest pain and evidence of ischaemia with non-obstructive coronary artery disease, is the consequence of altered coronary microvascular response to various stimuli despite non-obstructed epicardial vessels.

scholarly journals Prevalence of microvascular angina among patients with stable symptoms in the absence of obstructive coronary artery disease: a systematic review

2021 ◽  
Author(s):  
Elif Aribas ◽  
Jeanine E Roeters van Lennep ◽  
Suzette E Elias-Smale ◽  
Jan J Piek ◽  
Maurits Roos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Comprehensive Evaluation ◽  
Obstructive Coronary Artery Disease ◽  
Microvascular Dysfunction ◽  
Microvascular Angina ◽  
Non Invasive ◽  
Artery Disease ◽  
Reported Data

Abstract Our purpose was to perform a systematic review to assess the prevalence of microvascular angina (MVA) among patients with stable symptoms in the absence of obstructive coronary artery disease (CAD). We performed a systematic review of the literature to group the prevalence of MVA, based on diagnostic pathways and modalities. We defined MVA using three definitions: (i) suspected MVA using non-invasive ischaemia tests; proportion of patients with non-obstructive CAD among patients with symptoms and a positive non-invasive ischaemia test result, (ii) suspected MVA using specific modalities for MVA; proportion of patients with evidence of impaired microvascular function among patients with symptoms and non-obstructive CAD, and (iii) definitive MVA; proportion of patients with positive ischaemia test results among patients with an objectified impaired microvascular dysfunction. We further examined the ratio of women-to-men for the different groups. Of the 4547 abstracts, 20 studies reported data on MVA prevalence. The median prevalence was 43% for suspected MVA using non-invasive ischaemia test, 28% for suspected MVA using specific modalities for MVA, and 30% for definitive MVA. Overall, more women were included in the studies reporting sex-specific data. The women-to-men ratio for included participants was 1.29. However, the average women-to-men ratio for the MVA cases was 2.50. In patients with stable symptoms of ischaemia in the absence of CAD, the prevalences of suspected and definitive MVA are substantial. The results of this study should warrant cardiologists to support, promote and facilitate the comprehensive evaluation of the coronary microcirculation for all patients with symptoms and non-obstructive CAD.

scholarly journals Coronary Microvascular Dysfunction

2020 ◽  
Vol 9 (9) ◽  
pp. 2880
Author(s):  
Federico Vancheri ◽  
Giovanni Longo ◽  
Sergio Vancheri ◽  
Michael Henein
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Obstructive Coronary Artery Disease ◽  
Microvascular Dysfunction ◽  
Coronary Microcirculation ◽  
Coronary Microvascular Dysfunction ◽  
Microvascular Angina ◽  
Flow Reserve ◽  
Artery Disease

Many patients with chest pain undergoing coronary angiography do not show significant obstructive coronary lesions. A substantial proportion of these patients have abnormalities in the function and structure of coronary microcirculation due to endothelial and smooth muscle cell dysfunction. The coronary microcirculation has a fundamental role in the regulation of coronary blood flow in response to cardiac oxygen requirements. Impairment of this mechanism, defined as coronary microvascular dysfunction (CMD), carries an increased risk of adverse cardiovascular clinical outcomes. Coronary endothelial dysfunction accounts for approximately two-thirds of clinical conditions presenting with symptoms and signs of myocardial ischemia without obstructive coronary disease, termed “ischemia with non-obstructive coronary artery disease” (INOCA) and for a small proportion of “myocardial infarction with non-obstructive coronary artery disease” (MINOCA). More frequently, the clinical presentation of INOCA is microvascular angina due to CMD, while some patients present vasospastic angina due to epicardial spasm, and mixed epicardial and microvascular forms. CMD may be associated with focal and diffuse epicardial coronary atherosclerosis, which may reinforce each other. Both INOCA and MINOCA are more common in females. Clinical classification of CMD includes the association with conditions in which atherosclerosis has limited relevance, with non-obstructive atherosclerosis, and with obstructive atherosclerosis. Several studies already exist which support the evidence that CMD is part of systemic microvascular disease involving multiple organs, such as brain and kidney. Moreover, CMD is strongly associated with the development of heart failure with preserved ejection fraction (HFpEF), diabetes, hypertensive heart disease, and also chronic inflammatory and autoimmune diseases. Since coronary microcirculation is not visible on invasive angiography or computed tomographic coronary angiography (CTCA), the diagnosis of CMD is usually based on functional assessment of microcirculation, which can be performed by both invasive and non-invasive methods, including the assessment of delayed flow of contrast during angiography, measurement of coronary flow reserve (CFR) and index of microvascular resistance (IMR), evaluation of angina induced by intracoronary acetylcholine infusion, and assessment of myocardial perfusion by positron emission tomography (PET) and magnetic resonance (CMR).

scholarly journals Non-invasive assessment of microvascular dysfunction in families with premature coronary artery disease

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P263-P263 ◽  
Author(s):  
T. A. Mulders ◽  
M. Nieuwdorp ◽  
E. S. G. Stroes ◽  
H. Vink ◽  
S. J. Pinto-Sietsma
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Microvascular Dysfunction ◽  
Premature Coronary Artery Disease ◽  
Non Invasive ◽  
Artery Disease

scholarly journals Cornary microvascular dysfunction: an under- appreciatwed segment of coronary artery disease

2015 ◽  
Vol 9 (2) ◽  
pp. 107-111
Author(s):  
Md Fakhrul Islam Khaled ◽  
Sajal Krishna Banerjee ◽  
Tanjima Parvin ◽  
Dipal Krishna Adhikary ◽  
CM Ahmed ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Microvascular Dysfunction ◽  
Artery Disease

Abstract not availableUniversity Heart Journal Vol. 9, No. 2, July 2013; 107-111

scholarly journals Elevated C-reactive protein levels and coronary microvascular dysfunction in patients with coronary artery disease

2005 ◽  
Vol 26 (20) ◽  
pp. 2099-2105 ◽  
Author(s):  
Fabrizio Tomai ◽  
Flavio Ribichini ◽  
Anna S. Ghini ◽  
Valeria Ferrero ◽  
Giuseppe Andò ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
C Reactive Protein ◽  
Protein Levels ◽  
Reactive Protein ◽  
Artery Disease

Abstract 14277: Serum Nt-prob-type Natriuretic Peptide is Associated With Coronary Microvascular Dysfunction in Patients With Angina and Non-obstructive Coronary Artery Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ali Ahmad ◽  
Jaskanwal D Sara ◽  
Michel T Corban ◽  
Takumi Toya ◽  
Ilke Ozcan ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Natriuretic Peptide ◽  
Obstructive Coronary Artery Disease ◽  
Inverse Correlation ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Flow Reserve ◽  
Artery Disease ◽  
And Gender

Title: Serum NT-proB-type Natriuretic Peptide is associated with Coronary Microvascular Dysfunction in Patients with Angina and Non-obstructive Coronary Artery Disease Authors: Ali Ahmad, MD, Jaskanwal D. Sara, MBChB, Michel T. Corban, MD, Takumi Toya, MD, Ilke Özcan, MD, Lilach O. Lerman, MD PhD, Amir Lerman, MD Introduction: Coronary microvascular dysfunction (CMD) is prevalent in patients with heart failure with preserved ejection fraction. Subclinical ischemia and myocardial fibrosis in CMD might raise filling pressure, a hallmark of HFpEF, which induces secretion of NT-proB-type natriuretic peptide (NTpro-BNP). We sought to explore the relationship between CMD and NT-proBNP. Methods: We studied 698 patients with signs and/or symptoms of ischemia and with non-obstructive CAD (<40% angiographic stenosis) who underwent invasive CMD evaluation and had NT-proBNP checked within 6 weeks. CMD was defined as coronary flow reserve (CFR) (hyperemic flow/baseline flow as measured by the doppler wire) of ≤2.5 in response to intracoronary adenosine injection. Results: Overall mean age was 52.8±12.2 years, and women represented 69% of the patients. Log NT-proBNP showed a modest inverse correlation with CFR (Pearson’s R = -0.22, P<0.0001; Figure 1 ), which remained significant after adjusting for age and gender (Standardized ß coefficient = -0.14; P = 0.001). Patients with CMD had higher levels of NT-proBNP than those without (82 [44-190] vs. 62 (33-130], P <0.0001; Figure 2) . Conclusion: Declining coronary microvascular function is correlated with higher NT-proBNP levels. Patients with CMD had higher levels of NT-proBNP, a marker of elevated LV pressure, contributing to the possible role of CMD in early HFpEF pathophysiology. Keywords: Coronary microvascular dysfunction, NT-proBNP

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