Beyond Coronary Artery Disease: Assessing the Microcirculation

Interv Cardiol Clin. 2023 Jan;12(1):119-129. doi: 10.1016/j.iccl.2022.09.010.

Abstract

Ischemic heart disease (IHD) affects more than 20 million adults in the United States. Although classically attributed to atherosclerosis of the epicardial coronary arteries, nearly half of patients with stable angina and IHD who undergo invasive coronary angiography do not have obstructive epicardial coronary artery disease. Ischemia with nonobstructive coronary arteries is frequently caused by microvascular angina with underlying coronary microvascular dysfunction (CMD). Greater understanding the pathophysiology, diagnosis, and treatment of CMD holds promise to improve clinical outcomes of patients with ischemic heart disease.

Keywords: Coronary flow reserve; Coronary microvascular disease; Coronary microvascular dysfunction; Coronary physiology; Hyperemic microvascular resistance; INOCA; Index of microcirculatory resistance; Ischemia with nonobstructive coronary arteries.

Publication types

  • Review
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Coronary Angiography
  • Coronary Artery Disease* / diagnosis
  • Humans
  • Microcirculation / physiology
  • Microvascular Angina* / diagnosis
  • Microvascular Angina* / therapy