Beyond Coronary Artery Disease: Assessing the Microcirculation

Cardiol Clin. 2024 Feb;42(1):125-135. doi: 10.1016/j.ccl.2023.07.003.

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

MeSH terms

  • Adult
  • Coronary Angiography
  • Coronary Artery Disease* / diagnosis
  • Coronary Artery Disease* / therapy
  • Coronary Circulation
  • Coronary Vessels / diagnostic imaging
  • Humans
  • Microcirculation / physiology
  • Microvascular Angina* / diagnosis
  • Microvascular Angina* / therapy