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

Abstract

Background:Coronary artery disease (CAD) is predicted to be the most common cause of death and disability globally by 2020 1 . Early detection and management of coronary artery disease can improve CAD related morbidity and mortality. Coronary angiogram remains the final diagnostic procedure for CAD. The current treatment strategy for CAD is confined mainly on disease of the epicardial coronary arteries. But, normal epicardial coronary arteries are found in 20% of cases undergoing coronary angiography for chest pain evaluation 2 . Detection of normal coronary arteries in patients having angina pectoris does not exclude further coronary events; rather these patients bear more risk of future cardiac ischemic syndromes. Several studies tried to discover the dilemma of non-obstructive CAD.They concluded with proposition of coronary microvascular dysfunction. Normal epicardial coronary arteries at angiography in patients with angina: Proposition of coronary microvascular dysfunction. Dysfunction of the coronary microcirculation was explained earlier by 3,4 . Cannon and Epstein termed the condition as microvascular angina (MVA) 5 . Lanza and Crea described as Coronary microvascular dysfunction (CMVD) and demonstrated the pathophysiology with the following figure 6 : Prognosis of Coronary microvascular dysfunction (CMVD):Microvascular circulatory disease was previously considered not to confer elevated risk of future adverse cardiovascular events or early mortality 7,8