Vasomotor dysfunction in patients with angina and nonobstructive coronary artery disease is dominated by vasospasm

Abstract

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Sex Differences in Coronary Function Test Results in Patient With Angina and Nonobstructive Disease

“…The CFT was performed in accordance with the standardized protocol and as described earlier by Konst et al ( 10 ) and Ong et al ( 15 ). In short, patients were instructed to withhold all vasoactive medication and methylxanthine-containing substances, such as coffee and bananas, for 24–48 h before the procedure, depending on half-life time.…”

“…CMD (ADE+) was present when measurements showed an abnormal CFR <2.0 and/or an abnormal IMR ≥ 25, as defined by current consensus documents ( 21 ). The definitions of epicardial or microvascular spasm (ACH+) were defined in line with these guidelines as follows ( 10 , 21 , 22 ): epicardial vasospasm was defined as a focal or diffuse epicardial coronary diameter reduction ≥90% in response to ACH, compared to the relaxed state after intracoronary nitroglycerin infusion, with a reproduction of (recognizable) symptoms and ischemic ECG changes. Microvascular spasm was diagnosed when the patient experienced the reproduction of recognizable symptoms with ischemic ECG changes, in the absence of ≥90% epicardial diameter reduction during ACH infusion ( 21 ).…”

“…This condition is linked to increased cardiovascular risk, and impaired quality of life, and are a source of it leads to considerable health resource utilization (4)(5)(6). Although ANOCA is thought to be more prevalent in women and the majority of studies are performed in women (6)(7)(8), men are also affected by coronary vasomotor dysfunction (9,10).…”

Outpatient Management of Patients With Angina With No Obstructive Coronary Arteries: How to Come to a Proper Diagnosis and Therapy

“…It cannot distinguish between epicardial and microvascular vasospasm and, most essential, does not correlate well with invasively assessed vasospasm ( 15 ). This is an important limitation since vasospasm is the most prevalent endotype in patients with coronary vascular dysfunction, occurring in 81–97% of patients diagnosed with coronary vascular dysfunction, while an abnormal CFR or microvascular resistance without vasospasms occurred in only 3–19% ( 52 , 66 , 67 ). Therefore, one should realize that the diagnosis of coronary vascular dysfunction is easily missed with non-invasive diagnostics.…”

Doppler Echocardiography Assessment of Coronary Microvascular Function in Patients With Angina and No Obstructive Coronary Artery Disease

“…Another study in 391 patients with angina and no obstructive CAD utilized both adenosine and acetylcholine and found 52% had isolated CMD (low CFR), 17% had isolated vasospasm, and 21% had a mixed endotype (102). In contrast, a recent study in 111 ANOCA patients found 63% had isolated vasospasm, only 3% had isolated impaired vasodilation, and 34% had a mixed endotype (105). In sum, a considerable subset of ANOCA patients should be expected to suffer from isolated vasospasm which will inherently go undetected by TTDE CFVR evaluation.…”