Cardiac Rehabilitation and Exercise Prescription in Symptomatic Patients with Non-Obstructive Coronary Artery Disease—a Systematic Review

Abstract

Purpose of reviewNon-obstructive coronary artery disease (NOCAD) on coronary angiography is a common finding in patients with stable angina. Angina in NOCAD patients is thought to be caused by endothelial dysfunction of the epicardial coronary arteries and/or the microvasculature. Treatment is empiric, and 30% of patients remain symptomatic in spite of therapy. It is well known that physical exercise can improve endothelial function. The goal of this review was to assess the current literature on effects of physical exercise in NOCAD patients with angina. Therefore, a literature search was conducted to March 13, 2018 using the following search terms: syndrome X, microvascular angina, non-obstructive coronary artery disease and exercise training, cardiac rehabilitation, endothelial function. All original publications were included which examined the effect of a cardiac rehabilitation (CR) program or exercise training (ET) on patients with angina and NOCAD.Recent findingsEight studies, of which four were randomized controlled studies, examined 218 participants, 162 in an intervention and 56 in control groups. Most patients were women (97.7%). Exercise programs varied from 8 weeks to 4 months at moderate intensity and some included relaxation therapy. The studies examined the effect of CR on exercise capacity, quality of life (QoL), and perfusion defects. CR increased exercise capacity, oxygen uptake, symptom severity, and QoL. Myocardial perfusion improved.SummaryCR appears to be beneficial in symptomatic patients with NOCAD, improving exercise capacity and QoL and reducing severity of symptoms and myocardial perfusion defects. Data is limited to a small number of predominantly female patients. Further larger trials are warranted to determine the optimal rehabilitation protocols and define its long-term benefits.

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

“…Exercise helps to reduce symptoms and improve exercise tolerance ( 102 ). A regular cardiac rehabilitation program is often too strenuous for patients with seriously debilitating symptoms.…”

Novel advances in cardiac rehabilitation

“…[ 23 ] NOCAD Interventional study CR (no control group) Exercise capacity Increase from 6.5 to 8.1 METS p < 0.001 Szot et al. [ 26 ] NOCAD Meta-analysis CR Exercise capacity – 31–36% ↑ WR peak (W) – 15–26% ↑ V O 2,peak (l/min) Kissel and Nikoletou [ 27 ] Elderly CAD patients Cohort study CR vs no CR Mortality 5 years 34% RRR Suaya et al. [ 29 ] CAD Cohort study CR uptake Women 15.5% Men 25.4% Colbert et al.…”

“…Furthermore, approximately 70% of women and 30% of men undergoing a coronary angiogram for angina symptoms are found to have non-obstructive CAD (NOCAD). This large, heterogeneous group of patients comprises distinct vasomotor disorders such as vasospastic angina and microvascular disease, caused by endothelial dysfunction [ 27 ]. Adequate lifestyle measures promote well-being, reduce symptoms and improve cardiovascular function and exercise tolerance in patients with NOCAD ([ 26 , 27 ]; Tab.…”

“…This large, heterogeneous group of patients comprises distinct vasomotor disorders such as vasospastic angina and microvascular disease, caused by endothelial dysfunction [ 27 ]. Adequate lifestyle measures promote well-being, reduce symptoms and improve cardiovascular function and exercise tolerance in patients with NOCAD ([ 26 , 27 ]; Tab. 1 ).…”

The effect of nicorandil in patients with cardiac syndrome X

“…Lifestyle modifications, cigarette quitting, blood pressure control, and cardiac rehabilitation are recommended to CSX patients. [ 15 , 16 ] As for pharmacological treatment, the classical antianginal medications are widely used to ameliorate clinical symptoms, including β-blockers, non-dihydropyridine calcium-antagonist drugs, and nitrates. β-blockers are appropriate for patients with increased adrenergic tone.…”