Microvascular Angina: an Update On Diagnosis and Treatment

Titterington, Jane; Hung, Olivia Y.; Wenger, Nanette K.

doi:10.2217/fca.14.79

Cited by 13 publications

(12 citation statements)

References 68 publications

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“…Most often it is the result of stenotic atherosclerotic changes in the epicardial coronary arteries, while a normal angiogram and/or non-obstructive stenosis is detected in 20–30% of patients with AP and previously noninvasively detected myocardial ischemia [1–3]. The causes of chest pain in these patients include either epicardial artery disease (endothelial dysfunction, coronary artery spasm, muscle bridge), microvascular coronary dysfunction and/or noncoronary disease [4].…”

Section: Introductionmentioning

confidence: 99%

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Moderate-dose atorvastatin improves arterial endothelial function in patients with angina pectoris and normal coronary angiogram: a pilot study

Kabaklić¹,

Fras²

2017

aoms

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IntroductionEndothelial dysfunction could contribute to the pathophysiology of angina pectoris (AP) in patients with normal coronary angiograms. Besides lipid-lowering effects, statins exert pleiotropic effects including improving endothelial function.Material and methodsOur double-blind study included 58 patients with AP, noninvasively confirmed myocardial ischemia and a normal coronary angiogram. The effect of once-daily 20 mg atorvastatin (A) was compared with placebo (P) for 6 months. Endothelial function was evaluated by flow-mediated dilation (FMD) of the brachial artery, and microcirculation by peripheral arterial tonometry (EndoPAT) measuring the reactive hyperemia index (RHI), indicating microcirculatory endothelial function, and the augmentation index (AI), an indicator of arterial stiffness. The impact of AP on the quality of life was monitored using the Seattle Angina Questionnaire (SAQ).ResultsBrachial artery endothelial dysfunction was found in 91.4% of patients at study entry, and subnormal RHI in 41%. Group A showed an improvement of FMD compared with group P, both at 3 and 6 months (+120.8% vs. –21.2%, and +70.8% vs. –1.9%, respectively, p < 0.001). No difference was detected in the RHI. Rate-normalized AI showed an improvement (−114.49% group A vs. –30.77% group P, p = 0.077), although the differences between the groups were not significant. According to the SAQ, an improvement was found in almost all observed variables with the exception of the issue of quality of life (QoL), where patients in both groups assessed their QoL at the control study visits as poorer compared with baseline.ConclusionsModerate-dose atorvastatin therapy improves endothelial function of large conduit arteries in patients with AP and a normal coronary angiogram, which probably reflects positive effects on coronary artery endothelial function. No effect was found with vascular effects at the level of the peripheral microcirculation.

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Section: Introductionmentioning

confidence: 99%

“…Ischemia probably occurs because of irregularly distributed and inappropriate constriction of periarteriolar blood vessels across the myocardium. A functional disorder of the coronary microcirculation can ensue as insufficient vasodilatation and/or hypersensitive vasoconstriction to various metabolic and pharmacological stimuli [1, 2]. …”

Section: Introductionmentioning

confidence: 99%

Moderate-dose atorvastatin improves arterial endothelial function in patients with angina pectoris and normal coronary angiogram: a pilot study

Kabaklić¹,

Fras²

2017

aoms

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“…Con la AMV, se desaconseja el uso de nitratos, puesto que los estudios no han mostrado beneficio y en algunos casos pudieran empeorar los síntomas (21,44,46). Se recomiendan como anti-isquémicos, los beta-bloqueadores cardioselectivos (bisoprolol y nebivolol) o aquellos con bloqueo alfa1 tipo carvedilol y los bloqueadores de los canales de calcio, y cuando hay pobre respuesta, se puede asociar la ranolazina (26,47,48). En los pacientes con angina de causa no isquémica, se sugiere la estrategia anti-nociceptiva: La aminofilina como inhibidor selectivo del receptor P1 de la adenosina, que ha mostrado mejoría de síntomas y de la capacidad de ejercicio en estudios con muestras limitadas (35,47).…”

Section: Manejo Terapéuticounclassified

Isquemia miocárdica con coronarias de aspecto angiográfico normal. Enfoque diagnóstico

Lopez-Hidalgo

Eblén-Zajjur

2020

Invest Clin

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Los pacientes con angina de pecho, evidencia de isquemia miocárdica y angiografía con coronarias no obstructivas, implican un verdadero reto diagnóstico. Estudios recientes han demostrado que, en esta entidad clínica, el pronóstico no es tan benigno como se pensaba. El síndrome X cardíaco, actualmente más conocido como isquemia miocárdica y arterias coronarias no obstructivas (INOCA: Ischemia and No Obstructive Coronary Arteries), se ha enfocado predominantemente en la disfunción microvascular, sin embargo, los otros mecanismos causales como la enfermedad aterosclerótica oculta, el espasmo de coronarias epicárdicas y el síndrome del corazón sensible, siempre deben ser considerados. Esta revisión basada en la evidencia de los últimos 20 años, plantea una visión práctica del síndrome INOCA. Se aborda la inquietud y esfuerzos de los diferentes investigadores que estudian este síndrome, con la finalidad de lograr un protocolo diagnóstico adecuado, para así orientar mejor la terapéutica según el mecanismo fisiopatológico predominante.

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“…The cause of MCD is not fully understood. There is altered endothelial tone and adverse structural changes, possibly related to hormonal changes (specifically the decline of oestrogen in the post-menopausal years) or chronic inflammation [110,112,113]. There is no proven risk factor modification or treatment for MCD.…”

Section: Microvascular Coronary Dysfunction and Non-obstructive Coronmentioning

confidence: 99%

Women and heart disease, the underrecognized burden: sex differences, biases, and unmet clinical and research challenges

Westerman

Wenger

2016

Clinical Science

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For many years the significance of heart disease in women was vastly underappreciated, and women were significantly underrepresented in cardiovascular clinical research. We now know that cardiovascular disease is the leading cause of death for women. Women and men share many similarities in the pathophysiology and manifestations of heart disease. However, as research advances with the continued inclusion of more women, knowledge about gender differences between the female and male heart, both on a physiological and pathophysiological basis, grows. These differences can be found in all domains of cardiovascular health and disease, including heart rhythm, heart failure, coronary disease and valvular disease. Further understanding of gender differences in the heart is crucial for advancing our ability to maintain a healthy population and identify and treat heart disease in both women and men. Specific examples within the spectrum of heart disease will be discussed in this review paper, and areas for further research will be proposed.

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Microvascular Angina: an Update On Diagnosis and Treatment

Cited by 13 publications

References 68 publications

Moderate-dose atorvastatin improves arterial endothelial function in patients with angina pectoris and normal coronary angiogram: a pilot study

Moderate-dose atorvastatin improves arterial endothelial function in patients with angina pectoris and normal coronary angiogram: a pilot study

Isquemia miocárdica con coronarias de aspecto angiográfico normal. Enfoque diagnóstico

Women and heart disease, the underrecognized burden: sex differences, biases, and unmet clinical and research challenges

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