Microvascular Angina: Diagnosis, Assessment, and Treatment

Abstract

In patients with angina symptoms but with no coronary artery disease, as revealed by normal or near-normal coronary angiogram, a potential diagnosis of microvascular angina (MVA) might be considered. This review examines the evidence on long-term prognosis, state-of-the-art assessment and treatment strategies, and the overwhelming need for standardisation of diagnostic pathways in this patient population. The rising clinical relevance of MVA is explored along with how the absence of obstructive coronary artery disease on coronary angiography may not be a guarantee of benign prognosis in this patient subgroup. A definitive diagnosis of MVA requires evidence of coronary microvascular dysfunction found in up to 60% of patients with symptoms or signs of myocardial ischaemia and no obstructive coronary artery disease. Sex differences affect immune responses associated with hormonal, genetic, and environmental factors, and identification of patients susceptible to microvascular dysfunction ultimately requires the examination of the functional capacity of microvasculature for the proper diagnosis of MVA. Studies of novel therapies are now more widely available, the positive results of which will encourage more extensive studies in the future. Currently, the evidence base seems to support a stratified approach with medication therapy tailored to the findings of the assessment of the microcirculation.