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Review
. 2021 Sep 3:16:e30.
doi: 10.15420/ecr.2021.23. eCollection 2021 Feb.

Pathophysiology and Diagnosis of Coronary Functional Abnormalities

Jun Takahashi  1 , Akira Suda  1 , Kensuke Nishimiya  1 , Shigeo Godo  1 , Satoshi Yasuda  1 , Hiroaki Shimokawa  1
Affiliations
Review

Pathophysiology and Diagnosis of Coronary Functional Abnormalities

Jun Takahashi et al. Eur Cardiol. .

Abstract

Approximately one-half of patients undergoing diagnostic coronary angiography for angina have no significant coronary atherosclerotic stenosis. This clinical condition has recently been described as ischaemia with non-obstructive coronary arteries (INOCA). Coronary functional abnormalities are central to the pathogenesis of INOCA, including epicardial coronary spasm and coronary microvascular dysfunction composed of a variable combination of increased vasoconstrictive reactivity and/or reduced vasodilator function. During the last decade - in INOCA patients in particular - evidence for the prognostic impact of coronary functional abnormalities has accumulated and various non-invasive and invasive diagnostic techniques have enabled the evaluation of coronary vasomotor function in a comprehensive manner. In this review, the authors briefly summarise the recent advances in the understanding of pathophysiology and diagnosis of epicardial coronary artery spasm and coronary microvascular dysfunction.

Keywords: Epicardial coronary spasm; Rho-kinase; biomarker; coronary flow reserve; coronary microvascular dysfunction; coronary vasoreactivity testing.

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Conflict of interest statement

Disclosure: HS is an international advisor on the European Cardiology Review editorial board; this did not affect peer review. All other authors have no conflicts of interest to declare. Support: This work was supported in part by the Grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science, and Technology, Tokyo, Japan (16K09413, 17K15983) and the Agency for Medical Research and Development (21gk0210030h0001).

Figures

Figure 1:
Figure 1:. Vessel-size-dependent Contribution of Endothelium-derived Relaxing Factors and Rho-kinase-mediated Vascular Smooth Muscle Hypercontraction
Figure 2:
Figure 2:. Protocol for the Invasive Diagnostic Procedure
See this image and copyright information in PMC

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