Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Apr 16:42:100391.
doi: 10.1016/j.ahjo.2024.100391. eCollection 2024 Jun.

INOCA: Ischemia in non-obstructive coronary arteries

Shereen AlShaikh  1 , Charlene L Rohm  2 , Nadia R Sutton  2   3 , Sonya N Burgess  4 , Mirvat Alasnag  5
Affiliations

INOCA: Ischemia in non-obstructive coronary arteries

Shereen AlShaikh et al. Am Heart J Plus. .

Abstract

This article provides a summary of the clinical spectrum of no obstructive coronary arteries. We describe the pathologies, invasive and noninvasive assessment, and management strategies.

Keywords: Cardiac imaging; Epicardial coronary arteries; Functional testing; Intracoronary imaging; Ischemia.

PubMed Disclaimer

Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: N.R.S. is a consultant for Abbott and Philips and has received honoraria for speaking from Abbott, Philips, and Zoll. None of the other authors have any relevant disclosures.

Figures

Fig. 1
Fig. 1
Causes of microvascular dysfunction. CAD: Coronary artery disease.
Fig. 2
Fig. 2
Central illustration. FFR: Fractional flow reserve; CFR: Coronary flow reserve; IMR: Index of microcirculatory resistance; HMR: Hyperemic microvascular resistance.
Fig. 3
Fig. 3
Invasive diagnosis of INOCA.
Unlabelled Image
A coronary angiogram reveals no obstructive coronary artery disease (Panel A). The patient is found to have non-obstructive coronary artery disease. Coronary functional testing included coronary acetylcholine administration, with no evidence of spasm. Microvascular functional testing was performed (Panel B). The coronary flow reserve was 2.0 and the index of microvascular resistance, 15.
Unlabelled Image
No new obstructive coronary artery disease is present (Panel A), and his left ventricular filling pressure is normal. Coronary functional testing including microvascular dysfunction testing is performed (Panel B). His baseline coronary flow is slow and increases significantly after hyperemia is induced with adenosine. His CFR is greater than 2, but his index of microvascular resistance is still elevated, 30.
See this image and copyright information in PMC

References

    1. Jespersen L., Hvelplund A., Abildstrom S.Z., Pedersen F., Galatius S., Madsen J.K., Jorgensen E., Kelbaek H., Prescott E. Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events. Eur. Heart J. 2012;33:734–744. - PubMed
    1. Gulati M., Levy P.D., Mukherjee D., Amsterdam E., Bhatt D.L., Birtcher K.K., Blankstein R., Boyd J., Bullock-Palmer R.P., Conejo T., Diercks D.B., Gentile F., Greenwood J.P., Hess E.P., Hollenberg S.M., Jaber W.A., Jneid H., Joglar J.A., Morrow D.A., O’Connor R.E., Ross M.A., Shaw L.J. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021 Nov 30;144(22):e368–e454. doi: 10.1161/CIR.0000000000001029. (Epub 2021 Oct 28. Erratum in: Circulation. 2021 Nov 30; 144(22): e455) - DOI - PubMed
    1. Lindahl B., Baron T., Erlinge D., Hadziosmanovic N., Nordenskjöld A., Gard A., Jernberg T. Medical therapy for secondary prevention and long-term outcome in patients with myocardial infarction with nonobstructive coronary artery disease. Circulation. 2017 Apr 18;135(16):1481–1489. - PubMed
    1. Sharaf B., Wood T., Shaw L., Johnson B.D., Kelsey S., Anderson R.D., Pepine C.J., Bairey Merz C.N. Adverse outcomes among women presenting with signs and symptoms of ischemia and no obstructive coronary artery disease: findings from the National Heart, Lung, and Blood Institute-sponsored Women’s Ischemia Syndrome Evaluation (WISE) angiographic core laboratory. Am. Heart J. 2013 Jul;166(1):134–141. - PMC - PubMed
    1. Ford T.J., Stanley B., Sidik N., Good R., Rocchiccioli P., McEntegart M., Watkins S., Eteiba H., Shaukat A., Lindsay M., et al. 1-Year outcomes of angina management guided by invasive coronary function testing (CorMicA) JACC Cardiovasc. Interv. 2020;13:33–45. - PMC - PubMed

LinkOut - more resources