CORONARY ARTERY MICROVASCULAR DYSFUNCTION

Introduction Ischaemia with Non Obstructed Coronary Arteries (INOCA) represents a significant challenge in cardiovascular (CV) medicine. Conventional imaging methods often fail to detect underlying microvascular dysfunction.
Aim To identify microvascular dysfunction (vasomotor disorders) in coronary arterial system, evaluate its risk, and compare it with similar conditions in peripheral arteries.
Patients and Methods This prospective controlled study aims to enroll 40-60 adults with negative coronary angiograms (atherosclerosis ≤ 30% of the artery lumen), indicated for typical angina pectoris or myocardial dysfunction (left ventricular ejection fraction < 50%), along with abnormal electrocardiograms (ECG) of unknown etiology suggestive of ischemia. Exclusion criteria include other significant active or uncontrolled comorbidities (e.g., neoplasms, inflammatory diseases, myocardial hypertrophy, aortic valve stenosis), localized myocardial dysfunction, and well-known conditions (e.g., thyroid disorders, toxo-nutritional issues). An innovative dynamic myocardial SPECT technique will be the primary method for assessing coronary microvascular dysfunction. To detect microvascular dysfunction in peripheral artery networks relevant dynamic tests will be used. The matched control group will be selected from participants with normal results in coronary angiograms, myocardial function, SPECT, and ECG. Risk assessment will be based on "Major Adverse Cardiac Events (MACE)" during a 1-year follow-up. Data will be expressed as mean (standard deviation) or median (maximmum, minimum). Statistical significance will be set at P < 0.05.
Conclusion The authors expect to identify microvascular coronary dysfunction in 30% of the selected patients, with no incidence of major adverse cardiac events (MACE), due to the short follow-up period.