Microvascular Angina Pectoris: The Pathophysiology of Decreased Coronary Reserve

M. A. Kravchenko; L. D. Khidirova

doi:10.20514/2226-6704-2026-16-2-96-103

Microvascular Angina Pectoris: The Pathophysiology of Decreased Coronary Reserve

M. A. Kravchenko, L. D. Khidirova

https://doi.org/10.20514/2226-6704-2026-16-2-96-103

EDN: KGZJWD

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Abstract

A review of modern Russian and foreign literature on the problem of impaired coronary blood flow reserve as a manifestation of microvascular dysfunction has been conducted. When searching for information on this issue, materials from the following databases were used: RSCI, Best Evidence, Scopus, Elsevier, PubMed, Clinical Evidence, Cochrane Library. Violation of the coronary blood flow reserve is an important manifestation of microvascular dysfunction and a key diagnostic criterion for microvascular angina. The evaluation of this indicator has high prognostic and therapeutic significance. Given the heterogeneity of pathogenesis, further research is needed for a personalized approach to the treatment of patients with microvascular angina.

Keywords

microvascular dysfunction, coronary blood flow reserve, ischemia, endothelial dysfunction, smooth muscle cell hyperreactivity, PET, OCT, MRI, CFR

About the Authors

M. A. Kravchenko

Novosibirsk Clinical Cardiology Dispensary
Russian Federation

Marina A. Kravchenko — 5th-year student

Novosibirsk

Competing Interests:

The authors declare no conflict of interests

L. D. Khidirova

Novosibirsk State Medical University of the Ministry of Health of the Russian Federation, Department of Pharmacology, Clinical Pharmacology and Evidence-Based Medicine ; Novosibirsk Clinical Cardiology Dispensary
Russian Federation

Lyudmila D. Khidirova — Doctor of Medical Sciences, Professor; Leading Cardiologist

Novosibirsk

Competing Interests:

The authors declare no conflict of interests

References

1. Gorshenina E.I., Inevatkina Y.N., Kurkina N.V., et al. Microvascular angina. Sovremennye Problemy Nauki i Obrazovaniya. 2021; 3: 185. doi: 10.17513/spno.30835 [In Russian].

2. Kaski J.S., Crea F., Hersh B.J., Kamichi G. Reassessment of coronary heart disease. Circulation. 2018; 138(14): 1463–1480. doi: 10.1161/Circulationaha.118.031373. PMID:30354347.

3. Jarczewski J., Jarczewska A., Boryczko A., et al. Microvascular angina (Cardiac Syndrome X) from a historical overview, epidemiology, pathophysiology to treatment recommendations — a mini-review. Folia Med Cracov. 2021; 61(3): 95–114. doi: 10.24425/fmc.2021.138954.

4. Sagris M., Theofilis P., Antonopoulos A.S., et al. Inflammation in coronary microvascular dysfunction. Int J Mol Sci. 2021; 22(24): 13471. doi: 10.3390/ijms222413471.

5. Smilowitz N.R., Toleva O., Chieffo A., Perera D., Berry C. Coronary microvascular disease in contemporary clinical practice. Circ Cardiovasc Interv. 2023; 16(6): e012568. doi: 10.1161/CIRCINTERVENTIONS.122.012568.

6. Kelshiker M.A., Seligman H., Howard J.P., et al. Coronary flow reserve and cardiovascular outcomes: a systematic review and meta-analysis. Eur Heart J. 2022; 43(16): 1582–1593. doi: 10.1093/eurheartj/ehab775.

7. Rehan R., Yong A., Ng M., Weaver J., Puranik R. Coronary microvascular dysfunction: a review of recent progress and clinical implications. Front Cardiovasc Med. 2023; 10: 1111721. doi: 10.3389/fcvm.2023.1111721.

8. Weerts J., Mourmans S.G.J., Barandiarán Aizpurua A., et al. The role of systemic microvascular dysfunction in heart failure with preserved ejection fraction. Biomolecules. 2022; 12(2): 278. doi: 10.3390/biom12020278.

9. La Vecchia G., Fumarulo I., Caffè A., Chiatto M., Montone R.A., Aspromonte N. Microvascular dysfunction across the spectrum of heart failure pathology: pathophysiology, clinical features and therapeutic implications. Int J Mol Sci. 2024; 25(14): 7628. doi: 10.3390/ijms25147628.

10. Del Buono M.G., Montone R.A., Camilli M., et al. Coronary microvascular dysfunction across the spectrum of cardiovascular diseases: JACC state-of-the-art review. J Am Coll Cardiol. 2021; 78(13): 1352–1371. doi: 10.1016/j.jacc.2021.07.042.

11. Deng J. Research progress on the molecular mechanism of coronary microvascular endothelial cell dysfunction. Int J Cardiol Heart Vasc. 2021; 34: 100777. doi: 10.1016/j.ijcha.2021.100777.

12. Kontovskiy E.A., Kosheleva E.N., Dubovik A.V., et al. Correction of endothelial dysfunction in patients with microvascular angina. Universitetskaya Klinika. 2020; 2(35): 60–66. doi: 10.26435/UC.V0I2(35).441 [In Russian].

13. Hansen B., Holtzman J.N., Juszczynski C., et al. Ischemia with no obstructive arteries (INOCA): a review of the prevalence, diagnosis and management. Curr Probl Cardiol. 2023; 48(1): 101420. doi: 10.1016/j.cpcardiol.2022.101420.

14. Yang R., Bai Z., Liang C., Qi F. Treatment of microvascular angina pectoris by activating blood circulation to remove blood stasis: a systematic review and meta-analysis. Medicine (Baltimore). 2024; 103(41): e40012. doi: 10.1097/MD.0000000000040012.

15. Mehta P.K., Huang J., Levit R.D., Malas W., Waheed N., Bairey Merz C.N. Ischemia and no obstructive coronary arteries (INOCA): a narrative review. Atherosclerosis. 2022; 363: 8–21. doi: 10.1016/j.atherosclerosis.2022.11.009.

16. Zhang Y., Wang X., Liu R., et al. The effectiveness and safety of nicorandil in the treatment of patients with microvascular angina: a protocol for systematic review and meta-analysis. Medicine (Baltimore). 2021; 100(2): e23888. doi: 10.1097/MD.0000000000023888.

17. Soleymani M., Masoudkabir F., Shabani M., Vasheghani-Farahani A., Behnoush A.H., Khalaji A. Updates on pharmacologic management of microvascular angina. Cardiovasc Ther. 2022; 2022: 6080258. doi: 10.1155/2022/6080258.

18. Bokeria O.L., Hebert K., Kudzoeva Z.F. Ranolazine — late sodium current inhibitor: possibilities of use for arrhythmias, results of clinical trials. Annals of Arrhythmology. 2015; 2: 151–161 [In Russian].

19. Ullrich-Daub H., Daub S., Olschewski M., Münzel T., Gori T. Diseases of the coronary microcirculation: diagnosis and treatment. Dtsch Arztebl Int. 2023; 120(44): 739–746. doi: 10.3238/arztebl.m2023.0205.

20. Larina V.N., Korchagin I.A. Consensus of European experts on the management of patients with ischemia with non-obstructive coronary arteries and chronic coronary syndrome: possibilities for use in outpatient clinical practice in Russia. Russian Archives of Internal Medicine. 2022; 12(5): 330–340. doi: 10.20514/2226-6704-2022- 12-5-330-340 [In Russian].

21. Odanović N., Schwann A.N., Zhang Z., et al. Long-term outcomes of ischaemia with no obstructive coronary artery disease (INOCA): a systematic review and meta-analysis. Open Heart. 2024; 11(2): e002852. doi: 10.1136/openhrt-2024-002852.

22. Shimokawa H., Suda A., Takahashi J., et al. Clinical characteristics and prognosis of patients with microvascular angina: an international and prospective cohort study by the Coronary Vasomotor Disorders International Study (COVADIS) Group. Eur Heart J. 2021; 42(44): 4592–4600. doi: 10.1093/eurheartj/ehab282.

23. Filali Y., Kesäniemi A., Ukkola O. Soluble ST2, a biomarker of fibrosis, is associated with multiple risk factors, chronic diseases and total mortality in the OPERA study. Scand J Clin Lab Invest. 2021; 81(4): 324–331. doi: 10.1080/00365513.2021.1904518.

24. Maron D.J., Hochman J.S., O’Brien S.M., et al. International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial: rationale and design. Am Heart J. 2018; 201: 124–135. doi: 10.1016/j.ahj.2018.04.011.

25. Boden W.E., O’Rourke R.A., Teo K.K., et al.; COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007; 356: 1503–1516. doi: 10.1056/NEJMoa070829.

26. Tjoe B., Barsky L., Wei J., Samuels B., Azarbal B., Merz C.N.B., Shufelt C. Coronary microvascular dysfunction: considerations for diagnosis and treatment. Cleve Clin J Med. 2021; 88(10): 561–571. doi: 10.3949/ccjm.88a.20140.

27. Schroder J., Michelsen M.M., Mygind N.D., et al. Coronary flow velocity reserve predicts adverse prognosis in women with angina and no obstructive coronary artery disease: results from the iPOWER study. Eur Heart J. 2021; 42(3): 228–239. doi: 10.1093/eurheartj/ehaa944.

28. Karpov Yu.A., Soboleva G.N., Erpylova E.A. Microvascular angina: diagnosis and treatment. Atmosphere. Cardiology News. 2019; 4: 22–24 [In Russian].

29. Vrints C., Andreotti F., Koskinas K.C., et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024; 45:in press.

30. Knuuti J., Wijns W., Saraste A., et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020; 41: 407–477. doi: 10.1093/eurheartj/ehz425.

31. Maslennikova O.M., Oynotkinova O.Sh., Starodubova A.V., et al. Review of the recommendations of the European Society of Cardiology in 2024 on chronic coronary syndromes: what’s new. Effective Pharmacotherapy. 2024; 20(31): 9–22. doi: 10.33978/2307-3586-2024-20-31-9-22 [In Russian].

32. Barbarash O.L., Karpov Yu.A., Panov A.V., et al. Stable coronary heart disease. Clinical guidelines 2024. Russian Journal of Cardiology. 2024; 29(9): 6110. doi: 10.15829/1560-4071-2024-6110 [In Russian].

33. Gorshenina E.I., Inevatkina Yu.N., Kurkina N.V., et al. Microvascular angina pectoris. Modern Problems of Science and Education. 2021; 3. doi: 10.17513/spno.30835 [In Russian].

Review

For citations:

Kravchenko M.A., Khidirova L.D. Microvascular Angina Pectoris: The Pathophysiology of Decreased Coronary Reserve. The Russian Archives of Internal Medicine. 2026;16(2):96-103. https://doi.org/10.20514/2226-6704-2026-16-2-96-103. EDN: KGZJWD

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