INOCA/ANOCA: Mechanisms and novel treatments

Namrita D. Ashokprabhu; Odayme Quesada; Yulith Roca Alvarez; Timothy D. Henry

American Heart Journal Plus (Jun 2023)

INOCA/ANOCA: Mechanisms and novel treatments

Namrita D. Ashokprabhu,
Odayme Quesada,
Yulith Roca Alvarez,
Timothy D. Henry

Affiliations

Namrita D. Ashokprabhu: Women's Heart Center at The Christ Hospital, Cincinnati, OH, USA; The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH, USA; The Christ Hospital Heart and Vascular Institute, Cincinnati, OH, USA
Odayme Quesada: Women's Heart Center at The Christ Hospital, Cincinnati, OH, USA; The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH, USA; The Christ Hospital Heart and Vascular Institute, Cincinnati, OH, USA
Yulith Roca Alvarez: Women's Heart Center at The Christ Hospital, Cincinnati, OH, USA; The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH, USA; The Christ Hospital Heart and Vascular Institute, Cincinnati, OH, USA
Timothy D. Henry: Corresponding author at: The Christ Hospital Health Network, 2123 Auburn Avenue, Suite 424, Cincinnati, OH 45219, USA.; Women's Heart Center at The Christ Hospital, Cincinnati, OH, USA; The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH, USA; The Christ Hospital Heart and Vascular Institute, Cincinnati, OH, USA

Journal volume & issue: Vol. 30
p. 100302

Abstract

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Angina or ischemia with no obstructive coronary disease (ANOCA/INOCA) is a common but under-treated condition due to poorly understood pathophysiologic mechanisms, limited diagnostic tools, and lack of proven targeted therapy. Coronary microvascular dysfunction (CMD) occurs when the microvasculature inadequately perfuses the myocardium under stress, or at rest in the case of microvascular spasm resulting in ANOCA/INOCA. Coronary functional angiography (CFA) measures endothelial independent microvascular dysfunction (coronary flow reduction <2.5) in response to adenosine and endothelial dependent microvascular dysfunction (lack of dilation and/or constriction) to acetylcholine testing as well as epicardial and microvascular spasm. Current treatment for coronary microvascular dysfunction is limited to renin-angiotensin system (RAS) inhibitors and statins as well as antianginal medications. Novel therapies targeting the underlying pathology are under development and include the coronary sinus reducer, CD34+ stem cell therapy, and novel pharmacologic agents such as sGC stimulators or endothelin-receptor blockers. We review the current understanding of pathophysiology, diagnostic tools, and novel therapies for coronary microvascular dysfunction in ANOCA/INOCA.

Published in American Heart Journal Plus

ISSN: 2666-6022 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://www.journals.elsevier.com/american-heart-journal-plus-cardiology-research-and-practice

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Abstract

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