4.6 Review

Ischemia and no obstructive coronary arteries (INOCA): A narrative review

Journal

ATHEROSCLEROSIS
Volume 363, Issue -, Pages 8-21

Publisher

ELSEVIER IRELAND LTD
DOI: 10.1016/j.atherosclerosis.2022.11.009

Keywords

Coronary microvascular; Coronary vasospasm; Myocardial ischemia; Endothelial dysfunction

Funding

  1. National Institutes of Health [R01HL124649, U54 AG065141, 1U54AG062334-01, 1R01HL157311]
  2. Edythe L. Broad Fellowship
  3. Constance Austin Women's Heart Research Fellowship
  4. Cedars-Sinai Medical Center
  5. Barbra Streisand Women's Cardiovascular Research and Education Program
  6. Society for Women's Health Research (SWHR), Washington, DC
  7. Linda Joy Pollin Women's Heart Health Program
  8. Erika Glazer Women's Heart Health Project
  9. Adelson Family Foundation, Cedars-Sinai Medical Center, Los Angeles, California

Ask authors/readers for more resources

INOCA, a chronic coronary syndrome, is increasingly recognized as a significant contributor to adverse cardiovascular outcomes, including myocardial infarction and heart failure with preserved ejection fraction (HFpEF). Although occurring in both genders, women are more affected by INOCA and may experience angina, hospitalizations, and reduced quality of life. Abnormal coronary vascular function and microvascular dysfunction are common in INOCA patients, with treatment focusing on risk factor control, ischemia improvement, atherosclerosis progression reduction, and angina and quality of life improvement.
Myocardial ischemia with no obstructive coronary arteries (INOCA) is a chronic coronary syndrome condition that is increasingly being recognized as a substantial contributor to adverse cardiovascular mortality and out-comes, including myocardial infarction and heart failure with preserved ejection fraction (HFpEF). While INOCA occurs in both women and men, women are more likely to have the finding of INOCA and are more adversely impacted by angina, with recurrent hospitalizations and a lower quality of life with this condition. Abnormal epicardial coronary vascular function and coronary microvascular dysfunction (CMD) have been identified in a majority of INOCA patients on invasive coronary function testing. CMD can co-exist with obstructive epicardial coronary artery disease (CAD), diffuse non-obstructive epicardial CAD, and with coronary vasospasm. Epicardial vasospasm can also occur with normal coronary arteries that have no atherosclerotic plaque on intravascular imaging. While all predisposing factors are not clearly understood, cardiometabolic risk factors, and endothelium dependent and independent mechanisms that increase oxidative stress and inflammation are associated with microvascular injury, CMD and INOCA. Cardiac autonomic dysfunction has also been implicated in abnormal vasoreactivity and persistent symptoms. INOCA is under-recognized and under-diagnosed, partly due to the heterogenous patient populations and mechanisms. However, diagnostic testing methods are available to guide INOCA management. Treatment of INOCA is evolving, and focuses on cardiac risk factor control, improving ischemia, reducing atherosclerosis progression, and improving angina and quality of life. This review focuses on INOCA, relations to HFpEF, available diagnostics, current and investigational therapeutic strategies, and knowledge gaps in this condition.

Authors

I am an author on this paper
Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

4.6
Not enough ratings

Secondary Ratings

Novelty
-
Significance
-
Scientific rigor
-
Rate this paper

Recommended

No Data Available
No Data Available