Coronary Microvascular Dysfunction and Its Role in Angina

Coronary microvascular dysfunction (CMD) has emerged as a critical mechanism underlying angina in patients with non-obstructive coronary artery disease (ANOCA/INOCA). Unlike epicardial stenosis, CMD results from impaired vasodilation, endothelial dysfunction, and structural remodeling of the microcirculation, leading to inadequate myocardial perfusion during stress. Patients often present with typical angina but lack significant blockages on angiography, making diagnosis challenging. CMD not only affects quality of life but also confers an increased risk of heart failure with preserved ejection fraction (HFpEF).

Advances in non-invasive imaging—such as PET, cardiac MRI, and invasive coronary flow reserve (CFR) measurements—are improving CMD detection. Therapeutic strategies are evolving, ranging from endothelial-targeted agents (statins, ACE inhibitors) to novel vasodilators and lifestyle interventions. This track will examine diagnostic innovations, mechanistic insights, and tailored therapies for CMD. Discussions will focus on closing gaps in recognizing and managing angina without obstructive coronary disease, an area increasingly relevant to women and elderly populations.

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