Key result
Coronary endothelial dysfunction affects ~67% of non-obstructive CAD patients, driving higher morbidity and myocardial event risk.
Coronary endothelial dysfunction is a common and high-risk etiology in patients with non-obstructive coronary artery disease that requires greater awareness and testing.
May warrant consideration of endothelial function assessment in NoCAD; leaves open whether testing or targeted therapies alter outcomes.
Up to half of patients with signs and symptoms of stable ischemic heart disease have non-obstructive coronary artery disease (NoCAD). Recent evidence demonstrates that two-thirds of patients with NoCAD have demonstrable coronary endothelial dysfunction represented by microvascular or diffuse epicardial spasm following acetylcholine challenge. Patients with coronary endothelial dysfunction are recognized to have significant health services use and morbidity as well as increased risk of developing flow-limiting coronary artery disease and myocardial events, including death. Currently, there are few centers that test for this etiology owing to lack of knowledge, limited evidence for treatment options and invasive diagnostic strategies. This article reviews the pathophysiology, epidemiology, diagnosis and treatment of coronary endothelial dysfunction as a subgroup of NoCAD.
No takes yet. Share an insight, caveat, or question.
Shaw et al. (2015) conducted a review in Non-obstructive coronary artery disease (NoCAD). Coronary endothelial dysfunction affects up to two-thirds of patients with non-obstructive coronary artery disease, leading to increased morbidity and risk of myocardial events including death.
Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context: