Treatment of Microvascular Angina in the Absence of Significant Atherosclerotic Coronary Artery Disease in Patients With Cardio-Renal Metabolic Syndrome

Background. Ischemic heart disease (IHD) remains the most common cardiovascular disease and the leading cause of mortality worldwide. Systemic atherosclerosis results from various risk factors, such as genetic predisposition, smoking, and diabetes. Cardio-renal-metabolic (CRM) conditions combines heart failure, dysglycemia and chronic kidney disease, increasing the risk of INOCA. Aim: of study was to examine the prevalence and optimize the treatment of microvascular angina in patients with IHD, non-stenosing coronary atherosclerosis and CRM condition. Materials and methods. A total of 82 patients with CRM conditions were examined, including 54 males (65.8%) and 28 females (34.2%) with an average age of 56.9±3.9 years. Patients underwent an exercise stress test or stress echocardiography for myocardial ischemia assessment. Following IHD confirmation, invasive coronary angiography revealed non-stenosing coronary atherosclerosis or intact coronary arteries. Coronary microvascular dysfunction was diagnosed via echocardiography with intravenous dipyridamole administration, followed by coronary flow reserve (CFR) index assessment. Microvascular dysfunction was diagnosed with CFR <2. Patients with confirmed myocardial ischemia and no significant coronary artery lesions were diagnosed with microvascular angina (INOCA). Results. In 74 (90.2%) patients with CRM conditions and IHD without significant coronary artery lesions, the cause of ischemia was microvascular angina. The remaining 9.8% had myocardial demand-supply mismatch due to cardiac muscle hypertrophy. Research continued with 74 patients with microvascular angina. All patients received aspirin, statins, beta-blockers, calcium channel blockers, ACE inhibitors/sartans, indapamide, SGLT2 inhibitors, and metformin. To achieve a goal in glycaemic profiles, doses of metformin were adjusted for 46 patients, and liraglutide was added for 10. For all patients we prescribed nicorandil. After 28 days of nicorandil therapy, 97.3% of patients were free of angina symptoms. Nicorandil normalized coronary microvascular function in 91.9% and clinically relieved symptoms in 97.3%. Conclusion. In 90.2% patients with CRM conditions and IHD without significant coronary artery lesions, ischemic complaints are due to microvascular angina. Nicorandil in combination therapy achieves a clinical effect in 97.3% of cases and normalizes coronary flow reserve in 91.9% of patients.