Coronary Microvascular Dysfunction, Microvascular Angina, and Management

  • Adrián I. Löffler
  • Jamieson M. BourqueEmail author
Ischemic Heart Disease (D Mukherjee, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Ischemic Heart Disease


Recent analyses have found that coronary microvascular dysfunction (CMD) portends a poor prognosis in patients with and without obstructive epicardial coronary artery disease (CAD). Chest pain in the absence of epicardial CAD is a common entity. Angina caused by CMD, microvascular angina (MVA), is often indistinguishable from that caused by obstructive epicardial CAD. The recent emergence of noninvasive techniques that can identify CMD, such as stress positron-emission tomography (PET) and cardiovascular magnetic resonance (CMR) myocardial perfusion imaging, allow improved identification of MVA. Using these tools, higher risk patients with MVA can be differentiated from those at lower risk in the heterogeneous population historically labeled as cardiac syndrome X. Likewise, MVA can be diagnosed in those with obstructive epicardial CAD who have persistent angina despite successful revascularization. There is little evidence to support current treatment strategies for MVA and current literature has not clearly defined CMD or whether therapy improves prognosis.


Coronary microvascular dysfunction Microvascular angina Therapeutics Prognosis 



This research is supported by Dr. Bourque’s NIH grant 1K23HL119620-01.

Compliance with Ethical Standards

Conflict of Interest

Dr. Adrián I. Löffler declares that he has no conflict of interest. Dr. Jamieson Bourque receives research grant support from Astellas Pharma.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Division of Cardiovascular MedicineUniversity of Virginia Health SystemCharlottesvilleUSA
  2. 2.Division of Cardiovascular Medicine and RadiologyUniversity of Virginia Health SystemCharlottesvilleUSA

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