Cor Vasa 2025, 67(4):465-468 | DOI: 10.33678/cor.2025.062

(Coronary microvascular dysfunction)

Martin Pumprla^a, Radka Hazuková^a, Milan Kamínek^b, Petr Heinc^a

^a I. interní klinika - kardiologická, Lékařská fakulta Univerzity Palackého v Olomouci a Fakultní nemocnice Olomouc, Olomouc, Česká republika

^b Klinika nukleární medicíny, Lékařská fakulta Univerzity Palackého v Olomouci a Fakultní nemocnice Olomouc, Olomouc, Česká republika

The recent 2024 European Society of Cardiology (ESC) guidelines on chronic coronary syndromes (CCS) include, in addition to the standard issue of CCS on the basis of obstructive coronary disease (most commonly coronary artery disease, rarely congenital anomalies of the coronary arteries, and muscle bridges), also the issue of CCS on the basis of the non-obstructive coronary arteries/non-obstructive coronary artery diseases (NOCA/NOCAD). The main reason for the currently increased interest in CCS with NOCA/NOCAD is probably the recent data documenting their relatively frequent occurrence and their relatively unfavourable prognosis, which contrast with the original assumptions of the professional public. A typical sign of CCS in NOCA/NOCAD is a normal or near-normal coronary angiography. In the following text, the authors focused on coronary microvascular dysfunction (CMD), which represents NOCA/NOCAD at the microvascular level of the coronary artery. The cause of CMD can be structural, functional, or mixed (remodelling, endothelial dysfunction, abnormal vasodilation, microvascular vasospasm). Despite current advances, the issue of CMD remains difficult to grasp. Therefore, further research in this area is desirable. A promising method for diagnosing CMD seems to be dynamic myocardial SPECT (D-SPECT) with CZT cameras.

Keywords: ANOCA, Coronary hemodynamics, Coronary microvascular dysfunction, Dynamic CZT SPECT, INOCA, Vasospastic angina

Received: March 15, 2025; Revised: March 15, 2025; Accepted: April 6, 2025; Prepublished online: June 2, 2012; Published: October 6, 2025  Show citation