The Bottom Line: Primary Microvascular Angina (MVA) includes heterogeneous groups of patients, with different pathogenetic and pathophysiological mechanisms of CMVD, who might have different clinical implications and need different diagnostic and therapeutic approaches.
Lanza, Gaetano. Primary coronary microvascular dysfunction: clinical presentation, pathophysiology, and management. Circulation 2010 vol:121 iss:21 pg:2317 -2325
The Bottom Line: Microvascular angina (MVA) is an often overlooked cause of significant chest pain. Decreased myocardial perfusion secondary to dysregulated blood flow in the microvasculature can occur in the presence or absence of obstructive epicardial coronary artery disease. The corresponding myocardial ischemia and angina is now a well-established diagnosis, made by detection of decreased coronary flow reserve (CFR).
Vesely, Mark Microvascular angina: assessment of coronary blood flow, flow reserve, and metabolism. Current cardiology reports 2011 vol:13 iss:2 pg:151 -158
Although low CFR and MVA are associated with poor prognosis, there is initial evidence for reversibility of this abnormal vascular regulation with aggressive medical therapy and control of associated risk factors. Current assessment of MVA is carried out predominantly during cardiac catheterization; however, noninvasive techniques to assess CFR are being developed, including PET, MRI, and CT modalities.