MICROVASCULAR ANGINA IN PATIENTS WITH NON-STENOTIC CORONARY LESIONS

Background. According to various literature data, from 1/3 to 1/2 of patients whose complaints correspond to a typical picture of angina pectoris do not have obstructive lesions of the coronary vessels during invasive coronary angiography. These patients belong to the INOCA group. The main pathogenic mechanism of this problem is coronary microvascular dysfunction (CMD), which manifests as a violation of the coronary vasodilation reserve. Aim: to evaluate reserve of coronary vasodilatation and to determine the echocardiographic signs of myocardial ischemia in patients with angina pectoris and non-stenotic atherosclerosis of the coronary vessels according to the data of invasive coronary angiography. Materials and methods. We included 311 patients with a clinical diagnosis of «CAD: angina pectoris» who underwent invasive coronary angiography and who had intact coronary arteries or non-stenotic lesions were consecutively examined. Coronary microvascular dysfunction (reduced iCFR index) occurred in 78.1% of patients with coronary heart disease without hemodynamically significant lesions of the coronary arteries. In those patients, a significant decrease in the GLS indicator was observed -15.2±0.5% compared to the baseline -20.5±0.4% mainly due to segmental disorders - signs of myocardial ischemia. Conclusion. Stress echocardiography with strain imaging during intravenous dipyridamole was an effective method for simultaneously detecting violation of the coronary vasodilatation reserve and confirming the myocardial ischemia.