Coronary microcirculation dysfunction causing ischemia with non-obstructive coronary arteries: a case report
The study presents a case of INOCA attributed to CMVD in a 53-year-old male patient experiencing exertional angina, despite the absence of significant coronary artery stenosis on angiography. The patient presented with reversible myocardial ischemia detected by myocardial perfusion imaging, with an...
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Frontiers Media S.A.
2025-04-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1556064/full |
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| author | Wei Qi Wei Qi Yazheng Zhang Yazheng Zhang Le Wang Le Wang Kai Hou Kai Hou Ting Li Ting Li Jiachun Lang Jiachun Lang Hongliang Cong Hongliang Cong |
| author_facet | Wei Qi Wei Qi Yazheng Zhang Yazheng Zhang Le Wang Le Wang Kai Hou Kai Hou Ting Li Ting Li Jiachun Lang Jiachun Lang Hongliang Cong Hongliang Cong |
| author_sort | Wei Qi |
| collection | DOAJ |
| description | The study presents a case of INOCA attributed to CMVD in a 53-year-old male patient experiencing exertional angina, despite the absence of significant coronary artery stenosis on angiography. The patient presented with reversible myocardial ischemia detected by myocardial perfusion imaging, with an ischemic area accounting for 12% of the left ventricular wall. Diagnostic tests revealed an elevated index of microcirculatory resistance (IMR = 46.3) and a quantitative flow ratio (QFR = 0.94), confirming CMVD. Genetic testing identified a NOTCH1 c.3862G>A variant in the proband and some family members, suggesting a potential contribution to CMVD pathogenesis through impaired vascular remodeling and microcirculatory regulation. After six months of targeted treatment with nicorandil, coenzyme Q10, trimetazidine, and rosuvastatin, the patient's symptoms resolved, and myocardial ischemia reversed. While an MYH7 variant was also detected, its clinical relevance was ruled out due to the family's absence of associated cardiomyopathy phenotypes. The NOTCH1 gene may play a potential role in INOCA caused by CMVD, however, further research is needed to elucidate its underlying regulatory mechanisms. The findings provide a foundation for precise diagnosis and personalized management of INOCA. |
| format | Article |
| id | doaj-art-496f3b684d0044dfbc7ed9980c147cfb |
| institution | DOAJ |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-496f3b684d0044dfbc7ed9980c147cfb2025-08-20T03:06:58ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-04-011210.3389/fcvm.2025.15560641556064Coronary microcirculation dysfunction causing ischemia with non-obstructive coronary arteries: a case reportWei Qi0Wei Qi1Yazheng Zhang2Yazheng Zhang3Le Wang4Le Wang5Kai Hou6Kai Hou7Ting Li8Ting Li9Jiachun Lang10Jiachun Lang11Hongliang Cong12Hongliang Cong13Department of Cardiology, Tianjin Chest Hospital, Tianjin, ChinaDepartment of Cardiology, Chest Hospital, Tianjin University, Tianjin, ChinaDepartment of Cardiology, Tianjin Chest Hospital, Tianjin, ChinaDepartment of Cardiology, Chest Hospital, Tianjin University, Tianjin, ChinaDepartment of Cardiology, Tianjin Chest Hospital, Tianjin, ChinaDepartment of Cardiology, Chest Hospital, Tianjin University, Tianjin, ChinaDepartment of Cardiology, Tianjin Chest Hospital, Tianjin, ChinaResearch Center, Pu’er People’s Hospital, Pu'er City, Yunnan, ChinaDepartment of Cardiology, Tianjin Chest Hospital, Tianjin, ChinaDepartment of Cardiology, Chest Hospital, Tianjin University, Tianjin, ChinaDepartment of Cardiology, Tianjin Chest Hospital, Tianjin, ChinaDepartment of Cardiology, Chest Hospital, Tianjin University, Tianjin, ChinaDepartment of Cardiology, Tianjin Chest Hospital, Tianjin, ChinaDepartment of Cardiology, Chest Hospital, Tianjin University, Tianjin, ChinaThe study presents a case of INOCA attributed to CMVD in a 53-year-old male patient experiencing exertional angina, despite the absence of significant coronary artery stenosis on angiography. The patient presented with reversible myocardial ischemia detected by myocardial perfusion imaging, with an ischemic area accounting for 12% of the left ventricular wall. Diagnostic tests revealed an elevated index of microcirculatory resistance (IMR = 46.3) and a quantitative flow ratio (QFR = 0.94), confirming CMVD. Genetic testing identified a NOTCH1 c.3862G>A variant in the proband and some family members, suggesting a potential contribution to CMVD pathogenesis through impaired vascular remodeling and microcirculatory regulation. After six months of targeted treatment with nicorandil, coenzyme Q10, trimetazidine, and rosuvastatin, the patient's symptoms resolved, and myocardial ischemia reversed. While an MYH7 variant was also detected, its clinical relevance was ruled out due to the family's absence of associated cardiomyopathy phenotypes. The NOTCH1 gene may play a potential role in INOCA caused by CMVD, however, further research is needed to elucidate its underlying regulatory mechanisms. The findings provide a foundation for precise diagnosis and personalized management of INOCA.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1556064/fullcoronary arteriesmicrocirculation dysfunctionmyocardial ischemiaanginavariation |
| spellingShingle | Wei Qi Wei Qi Yazheng Zhang Yazheng Zhang Le Wang Le Wang Kai Hou Kai Hou Ting Li Ting Li Jiachun Lang Jiachun Lang Hongliang Cong Hongliang Cong Coronary microcirculation dysfunction causing ischemia with non-obstructive coronary arteries: a case report Frontiers in Cardiovascular Medicine coronary arteries microcirculation dysfunction myocardial ischemia angina variation |
| title | Coronary microcirculation dysfunction causing ischemia with non-obstructive coronary arteries: a case report |
| title_full | Coronary microcirculation dysfunction causing ischemia with non-obstructive coronary arteries: a case report |
| title_fullStr | Coronary microcirculation dysfunction causing ischemia with non-obstructive coronary arteries: a case report |
| title_full_unstemmed | Coronary microcirculation dysfunction causing ischemia with non-obstructive coronary arteries: a case report |
| title_short | Coronary microcirculation dysfunction causing ischemia with non-obstructive coronary arteries: a case report |
| title_sort | coronary microcirculation dysfunction causing ischemia with non obstructive coronary arteries a case report |
| topic | coronary arteries microcirculation dysfunction myocardial ischemia angina variation |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1556064/full |
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