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CASE REPORT article
Front. Cardiovasc. Med.
Sec. Cardiovascular Surgery
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1556064
This article is part of the Research Topic Surgical Revascularization of the Ischemic Myocardium in the third millennium View all 4 articles
Coronary Microcirculation Dysfunction Causing Ischemia With Non-Obstructive Coronary Arteries: A Case Report
Provisionally accepted- Tianjin Chest Hospital, Tianjin, China
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.
Keywords: Coronary arteries, microcirculation dysfunction, Myocardial Ischemia, angina, variation
Received: 06 Jan 2025; Accepted: 28 Mar 2025.
Copyright: © 2025 Qi, Zhang, Wang, Hou, Li, Lang and Cong. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Hongliang Cong, Tianjin Chest Hospital, Tianjin, China
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