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Use of pharmacology in the diagnosis and management of vasomotor and microcirculation disorders
  1. Johanna McChord,
  2. Peter Ong
  1. Department of Cardiology, Robert-Bosch-Krankenhaus GmbH, Stuttgart, Germany
  1. Correspondence to Dr Peter Ong, Department of Cardiology, Robert-Bosch-Krankenhaus GmbH, Stuttgart 70376, Germany; Peter.Ong{at}

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Learning objectives

  • To learn the most commonly used methods of intracoronary function testing to diagnose coronary vasomotor and microcirculation disorders.

  • Understanding the complexity of different coronary vasomotor and microcirculation disorder subtypes.

  • To learn about the pharmacological management regarding common pharmacotherapy strategies targeted on the diagnosed subtypes.


In recent years, major advances in diagnostic evaluation and therapeutic strategies have been achieved in the evolving area of coronary vasomotor and microcirculation disorders. Up to 50% of patients with symptoms and/or signs of myocardial ischaemia do not have obstructive epicardial coronary disease. This constellation is also referred to as angina pectoris and non-obstructive coronary arteries (ANOCA). About 75% of patients with ANOCA have coronary vasomotion disorders which can be diagnosed using invasive coronary function testing (CFT). The test checks for the prevalence of epicardial and/or microvascular spasm, impaired coronary vasodilation and increased microvascular resistance (MVR). However, CFTs have not entered routine practice yet, although there is a class IIa recommendation in the current European Society of Cardiology guidelines for the management of chronic coronary syndromes.1 Different subtypes of coronary vasomotor disorders can be distinguished, but the disease mechanisms may overlap in a given patient. Despite the fact that there are not much data from randomised clinical studies, there is some evidence that targeted pharmacological treatment built on the acknowledged disease mechanism may improve symptoms and prognosis. The CorMicA trial2 outcomes published in 2020 included 151 patients with ANOCA who had received invasive CFT and were followed up over a 12-month period after diagnosis. At 6 and 12 months, a stratified antianginal therapy algorithm based on the CFT result showed an improvement in angina symptoms and quality of life compared with a control group treated with standard therapy. These findings highlight the relevance of targeted pharmacological treatment in this patient population, which often suffers …

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  • Contributors JM and PO contributed equally to the planning and design of the work. JM drafted a first version of the manuscript. PO made critial revisions and suggestions for improvement. Both authors agreed on the final version.

  • Competing interests JM has no competing interests. PO has received speaker honoraria from Philipps and Abbott Medical.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Author note References which include a * are considered to be key references.