Research Topic

Sex differences in symptomatic patients with no-obstructive coronary artery disease (INOCA and MINOCA)

About this Research Topic

Signs and symptoms of ischemia are believed to be indicative for obstructive atherosclerotic coronary artery disease and therefore patients will undergo coronary angiography. However, in about 50% of these patients no obstructive disease is found on angiography. In this, sex differences appear, as 70% are (middle aged) women compared to 30% men. Therefore, assessment of risk focused on coronary stenosis often fails in women and they are left without a diagnosis and treatment. Why these differences exist, and which pathophysiologic mechanisms are contributing to this in patients with no obstructive coronary artery disease (INOCA) is still not exactly known.
As such coronary artery disease has been re-defined as ischemic heart disease that includes, aside from obstructive coronary artery disease, structural and functional disorders of the coronary vascular bed and can occur in different parts of the myocardial circulation, including the microcirculation. These so called coronary vasomotion disorders include epicardial disease (e.g. non- obstructive atherosclerosis, vasospasm, dissection, and thrombi) and coronary microvascular dysfunction (CMD) (e.g. impaired vasodilation, microvascular spasm and thrombi). Several non-invasive and invasive techniques are used needed to diagnose coronary vasomotor dysfunction and to differentiate between different mechanisms such as non- and endothelial dependent dysfunction (coronary flow reserve, index microvascular resistance, acetylcholine provocation test), obstructive CAD (using FFR) or myocardial bridging. Also, important to realize is that these different mechanisms can overlap in one patient. Although there is no worldwide standardized diagnostic protocol or effective therapy, invasive measurements play a key role in unraveling the pathophysiologic mechanism and some therapies can be used when taking into account some of these (overlapping) underlying mechanisms.

Hence, research is necessary to elaborate prevalence, pathophysiologic mechanism, diagnostic techniques and management of patients with INOCA but also with Myocardial Infarction with no-obstructive coronary artery disease [MINOCA] and without other structural heart disease. Also, the possible sex differences in both entities need to be sorted out.

Therefore, the themes covered by this research topic should include but are not limited to sex differences in coronary vasomotion disorders and:
- Prevalence
- Phenotyping patients
- Role of hormones
- Assessment or how to diagnose
- Pathophysiology
- Treatment
- Future perspectives in diagnosing and treatment
- New pathophysiologic mechanisms


Keywords: Sex, non-obstructive coronary artery disease, coronary microvascular dysfunction, coronary vasospasm, management, imaging, invasive techniques, provocation test, INOCA, MINOCA


Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

Signs and symptoms of ischemia are believed to be indicative for obstructive atherosclerotic coronary artery disease and therefore patients will undergo coronary angiography. However, in about 50% of these patients no obstructive disease is found on angiography. In this, sex differences appear, as 70% are (middle aged) women compared to 30% men. Therefore, assessment of risk focused on coronary stenosis often fails in women and they are left without a diagnosis and treatment. Why these differences exist, and which pathophysiologic mechanisms are contributing to this in patients with no obstructive coronary artery disease (INOCA) is still not exactly known.
As such coronary artery disease has been re-defined as ischemic heart disease that includes, aside from obstructive coronary artery disease, structural and functional disorders of the coronary vascular bed and can occur in different parts of the myocardial circulation, including the microcirculation. These so called coronary vasomotion disorders include epicardial disease (e.g. non- obstructive atherosclerosis, vasospasm, dissection, and thrombi) and coronary microvascular dysfunction (CMD) (e.g. impaired vasodilation, microvascular spasm and thrombi). Several non-invasive and invasive techniques are used needed to diagnose coronary vasomotor dysfunction and to differentiate between different mechanisms such as non- and endothelial dependent dysfunction (coronary flow reserve, index microvascular resistance, acetylcholine provocation test), obstructive CAD (using FFR) or myocardial bridging. Also, important to realize is that these different mechanisms can overlap in one patient. Although there is no worldwide standardized diagnostic protocol or effective therapy, invasive measurements play a key role in unraveling the pathophysiologic mechanism and some therapies can be used when taking into account some of these (overlapping) underlying mechanisms.

Hence, research is necessary to elaborate prevalence, pathophysiologic mechanism, diagnostic techniques and management of patients with INOCA but also with Myocardial Infarction with no-obstructive coronary artery disease [MINOCA] and without other structural heart disease. Also, the possible sex differences in both entities need to be sorted out.

Therefore, the themes covered by this research topic should include but are not limited to sex differences in coronary vasomotion disorders and:
- Prevalence
- Phenotyping patients
- Role of hormones
- Assessment or how to diagnose
- Pathophysiology
- Treatment
- Future perspectives in diagnosing and treatment
- New pathophysiologic mechanisms


Keywords: Sex, non-obstructive coronary artery disease, coronary microvascular dysfunction, coronary vasospasm, management, imaging, invasive techniques, provocation test, INOCA, MINOCA


Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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Submission Deadlines

31 May 2021 Manuscript

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Manuscripts can be submitted to this Research Topic via the following journals:

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Topic Editors

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Submission Deadlines

31 May 2021 Manuscript

Participating Journals

Manuscripts can be submitted to this Research Topic via the following journals:

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