INOCA e ANOCA: como investigar a microcirculação de forma invasiva?

Coronary angiography came back normal. But the patient continues to have pain, a positive ischemic test, and very poor quality of life. What are you failing to investigate? In this episode, Mateus Prata and Raphael Rossi delve into the invasive physiology of the coronary microcirculation—the territory that angiography simply doesn't see. We talk about INOCA, ANOCA, microvascular dysfunction, and coronary spasm: why these diagnoses still escape detection and how invasive physiological testing can concretely change the clinical course. 📌 Timestamps: (0:15) Opening and presentation of the topic (1:17) Episode context; sponsors (MEV Brasil, 12 News Prime) (2:37) Review of previous episodes (MINOCA, INOCA, ischemia in women) (3:18) Definition of ANOCA and INOCA; prevalence in women (up to 70%) (4:51) Prognostic impact: 2x higher CV risk vs. normal population; up to 5x with 3 vessels (5:50) Arrival of invasive assessment in Brazil (Dante Pazzanese); destigmatization of the patient (7:03) Pathophysiological classification of ANOCA: vasospasm (epicardial vs. microvascular), endothelial dysfunction, DCM, myocardial bridging (11:07) Risk factors for endothelial and microvascular dysfunction (smoking, DM, AT1/AT2 receptors) (13:38) Prevalence of subtypes — CórMICA data (50% microvasculature, 16% vasospasm, 20% both) (16:01) Difference between MINOCA vs. INOCA/ANOCA protocols (16:37) Step 1: Epicardial assessment with FFR — ruling out obstructive disease (18:18) Step 2: Microvascular assessment with CFR and IMR — structural vs. subtypes Functional (23:29) Validation of curves and exam quality (24:17) Step 3: Vasospasm test with acetylcholine (doses 50→100→200 µg; criteria: pain + ECG + angiography; role of tridil) (30:11) Step 4: Myocardial bridging assessment with dobutamine + FFR/iFR (30:26) Safety: 0.5% serious event; risk of paroxysmal AF with acetylcholine (32:41) WISE study: female underrepresentation, role of ACE inhibitors (35:07) CórMICA Trial & ILIA ANOCA: guided treatment improves quality of life (38:56) WARRIOR study: limitations — 50–60% already using ACE inhibitors/statins; Inconclusive (42:35) Ranolazine and Nebivolol: evidence in specific subtypes of DCM (43:39) Clinical case 1: Vasospasm over a 40% plaque in the LAD — angioplasty as a treatment (46:22) Clinical case 2: Vasospasm of the left main coronary artery — therapeutic limits (48:51) Final considerations: control of risk factors, popularization of the examination, conclusion 🔔 Subscribe to the channel and activate the bell so you don't miss the next episodes of DozeCast. #INOCA #ANOCA #CoronaryMicrocirculation #MicrovascularDysfunction #CoronarySpasm #CFR #IMR #InvasivePhysiology #Cardiology #DozeCast #CardiologyPodcast #CardioTwitter __________________________________________________ Receive weekly didactic reviews of Cardiology on DozeNews PRIME — the lightest and fastest way to stay updated, through the link https://news.dozeporoito.com/dozecast26. 👉 Subscribe now! EXCLUSIVE discount for DozeCast listeners through the link! _______________________________ MEVBrasil, the Brazilian School of Lifestyle Medicine: MEVBrasil is a pioneering institution in the exclusive teaching of Lifestyle Medicine in Brazil and has a very clear focus: to help cardiologists apply, in a practical and evidence-based way, the behavioral techniques of Lifestyle Medicine in the office. Check it out at the link: http://www.mevbrasil.com.br/mevclinic...