Clinical case of ischemia with non-Obstructive
coronary artery Disease (INOCA). A 70-year-old woman with recurrent
hospitalizations with chest pain. High-sensitivity troponin I concentrations
measured within the normal sex-specific range (16 ng/L). The exercise
treadmill test was strongly positive for ischemia with widespread horizontal
ST-segment depression. The invasive coronary angiogram showed minor
atherosclerotic plaque only. CMR stress and rest imaging revealed a
circumferential subendocardial perfusion defect, low stress MBF (Global stress
MBF = 1.80 mL/min/g) and low MPR (Global MPR = 1.67). The final diagnosis was
microvascular angina. Abbreviations: CAD, coronary artery disease; CMR, cardiac
magnetic resonance imaging; MBF, myocardial blood flow; MPR, myocardial perfusion
reserve. (Acknowledgement to Dr C Bradley, Dr P Kellman and Dr H Xue, National
Institutes of Health).