Clinical Outcome
Prospective studies in well characterized patients with clinical features of typical stable MVA have consistently shown a good long-term prognosis. Recent studies have challenged this view, showing that patients with chest pain and normal coronary arteries may have an appreciably increased risk of cardiovascular events, particularly when CMVD can be documented. However, patients enrolled in these studies are clearly different from those with typical stable MVA, having variably included those with an acute clinical presentation, evidence of intermediate coronary stenoses, previous coronary interventions, and significant left ventricular dysfunction or hypertrophy, all conditions with a negative impact on clinical outcome, independent of CMVD.
Despite the good prognosis, MVA is associated with a significant long-term morbidity, with 20–30 % of patients referring with progressive worsening of symptoms, with angina becoming more frequent and prolonged over time, leading to poor quality of life. Worsening of symptoms may suggest progression of CMVD and/or worsening of enhanced pain perception.