Title : A comprehensive literature review discussing diagnostic challenges of prinzmetal or vasospastic angina
Abstract:
Objectives: This review explores the diagnostic challenges of Vasospastic Angina (VSA) or Prinzmetal angina by summarizing current methods, limitations, and advancements that support timely and accurate diagnosis.
Methods: A narrative review of peer-reviewed studies published in the last 10 years was conducted using PubMed and other reputable scientific sources. The discussion focuses on clinical features, diagnostic tools, and guideline-based approaches for VSA and Ischemia with Non-Obstructive Coronary Arteries (INOCA), emphasizing invasive, non-invasive, and emerging modalities, as well as patient-specific diagnostic complexities.
Results: VSA is frequently misdiagnosed due to its episodic nature and overlapping features with acute coronary syndromes. Acetylcholine or ergonovine provocation testing remains the gold standard, though underutilized due to procedural variability and accessibility issues. Non-invasive options like PET, cardiac MRI, OCT and ambulatory ECG show promise but yield inconsistent results. Diagnostic interpretation is complicated by age, sex, symptom variability, and comorbidities. New tools such as AI-based ECG analysis, micro RNA profiles, and inflammatory biomarkers are showing potential to refine diagnosis and stratify risk.
Conclusion & Relevance: Improvement in VSA diagnosis requires harmonized testing protocols, increased use of coronary function testing, and integration of advanced imaging, AI, and novel biomarkers. Recognizing atypical symptoms, especially in women and younger patients, is essential to reduce misdiagnosis and improve outcomes.
