IMMUNOINFLAMMATORY MECHANISMS OF MICROVASCULAR ANGINA: A LITERATURE REVIEW AND CLINICAL SIGNIFICANCE

Relevance. Microvascular angina (MVA, INOCA) is characterized by the development of myocardial ischemia in the absence of hemodynamically significant coronary artery stenosis. Immune-inflammatory mechanisms and endothelial dysfunction play an important role in its pathogenesis. Objective. To evaluate the role of immunoinflammatory markers in the pathogenesis, diagnosis, and prognosis of MVA. Methods. Publications from 2014–2025, presented in the PubMed, Scopus, and Web of Science databases, were analyzed. Results. Patients with MVA were found to have increased levels of IL-6, TNF-α, C-reactive protein, sICAM-1, sVCAM-1, and endothelin-1, correlating with the severity of microvascular dysfunction and myocardial ischemia. Differences in the profiles of inflammatory markers in different INOCA phenotypes were established. A promising approach is the use of immunomodulatory therapy, including IL-6 inhibition. Conclusion. Immunoinflammatory markers can be used for diagnosis and risk stratification in MCC. Further research is needed to develop comprehensive diagnostic panels and evaluate the effectiveness of pathogenetic immunomodulatory therapy.

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