{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T23:49:30Z","timestamp":1790812170873,"version":"4.1.0"},"reference-count":56,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,7,10]],"date-time":"2024-07-10T00:00:00Z","timestamp":1720569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: Coronary microvascular dysfunction (CMD), characterised by a reduced coronary flow reserve (CFR) or an increased index of microcirculatory resistance (IMR), has received considerable attention as a cause of chest pain in recent years. However, the risks and causes of CMD remain unclear; therefore, effective treatment strategies have not yet been established. Heart failure or coronary artery disease (CAD) is a risk factor for CMD, with a higher prevalence among women. However, the other contributing factors remain unclear. In this study, we assessed the risk in patients with angina and non-obstructive coronary artery disease (ANOCA), excluding those with heart failure or organic stenosis of the coronary arteries. Furthermore, we analysed whether the risk of CMD differed according to component factors and sex. Methods: This study included 84 patients with ANOCA (36 men and 48 women; mean age, 63 years) who underwent coronary angiography and functional testing (CFT). The CFT included a spasm provocation test (SPT), followed by a coronary microvascular function test (CMVF). In the SPT, patients were mainly provoked by acetylcholine (ACh), and coronary spasm was defined as &gt;90% transient coronary artery constriction on coronary angiography, accompanied by chest pain or ischaemic changes on electrocardiography. In 15 patients (18%) with negative ACh provocation, ergonovine maleate (EM) was administered as an additional provocative drug. In the CMVF, a pressure wire was inserted into the left anterior descending coronary artery using intravenous adenosine triphosphate, and the CFR and IMR were measured using previously described methods. A CFR &lt; 2.0 or IMR \u2265 25 was indicative of CMD. The correlations between various laboratory indices and CMD and its components were investigated, and logistic regression analysis was performed, focusing on factors where p &lt; 0.05. Results: Of the 84 patients, a CFR &lt; 2.0 was found in 22 (26%) and an IMR \u2265 25 in 40 (48%) patients, with CMD identified in 46 (55%) patients. CMD was correlated with smoking (p = 0.020) and the use of EM (p = 0.020). The factors that correlated with a CFR &lt; 2.0 included the echocardiograph index E\/e\u2032 (p = 0.013), which showed a weak but positive correlation with the CFR (r = 0.268, p = 0.013). Conversely, the factors correlated with an IMR \u2265 25 included RAS inhibitor usage (p = 0.018) and smoking (p = 0.042). Assessment of the risk of CMD according to sex revealed that smoking (p = 0.036) was the only factor associated with CMD in men, whereas the left ventricular mass index (p = 0.010) and low glycated haemoglobin levels (p = 0.012) were associated with CMD in women. Conclusions: Our results indicated that smoking status and EM use were associated with CMD. The risk of CMD differed between the two CMD components and sex. Although these factors should be considered when treating CMD, smoking cessation remains important. In addition, CMD assessment should be performed carefully when EM is used after ACh provocation. Further validation of our findings using prospective studies and large registries is warranted.<\/jats:p>","DOI":"10.3390\/jcdd11070217","type":"journal-article","created":{"date-parts":[[2024,7,10]],"date-time":"2024-07-10T13:34:38Z","timestamp":1720618478000},"page":"217","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Factors Contributing to Coronary Microvascular Dysfunction in Patients with Angina and Non-Obstructive Coronary Artery Disease"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0183-2541","authenticated-orcid":false,"given":"Hiroki","family":"Teragawa","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, JR Hiroshima Hospital, 3-1-36, Futabanosato, Higashi-Ku, Hiroshima 732-0057, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuko","family":"Uchimura","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, JR Hiroshima Hospital, 3-1-36, Futabanosato, Higashi-Ku, Hiroshima 732-0057, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chikage","family":"Oshita","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, JR Hiroshima Hospital, 3-1-36, Futabanosato, Higashi-Ku, Hiroshima 732-0057, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Hashimoto","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, JR Hiroshima Hospital, 3-1-36, Futabanosato, Higashi-Ku, Hiroshima 732-0057, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuichi","family":"Nomura","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, JR Hiroshima Hospital, 3-1-36, Futabanosato, Higashi-Ku, Hiroshima 732-0057, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1093\/eurheartj\/ehz425","article-title":"2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes","volume":"41","author":"Knuuti","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3504","DOI":"10.1093\/eurheartj\/ehaa503","article-title":"An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group","volume":"41","author":"Kunadian","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1253\/circj.CJ-22-0779","article-title":"JCS\/CVIT\/JCC 2023 Guideline Focused Update on Diagnosis and Treatment of Vasospastic Angina (Coronary Spastic Angina) and Coronary Microvascular Dysfunction","volume":"87","author":"Hokimoto","year":"2023","journal-title":"Circ. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1016\/j.jacc.2023.06.043","article-title":"Comprehensive Management of ANOCA, Part 1-Definition, Patient Population, and Diagnosis: JACC State-of-the-Art Review","volume":"82","author":"Samuels","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1093\/eurheartj\/ehab775","article-title":"Coronary flow reserve and cardiovascular outcomes: A systematic review and meta-analysis","volume":"43","author":"Kelshiker","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2350","DOI":"10.1016\/j.jacc.2019.08.1056","article-title":"Coronary Functional Abnormalities in Patients with Angina and Nonobstructive Coronary Artery Disease","volume":"74","author":"Suda","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Milzi, A., Dettori, R., Lubberich, R.K., Reith, S., Frick, M., Burgmaier, K., Marx, N., and Burgmaier, M. (2023). Coronary microvascular dysfunction is a hallmark of all subtypes of MINOCA. Clin. Res. Cardiol.","DOI":"10.1007\/s00392-023-02294-1"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1016\/j.jcin.2015.03.045","article-title":"Effect of Sex Differences on Invasive Measures of Coronary Microvascular Dysfunction in Patients with Angina in the Absence of Obstructive Coronary Artery Disease","volume":"8","author":"Kobayashi","year":"2015","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Yamazaki, T., Saito, Y., Yamashita, D., Kitahara, H., and Kobayashi, Y. (2023). Factors Associated with Impaired Resistive Reserve Ratio and Microvascular Resistance Reserve. Diagnostics, 13.","DOI":"10.3390\/diagnostics13050950"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Paolisso, P., Gallinoro, E., Belmonte, M., Bertolone, D.T., Bermpeis, K., De Colle, C., Shumkova, M., Leone, A., Caglioni, S., and Esposito, G. (2024). Coronary Microvascular Dysfunction in Patients with Heart Failure: Characterization of Patterns in HFrEF Versus HFpEF. Circ. Heart Fail., 17.","DOI":"10.1161\/CIRCHEARTFAILURE.123.010805"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Teragawa, H., Oshita, C., and Uchimura, Y. (2022). Clinical Characteristics and Prognosis of Patients with Multi-Vessel Coronary Spasm in Comparison with Those in Patients with Single-Vessel Coronary Spasm. J. Cardiovasc. Dev. Dis., 9.","DOI":"10.3390\/jcdd9070204"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1097\/MCA.0000000000000267","article-title":"Sequential spasm provocation tests might overcome a limitation of the standard spasm provocation tests","volume":"26","author":"Sueda","year":"2015","journal-title":"Coron. Artery Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2377","DOI":"10.2169\/internalmedicine.2710-19","article-title":"Vasospastic Angina Diagnosed by the Spasm Provocation Test with the Combined Use of the Acetylcholine and Ergonovine Provocation Tests","volume":"58","author":"Matsumura","year":"2019","journal-title":"Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Teragawa, H., Oshita, C., and Uchimura, Y. (2022). The Impact of Myocardial Bridging on the Coronary Functional Test in Patients with Ischaemia with Non-Obstructive Coronary Artery Disease. Life, 12.","DOI":"10.3390\/life12101560"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1007\/s00380-019-01413-1","article-title":"History of gastroesophageal reflux disease in patients with suspected coronary artery disease","volume":"34","author":"Teragawa","year":"2019","journal-title":"Heart Vessel."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2779","DOI":"10.1253\/circj.CJ-66-0098","article-title":"Guidelines for diagnosis and treatment of patients with vasospastic angina (Coronary Spastic Angina) (JCS 2013)","volume":"78","author":"Group","year":"2014","journal-title":"Circ. J."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Sato, K., Kaikita, K., Nakayama, N., Horio, E., Yoshimura, H., Ono, T., Ohba, K., Tsujita, K., Kojima, S., and Tayama, S. (2013). Coronary vasomotor response to intracoronary acetylcholine injection, clinical features, and long-term prognosis in 873 consecutive patients with coronary spasm: Analysis of a single-center study over 20 years. J. Am. Heart Assoc., 2.","DOI":"10.1161\/JAHA.113.000227"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.ijcard.2017.08.068","article-title":"International standardization of diagnostic criteria for microvascular angina","volume":"250","author":"Ong","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Teragawa, H., Uchimura, Y., Oshita, C., Hashimoto, Y., and Nomura, S. (2023). Frequency and Clinical Impact of Family History of Coronary Artery Disease in Patients with Vasospastic Angina. J. Cardiovasc. Dev. Dis., 10.","DOI":"10.3390\/jcdd10060249"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Teragawa, H., Oshita, C., Uchimura, Y., Akazawa, R., and Orita, Y. (2021). Coronary Microvascular Vasodilatory Function: Related Clinical Features and Differences According to the Different Coronary Arteries and Types of Coronary Spasm. J. Clin. Med., 11.","DOI":"10.3390\/jcm11010130"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1053\/j.ajkd.2008.12.034","article-title":"Revised equations for estimated GFR from serum creatinine in Japan","volume":"53","author":"Matsuo","year":"2009","journal-title":"Am. J. Kidney Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1161\/01.CIR.55.4.613","article-title":"Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method","volume":"55","author":"Devereux","year":"1977","journal-title":"Circulation"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1016\/S0735-1097(84)80141-2","article-title":"Standardization of M-mode echocardiographic left ventricular anatomic measurements","volume":"4","author":"Devereux","year":"1984","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_24","first-page":"1222","article-title":"Effects of ipragliflozin on left ventricular diastolic function in patients with type 2 diabetes: A sub-analysis of the PROTECT trial","volume":"4","author":"Kusunose","year":"2024","journal-title":"J. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1584","DOI":"10.1016\/j.amjcard.2019.08.011","article-title":"Frequency of Coronary Microvascular Dysfunction and Diffuse Myocardial Fibrosis (Measured by Cardiovascular Magnetic Resonance) in Patients with Heart Failure and Preserved Left Ventricular Ejection Fraction","volume":"124","author":"Loffler","year":"2019","journal-title":"Am. J. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"4592","DOI":"10.1093\/eurheartj\/ehab282","article-title":"Clinical characteristics and prognosis of patients with microvascular angina: An international and prospective cohort study by the Coronary Vasomotor Disorders International Study (COVADIS) Group","volume":"42","author":"Shimokawa","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/j.jacc.2016.05.070","article-title":"Ischemia in Aortic Stenosis: New Insights and Potential Clinical Relevance","volume":"68","author":"Gould","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Zelis, J.M., Tonino, P.A.L., Pijls, N.H.J., De Bruyne, B., Kirkeeide, R.L., Gould, K.L., and Johnson, N.P. (2020). Coronary Microcirculation in Aortic Stenosis: Pathophysiology, Invasive Assessment, and Future Directions. J. Interv. Cardiol., 2020.","DOI":"10.1155\/2020\/4603169"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1007\/s00380-016-0939-2","article-title":"Paroxysmal atrial fibrillation during intracoronary acetylcholine provocation test","volume":"32","author":"Saito","year":"2017","journal-title":"Heart Vessel."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1016\/j.metabol.2013.02.011","article-title":"Effects of prediabetes and diabetes on left ventricular and coronary microvascular functions","volume":"62","author":"Erdogan","year":"2013","journal-title":"Metabolism"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"375","DOI":"10.2147\/VHRM.S209003","article-title":"PROspective evaluation of coronary FLOW reserve and molecular biomarkers in patients with established coronary artery disease the PROFLOW-trial: Cross-sectional evaluation of coronary flow reserve","volume":"15","author":"Haraldsson","year":"2019","journal-title":"Vasc. Health Risk Manag."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/j.amjmed.2024.02.034","article-title":"Smoking and Respiratory Diseases in Patients with Coronary Microvascular Dysfunction","volume":"137","author":"Freund","year":"2024","journal-title":"Am. J. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1161\/01.CIR.87.1.76","article-title":"Cigarette smoking is a major risk factor for coronary spasm","volume":"87","author":"Sugiishi","year":"1993","journal-title":"Circulation"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/0002-9149(80)90218-0","article-title":"Coronary hemodynamic effects of ergonovine maleate in human subjects","volume":"45","author":"Orlick","year":"1980","journal-title":"Am. J. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1161\/01.CIR.75.1.163","article-title":"Limited coronary flow reserve after dipyridamole in patients with ergonovine-induced coronary vasoconstriction","volume":"75","author":"Cannon","year":"1987","journal-title":"Circulation"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1161\/01.CIR.62.1.149","article-title":"Regional coronary hemodynamic effects of ergonovine in patients with and without variant angina","volume":"62","author":"Feldman","year":"1980","journal-title":"Circulation"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/17539447241233168","article-title":"Safety and potential usefulness of sequential intracoronary acetylcholine and ergonovine administration for spasm provocation testing","volume":"18","author":"Kinoshita","year":"2024","journal-title":"Ther. Adv. Cardiovasc. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1093\/eurheartj\/ehx721","article-title":"Coronary microvascular dysfunction and future risk of heart failure with preserved ejection fraction","volume":"39","author":"Taqueti","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"D\u2019Amario, D., Laborante, R., Bianchini, E., Ciliberti, G., Paglianiti, D.A., Galli, M., Restivo, A., Stolfo, D., Vergallo, R., and Rosano, G.M.C. (2024). Impact of coronary microvascular dysfunction in heart failure with preserved ejection fraction: A meta-analysis. ESC Heart Fail.","DOI":"10.1002\/ehf2.14626"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1111\/echo.14794","article-title":"Relationship between coronary microvascular dysfunction and left ventricular diastolic function in patients with chest pain and unobstructed coronary arteries","volume":"37","author":"Lam","year":"2020","journal-title":"Echocardiography"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/BF02988695","article-title":"Evaluation of coronary blood flow reserve by 13N-NH3 positron emission computed tomography (PET) with dipyridamole in the treatment of hypertension with the ACE inhibitor (Cilazapril)","volume":"14","author":"Masuda","year":"2000","journal-title":"Ann. Nucl. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1097\/MCA.0b013e328351ab42","article-title":"Candesartan improves impaired endothelial function in the human coronary artery","volume":"23","author":"Iino","year":"2012","journal-title":"Coron. Artery Dis."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1159\/000339762","article-title":"Olmesartan improves coronary flow reserve of hypertensive patients using coronary magnetic resonance imaging compared with amlodipine","volume":"122","author":"Toyama","year":"2012","journal-title":"Cardiology"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1038\/jhh.2013.125","article-title":"Pleiotropic effects of the acute and chronic inhibition of the renin-angiotensin system in hypertensives","volume":"28","author":"Stamatelopoulos","year":"2014","journal-title":"J. Hum. Hypertens."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1038\/nrcardio.2015.72","article-title":"Coronary microvascular dysfunction: Sex-specific risk, diagnosis, and therapy","volume":"12","author":"Dean","year":"2015","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1016\/j.jcin.2015.06.017","article-title":"Prevalence of Coronary Microvascular Dysfunction Among Patients with Chest Pain and Nonobstructive Coronary Artery Disease","volume":"8","author":"Sara","year":"2015","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_47","first-page":"1","article-title":"Gender Differences in Endothelial Function and Coronary Vasomotion Abnormalities","volume":"4","author":"Godo","year":"2020","journal-title":"Gend. Genome"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/j.jcmg.2016.02.003","article-title":"Imaging Microvascular Dysfunction and Mechanisms for Female-Male Differences in CAD","volume":"9","author":"Patel","year":"2016","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1016\/j.jcin.2012.03.014","article-title":"Invasive coronary vasoreactivity testing to diagnose microvascular dysfunction in women","volume":"5","author":"Bailey","year":"2012","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1586\/erc.11.165","article-title":"Microvascular dysfunction: What have we learned from WISE?","volume":"9","author":"Park","year":"2011","journal-title":"Expert. Rev. Cardiovasc. Ther."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2109","DOI":"10.1097\/01.hjh.0000244962.77609.57","article-title":"Effect of candesartan on coronary flow reserve in patients with systemic hypertension","volume":"24","author":"Tomas","year":"2006","journal-title":"J. Hypertens."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1016\/j.amjhyper.2007.08.005","article-title":"Determinants of reduction of coronary flow reserve in patients with type 2 diabetes mellitus or arterial hypertension without angiographically determined epicardial coronary stenosis","volume":"20","author":"Galderisi","year":"2007","journal-title":"Am. J. Hypertens."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1038\/ajh.2010.59","article-title":"Association of serum osteoprotegerin with left ventricular mass in African American adults with hypertension","volume":"23","author":"Noheria","year":"2010","journal-title":"Am. J. Hypertens."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1111\/ijcp.12597","article-title":"Hormone replacement therapy, renal function and heart ultrasonographic parameters in postmenopausal women: An observational study","volume":"69","author":"Vitolo","year":"2015","journal-title":"Int. J. Clin. Pract."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1186\/s12933-015-0269-1","article-title":"Lack of correlation between the optimal glycaemic control and coronary micro vascular dysfunction in patients with diabetes mellitus: A cross sectional study","volume":"14","author":"Matsuzawa","year":"2015","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.jjcc.2023.06.010","article-title":"Impact of preceding acetylcholine provocation testing on following coronary physiological assessment during an interventional diagnostic procedure","volume":"82","author":"Yamazaki","year":"2023","journal-title":"J. Cardiol."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/11\/7\/217\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:12:41Z","timestamp":1760109161000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/11\/7\/217"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,10]]},"references-count":56,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,7]]}},"alternative-id":["jcdd11070217"],"URL":"https:\/\/doi.org\/10.3390\/jcdd11070217","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,10]]}}}