Insulin Resistance and Coronary Microvascular Dysfunction in Patients With Myocardial Ischemia and Non-obstructive Coronary Artery Disease

The goal of this prospective study is to assess the correlation between coronary microvascular disfunction and insulin resistance in patients with INOCA. Patients with ANOCA and without diabetes will undergo invasive coronary microvascular assessment through coronary angiography and insulin resistance assessment through hyperinsulinemic-euglycemic clamp test. Patients enrolled in the study will be followed for a period of 2 years to monitor their clinical status.

Inclusion Criteria: * Aged over 18 years. * Cardiac chest pain with evidence of myocardial ischemia at noninvasive myocardial stress imaging and clinical indication to diagnostic coronary angiography * Willing and able to give informed consent for participation in the study Exclusion Criteria: * Obstructive CAD (defined as more than 70% luminal stenosis and/or FFR ≤0.80 in 1 or more epicardial vessels). * History of previous myocardial infarction, percutaneous revascularization or coronary-aortic bypass graft (CABG) surgery. * Diagnosis of type II diabetes. * BMI ≥ 35 kg/m2. * Stage IV and V of chronic kidney disease (eGFR ≤ 30 ml/min, estimated through CKD - EPI Creatinine Equation). * Allergy or other contraindication to iodinated contrast and/or gadolinium and/or adenosine. * Chronic resting O2 saturation ≤ 85%. * Pregnancy or suspected pregnancy.