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Assessment of Vascular Dysfunction in Patients Without Obstructive Coronary Artery Disease: Why, How, and When
Thomas J Ford1, Peter Ong2, Udo Sechtem2
1British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom; Faculty of Medicine, University of Newcastle, Callaghan, Australia; Department of Cardiology, Gosford Hospital, Central Coast Local Health District, Gosford, Australia.
Insights
Coronary vascular dysfunction, a cause of angina in patients without obstructive coronary artery disease, can be invasively assessed. This approach improves angina and quality of life, guiding stratified therapy for better patient care.
Area of Science:
- Cardiology
- Vascular Biology
- Diagnostic Procedures
Background:
- Ischemic heart disease from coronary vascular dysfunction causes angina, impacting quality of life and prognosis.
- Approximately 50% of patients with ischemic symptoms lack obstructive coronary artery disease, suggesting vascular dysfunction is relevant.
- Current diagnostic methods for coronary vasomotion include guidewire-based techniques and reactivity testing.
Purpose of the Study:
- To provide a comprehensive review on the invasive assessment of coronary vascular dysfunction.
- To discuss the rationale, methods, and clinical scenarios for invasive assessment.
- To propose a consensus approach for performing interventional diagnostic procedures.
Main Methods:
- Review of pathophysiology and clinical evidence for coronary vascular dysfunction.
- Discussion of guidewire-based techniques and reactivity testing.
- Consensus approach for interventional diagnostic procedures.
Main Results:
- The CorMicA trial demonstrated improved angina and quality of life with interventional diagnostic procedures and stratified therapy.
- Invasive assessment of coronary vascular dysfunction is crucial for patients with angina and non-obstructive coronary artery disease.
- Measurement of coronary vascular function can aid patient care in stable and acute coronary syndromes.
Conclusions:
- Invasive assessment of coronary vascular dysfunction is valuable for diagnosing and managing angina in patients without obstructive coronary artery disease.
- A consensus approach to interventional diagnostic procedures can standardize assessment.
- Understanding and measuring coronary vascular function improves patient outcomes and guides therapy.
Abstract:
Ischemic heart disease secondary to coronary vascular dysfunction causes angina and impairs quality of life and prognosis. About one-half of patients with symptoms and signs of ischemia turn out not to have obstructive coronary artery disease, and coronary vascular dysfunction may be relevant. Adjunctive tests of coronary vasomotion include guidewire-based techniques with adenosine and reactivity testing, typically by intracoronary infusion of acetylcholine. The CorMicA (Coronary Microvascular Angina) trial provided evidence that routine management guided by an interventional diagnostic procedure and stratified therapy improves angina and quality of life in patients with angina but no obstructive coronary artery disease. In this paper, the COVADIS study group provide a comprehensive review of why, how, and when coronary vascular dysfunction should be assessed invasively. They discuss the rationale through a shared understanding of vascular pathophysiology and clinical evidence. They propose a consensus approach to how an interventional diagnostic procedure is performed with focus on practical aspects. Finally, the authors discuss the clinical scenarios in patients with stable and acute coronary syndromes in which measurement of coronary vascular function may be helpful for patient care.
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