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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
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Interventional Diagnostic Procedure: a Practical Guide for the Assessment of Coronary Vascular Function
Daniel T Y Ang1, Novalia P Sidik1, Andrew J Morrow1
1Department of Cardiology, Golden Jubilee National Hospital; British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow.
Journal of Visualized Experiments : Jove
|April 4, 2022
Summary
Many patients with angina have no obstructive coronary artery disease. Interventional diagnostic procedures (IDP) during angiography help identify abnormal coronary function, guiding personalized treatment for conditions like vasospastic angina.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diagnostic Procedures
Background:
- Approximately 40% of patients with angina lack obstructive coronary artery disease (ANOCA).
- Abnormal coronary function underlies various endotypes, including coronary endothelial dysfunction, microvascular angina, vasospastic angina, and MINOCA.
- Established guidelines now exist for diagnosing and treating these conditions.
Purpose of the Study:
- To provide practical guidance on the preparation and administration of interventional diagnostic procedures (IDP) in clinical practice.
- To detail key preparation and safety considerations for successful procedural outcomes.
- To highlight how IDP supports stratified medicine and personalized patient care.
Main Methods:
- Coronary function tests are performed as adjunctive interventional diagnostic procedures (IDP) during coronary angiography.
- IDP comprises a diagnostic guidewire test (5 minutes) measuring flow limitation parameters (FFR, CFR, IMR) and a pharmacological coronary reactivity test (10-15 minutes).
- Pharmacological testing involves intra-coronary infusion of acetylcholine and glyceryl trinitrate (GTN) to assess vasodilator potential and vasospasm.
Main Results:
- The diagnostic guidewire test measures key parameters of coronary flow limitation and vasodilator function.
- The pharmacological test differentiates normal vasodilation from abnormal vasospasm, aiding diagnosis of vasospastic angina.
- IDP enables differentiation of patients according to specific endotypes based on distinct disease mechanisms.
Conclusions:
- Interventional diagnostic procedures (IDP) are crucial for identifying abnormal coronary function in patients with angina and no obstructive coronary artery disease.
- IDP facilitates the diagnosis of specific endotypes, enabling tailored therapeutic strategies.
- The application of IDP promotes a personalized approach to cardiovascular health, aligning with stratified medicine principles.
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