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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function

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Phenotype-based management of coronary microvascular dysfunction.

Daniel Tze Yee Ang¹, Colin Berry¹, Juan-Carlos Kaski²

¹British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.

Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology

|June 7, 2022

Summary

This summary is machine-generated.

Many patients with ischemia symptoms lack obstructive coronary artery disease (INOCA). Coronary microvascular dysfunction (CMD) affects two-thirds, necessitating phenotype-based management for improved prognosis and quality of life.

Keywords:

CAD Microvascular dysfunction diagnostic and prognostic application myocardial blood flow myocardial ischemia and infarction vasodilators

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Non-invasive Assessment of Microvascular and Endothelial Function

Non-invasive Assessment of Microvascular and Endothelial Function

Published on: January 29, 2013

Area of Science:

Cardiology
Vascular Biology
Precision Medicine

Background:

40-70% of patients with ischemia symptoms undergoing coronary angiography have no obstructive coronary artery disease (INOCA).
Coronary microvascular dysfunction (CMD) is diagnosed in approximately two-thirds of these patients, linked to adverse outcomes.
Four distinct CMD phenotypes exist, each requiring tailored therapeutic strategies.

Purpose of the Study:

To present a contemporary, phenotype-based management approach for patients with INOCA.
To highlight the importance of identifying and stratifying patients with coronary microvascular dysfunction.
To emphasize the role of precision medicine in managing INOCA.

Main Methods:

Utilizing diagnostic criteria from the Coronary Vasomotor Disorders International Study Group (COVADIS).
Employing invasive and non-invasive modalities for coronary function testing.
Applying the 'functional angiography' concept to guide stratified medical therapy, as advocated by the CorMicA study.

Main Results:

Identification of four clinical phenotypes of INOCA: microvascular angina, vasospastic angina, mixed, and non-cardiac symptoms.
Demonstration that CMD is a prevalent condition in INOCA patients, associated with poor prognosis.
Evidence supporting phenotype-based management for improved patient outcomes.

Conclusions:

Phenotype-based management of INOCA, particularly CMD, is crucial for improving prognosis, symptom burden, and quality of life.
Tailored therapies, considering individual patient phenotypes and risk factors, are essential.
Precision medicine approaches offer a promising strategy for optimizing care in INOCA patients.