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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
10:28

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

Published on: March 15, 2022

5.1K

Initial single-center experience of a standardized protocol for invasive assessment of ischemia and non-obstructive

Vera Vaz Ferreira1, Ruben Ramos1, Alexandra Castelo1

  • 1Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.

Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology
|February 24, 2023
PubMed

Insights

A comprehensive coronary function test (CFT) is safe and feasible for diagnosing coronary vasomotion disorders (CVDs) like microvascular angina (MVA) and vasospastic angina (VSA) in patients with non-obstructive coronary artery disease (NOCAD). This test helps guide treatment for persistent angina.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Imaging

Background:

  • Coronary vasomotion disorders (CVDs), encompassing microvascular angina (MVA) and vasospastic angina (VSA), contribute significantly to morbidity in patients with non-obstructive coronary artery disease (NOCAD).
  • Current clinical protocols for CVD assessment lack standardization and can be challenging to implement, leading to diagnostic delays and suboptimal patient management.

Purpose of the Study:

  • To evaluate the safety and feasibility of a comprehensive coronary function test (CFT) protocol for diagnosing CVDs.
  • To determine the prevalence of various CVD phenotypes in patients experiencing angina despite having non-obstructive coronary artery disease (ANOCA).

Main Methods:

  • Prospective recruitment of patients with persistent angina and NOCAD undergoing invasive coronary angiography.
  • Performance of a comprehensive coronary function test (CFT) including assessment of fractional flow reserve, coronary flow reserve, index of myocardial resistance, and coronary vasoreactivity.

Main Results:

  • The CFT was successfully and safely performed in all 20 participants (mean age 63±13 years, 50% female) without complications.
  • Prevalence of CVD phenotypes included isolated MVA (25%), isolated VSA (40%), mixed MVA and VSA (10%), and non-cardiac chest pain (25%).
  • CFT results led to antianginal therapy modification in 70% of patients.

Conclusions:

  • A comprehensive coronary function test (CFT) is a feasible and safe diagnostic tool for patients with angina and non-obstructive coronary artery disease (ANOCA).
  • CVDs are highly prevalent in this patient group, with a significant proportion exhibiting mixed phenotypes.
  • CFT enables definitive diagnosis and guides pharmacological therapy stratification for persistent angina.
Abstract

Keywords:
ANOCAAngina microvascularAngina vasospásticaCoronary function testCoronary vasomotion disordersDistúrbios vasomotores coronáriosEstudo invasivo da função coronáriaMicrovascular anginaVasospastic angina

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