Prevalence of Coronary Vasomotor Disorders in Patients With Angina and Nonobstructive Coronary Arteries: A Sydney Experience
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Published on: February 3, 2021
Rajan Rehan1, Christopher C Y Wong2, Charlie Cooke3
1Department of Cardiology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Concord Hospital, University of Sydney, NSW, Australia; Faculty of Medicine, Health, and Human Sciences, Sydney Medical School, University of Sydney, Sydney, NSW, Australia. Electronic address: https://twitter.com/RajanRehan23.
Insights
Coronary vasomotor disorders (CVaD) are highly prevalent in Australian patients with angina and non-obstructive coronary arteries (ANOCA). Functional coronary angiography is crucial for diagnosing CVaD and managing these patients.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Patients with angina and non-obstructive coronary arteries (ANOCA) often experience coronary vasomotor disorders (CVaD).
- CVaD involves pathological vasoconstriction and/or impaired microvascular vasodilation.
- Functional coronary angiography is the gold standard for CVaD diagnosis but is not widely available.
Purpose of the Study:
- To determine the prevalence of CVaDs in an Australian ANOCA population.
- To identify predictive factors for specific CVaD endotypes.
Main Methods:
- Prospective observational study involving 110 ANOCA patients.
- Functional coronary angiography with intracoronary acetylcholine provocation.
- Coronary physiology assessment using a pressure-temperature sensor guidewire and collection of clinical data.
Main Results:
- 81.8% of ANOCA patients had a CVaD.
- Microvascular angina (MVA) affected 31.8%, vasospastic angina (VSA) 25.5%, and mixed presentations 24.5%.
- CVaD patients were older, more likely to be overweight, and had poorer quality of life. MVA linked to overweight and ischemia; VSA linked to smoking.
Conclusions:
- Coronary vasomotor disorders are highly prevalent in ANOCA patients.
- Increased national awareness and utilization of functional coronary angiography are essential for evaluating and managing this patient group.
Background:
Patients with angina and non-obstructive coronary arteries (ANOCA) frequently have coronary vasomotor disorders (CVaD), characterised by transient pathological vasoconstriction and/or impaired microvascular vasodilatation. Functional coronary angiography is the gold standard for diagnosing CVaD. Despite recommendations, testing is only available at a limited number of Australian and New Zealand centres. This study aimed to determine the prevalence of CVaDs in an Australian ANOCA population and identify predictive factors associated with specific endotypes.
Method:
Functional coronary angiography was performed in patients with suspected ANOCA. Vasoreactivity testing was performed using intracoronary acetylcholine provocation. A pressure-temperature sensor guidewire was used for coronary physiology assessment. Comprehensive clinical data on patient characteristics, cardiac risk factors, and symptom profiles was collected before testing.
Results:
This prospective observational study at Royal Prince Alfred and Concord Repatriation General Hospital included 110 patients (58±13 years with 63.6% women), with 81.8% (90/110) having a CVaD. Regarding specific ANOCA endotypes, microvascular angina (MVA) occurred in 31.8% (35/110) of cases, vasospastic angina (VSA) in 25.5% (28/110) and a mixed presentation of MVA and VSA in 24.5% (27/110) of patients. Patients with CVaD were found to be older (59±11 vs 51±15, p=0.024), overweight (61.1% vs 15.0%, p<0.001) and had a worse quality of life (EuroQol 5 Dimensions-5 Levels; 0.61 vs 0.67, p=0.043). MVA was associated with being overweight (odds ratio [OR] 4.2 [95% confidence interval [CI] 1.9-9.3]; p=0.015) and ischaemia on stress testing (OR 2.4 [95% CI 1.1-4.3]; p=0.028), while VSA was associated with smoking (OR 9.1 [95% CI 2.21-39.3]; p=0.007).
Conclusions:
Coronary vasomotor disorders are highly prevalent among ANOCA patients. This study highlights the importance of increasing national awareness and the use of functional coronary angiography to evaluate and manage this unique cohort.
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