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Utilizing Invasive Coronary Functional Testing in a Coronary Microvascular and Vasomotor Dysfunction Program: Methods
Odayme Quesada1,2, Namrita D Ashokprabhu1, Danielle N Tapp1
1Women's Heart Center, Heart & Vascular Institute, The Christ Hospital Health Network, Cincinnati, Ohio, USA.
Insights
Invasive coronary functional testing (ICFT) aids in diagnosing coronary microvascular dysfunction (CMVD). Standardized ICFT protocols improve patient care and advance specialized CMVD programs.
Area of Science:
- Cardiology
- Vascular Medicine
Background:
- Coronary microvascular and vasomotor dysfunction (CMVD) significantly increases major adverse cardiovascular events (MACE) risk.
- CMVD is the primary cause of angina/ischemia in patients with nonobstructive coronary artery disease (ANOCA/INOCA).
- Accurate CMVD assessment is crucial for targeted treatment and improved patient outcomes.
Purpose of the Study:
- To provide a comprehensive overview of Invasive Coronary Functional Testing (ICFT) protocols.
- To detail the structured approach for ICFT referral and clinical management.
- To quantify the impact of ICFT on the growth of a specialized Women's Heart Center (WHC) CMVD program.
Main Methods:
- Outlined standard operating procedures for ICFT at The Christ Hospital Women's Heart Center (TCH-WHC).
- Described two primary ICFT methods: Doppler and Thermodilution.
- Detailed a structured approach for ICFT referral and postdiagnostic management.
Main Results:
- A total of 422 patients underwent ICFT between October 2020 and July 2024.
- 64% of tests used the Doppler protocol, and 36% used Thermodilution.
- Diagnoses included various combinations of endothelial-independent/dependent CMD, microvascular VSA, and epicardial VSA, with 17% showing normal ICFT results.
Conclusions:
- ICFT offers diagnostic clarity and optimizes medical treatment for CMVD.
- A structured approach to ICFT referral and comprehensive protocol execution is vital for specialized CMVD program growth.
Background:
Coronary microvascular and vasomotor dysfunction (CMVD) is associated with a threefold increased risk of major adverse cardiovascular events (MACE) and is the primary mechanism responsible for angina/ischemia in patients with nonobstructive coronary artery disease (ANOCA/INOCA). Proper assessment for CMVD is vital to provide targeted treatment and improve patient outcomes. Invasive coronary functional testing (ICFT) is the "gold standard," for CMVD assessment and can be used to diagnose all endotypes. However, there is a lack of standardization for ICFT protocols and use in the treatment of CMVD.
Aims:
To provide a comprehensive overview of ICFT protocols utilized at the Christ Hospital Womens Heart Center (TCH-WHC).
Methods:
Here, we outline our standard operating procedures for ICFT utilized at TCH-WHC, including the procedures two main methods: Doppler and Thermodilution. We describe our structured approach for ICFT referral and postdiagnostic clinical management utilized at The Christ Hospital Women's Heart Center (TCH-WHC) CMVD program. We then quantified how ICFT has contributed to growth of the TCH-WHC.
Results:
From October of 2020 until July of 2024, a total of 422 patients have undergone ICFT at TCH-WCH, 64% were performed via the Doppler protocol and 36% were performed via the Thermodilution protocol. Based on exclusive endotype categories, 19% had an endothelial-independent CMD alone, 19% had endothelial-dependent CMD or microvascular VSA alone, 3% had epicardial VSA alone, 42% had mixed disease (any combination of the above categories), and 17% had a normal ICFT.
Conclusions:
ICFT provides opportunity to provide diagnostic clarity and optimize medical treatment for CMVD. TCH-WHC's structured approach for ICFT referral and protocol for conducting comprehensive ICFT which has been vital for the growth of our specialized CMVD program.
