A Standardized Invasive Protocol for the Investigation of Patients With Presumed Coronary Microvascular and Vasomotor...

As discussed in the preceding companion papers, there are complicated theoretical and practical issues that hinder progress in the evaluation and treatment of patients with coronary microvascular and vasomotor dysfunction. Solving this problem will require intellectual flexibility, but the invasive assessment requires a practical standardized protocol to minimize variations among participating sites. In this third companion paper, we review the indications and develop a standardized protocol for the invasive assessment of coronary vascular function that will be used in the Canadian Coronary Physiology Registry. It reflects the heterogeneous nature of the disease(s), is flexible enough to interrogate multiple distinct pathways, but is sufficiently structured to allow sites to combine and compare data. With comprehensive clinical assessment and mechanistic substudies, this protocol will facilitate the design and conduct of future clinical trials.