Assessment of vascular dysfunction in patients without obstructive coronary artery disease: why, how and when

Ford, T. J. et al. (2020) Assessment of vascular dysfunction in patients without obstructive coronary artery disease: why, how and when. JACC: Cardiovascular Interventions, 13(16), pp. 1847-1864. (doi: 10.1016/j.jcin.2020.05.052) (PMID:32819476) (PMCID:PMC7447977)

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Abstract

Ischemic heart disease secondary to coronary vascular dysfunction causes angina and impairs quality of life and prognosis. About one-half of patients with symptoms and signs of ischemia turn out not to have obstructive coronary artery disease, and coronary vascular dysfunction may be relevant. Adjunctive tests of coronary vasomotion include guidewire-based techniques with adenosine and reactivity testing, typically by intracoronary infusion of acetylcholine. The CorMicA (Coronary Microvascular Angina) trial provided evidence that routine management guided by an interventional diagnostic procedure and stratified therapy improves angina and quality of life in patients with angina but no obstructive coronary artery disease. In this paper, the COVADIS study group provide a comprehensive review of why, how, and when coronary vascular dysfunction should be assessed invasively. They discuss the rationale through a shared understanding of vascular pathophysiology and clinical evidence. They propose a consensus approach to how an interventional diagnostic procedure is performed with focus on practical aspects. Finally, the authors discuss the clinical scenarios in patients with stable and acute coronary syndromes in which measurement of coronary vascular function may be helpful for patient care.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Ford, Thomas
Authors: Ford, T. J., Ong, P., Sechtem, U., Beltrame, J., Camici, P. G., Crea, F., Kaski, J.-C., Bairey Merz, C. N., Pepine, C. J., Shimokawa, H., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:JACC: Cardiovascular Interventions
Publisher:Elsevier
ISSN:1936-8798
ISSN (Online):1876-7605
Published Online:17 August 2020
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in JACC: Cardiovascular Interventions 13(16):1847-1864
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
301454CORonary MICrovascular Angina (CorMicA): a pilot trial with a nested MRI sub-studyColin BerryBritish Heart Foundation (BHF)PG/17/25/32884CAMS - Cardiovascular Science
174109The conundrum of angina in patients without obstructive coronary disease: a randomised controlled pilot trial of routine testing of coronary function.Colin BerryBritish Heart Foundation (BHF)FS/17/26/32744Institute of Cardiovascular & Medical Sciences
303944BHF Centre of ExcellenceRhian TouyzBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science