Invasive coronary physiology in patients with angina and non-obstructive coronary artery disease: a consensus document from the coronary microvascular dysfunction workstream of the British Heart Foundation/National Institute for Health Research Partnership

Perera, D., Berry, C. , Hoole, S. P., Sinha, A., Rahman, H., Morris, P. D., Kharbanda, R. K., Petraco, R. and Channon, K. (2023) Invasive coronary physiology in patients with angina and non-obstructive coronary artery disease: a consensus document from the coronary microvascular dysfunction workstream of the British Heart Foundation/National Institute for Health Research Partnership. Heart, 109(2), pp. 88-95. (doi: 10.1136/heartjnl-2021-320718) (PMID:35318254) (PMCID:PMC9811089)

[img] Text
268641.pdf - Published Version
Available under License Creative Commons Attribution.

4MB

Abstract

Nearly half of all patients with angina have non-obstructive coronary artery disease (ANOCA); this is an umbrella term comprising heterogeneous vascular disorders, each with disparate pathophysiology and prognosis. Approximately two-thirds of patients with ANOCA have coronary microvascular disease (CMD). CMD can be secondary to architectural changes within the microcirculation or secondary to vasomotor dysfunction. An inability of the coronary vasculature to augment blood flow in response to heightened myocardial demand is defined as an impaired coronary flow reserve (CFR), which can be measured non-invasively, using imaging, or invasively during cardiac catheterisation. Impaired CFR is associated with myocardial ischaemia and adverse cardiovascular outcomes. The CMD workstream is part of the cardiovascular partnership between the British Heart Foundation and The National Institute for Health Research in the UK and comprises specialist cardiac centres with expertise in coronary physiology assessment. This document outlines the two main modalities (thermodilution and Doppler techniques) for estimation of coronary flow, vasomotor testing using acetylcholine, and outlines a standard operating procedure that could be considered for adoption by national networks. Accurate and timely disease characterisation of patients with ANOCA will enable clinicians to tailor therapy according to their patients’ coronary physiology. This has been shown to improve patients’ quality of life and may lead to improved cardiovascular outcomes in the long term.

Item Type:Articles
Additional Information:Funding The authors’ work is supported by grants from the Medical Research Council (MR/T029390/1), British Heart Foundation (FS/16/49/32320), the UK National Institute for Health Research (through the Biomedical Research Centre award to King’s College London and Guy’s and St Thomas’ Hospital), the Wellcome Trust [214567/Z/18/Z].
Keywords:Coronary angiography, microvascular angina, angina pectoris, chest pain.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin
Authors: Perera, D., Berry, C., Hoole, S. P., Sinha, A., Rahman, H., Morris, P. D., Kharbanda, R. K., Petraco, R., and Channon, K.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Heart
Publisher:BMJ Publishing Group
ISSN:1355-6037
ISSN (Online):1468-201X
Published Online:22 March 2022
Copyright Holders:Copyright © Author(s) (or their employer(s)) 2023
First Published:First published in Heart 109(2):88-95
Publisher Policy:Reproduced under a Creative Commons License

University Staff: Request a correction | Enlighten Editors: Update this record