What is the role of assessing ischemia to optimize therapy and outcomes for patients with stable angina and non-obstructed coronary arteries?

Berry, C. , Morrow, A. J. , Marzilli, M. and Pepine, C. J. (2022) What is the role of assessing ischemia to optimize therapy and outcomes for patients with stable angina and non-obstructed coronary arteries? Cardiovascular Drugs and Therapy, 36(5), pp. 1027-1038. (doi: 10.1007/s10557-021-07179-x) (PMID:33978865) (PMCID:PMC9519699)

[img] Text
238290.pdf - Published Version
Available under License Creative Commons Attribution.



Ischemic heart disease (IHD) is a leading global cause of ill-health and premature death. Clinical research into IHD is providing new insights into the pathophysiology, epidemiology and treatment of this condition. The major endotypes of IHD include coronary heart disease (CHD) and vasomotor disorders, including microvascular angina and vasospastic angina. Considering unselected patients presenting with stable chest pain, the pre-test probability of CHD is higher in men whereas the pre-test probability of a vasomotor disorder is higher in women. The diagnostic accuracy of diagnostic tests designed to assess coronary anatomy and disease and/or coronary vascular function (functional tests) differ for coronary endotypes. Clinical management should therefore be personalized and take account of sex-related factors. In this review, we consider the definitions of angina and myocardial ischemia. We then appraise the mechanistic links between myocardial ischemia and anginal symptoms and the relative merits of non-invasive and invasive diagnostic tests and related clinical management. Finally, we describe the rationale and importance of stratified medicine of IHD.

Item Type:Articles
Additional Information:A.J.M is supported by the Medical Research Council (MR/S005714/1). CB acknowledges research support from the British Heart Foundation (PG/17/2532884; FS/17/26/32744; RE/18/6134217) and Medical Research Council (MR/S005714/1).
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Morrow, Dr Andrew
Authors: Berry, C., Morrow, A. J., Marzilli, M., and Pepine, C. J.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Cardiovascular Drugs and Therapy
ISSN (Online):1573-7241
Published Online:12 May 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Cardiovascular Drugs and Therapy 36(5): 1027-1038
Publisher Policy:Reproduced under a Creative Commons License

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

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