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)
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Abstract
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). |
| Status: | Published |
| Refereed: | Yes |
| 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 |
| Publisher: | Springer |
| ISSN: | 0920-3206 |
| 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 |
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