Interventional diagnostic procedure: A practical guide for the assessment of coronary vascular function

Ang, D. T.Y., Sidik, N. P., Morrow, A. J. , Sykes, R. , McEntegart, M. B. and Berry, C. (2022) Interventional diagnostic procedure: A practical guide for the assessment of coronary vascular function. Journal of Visualized Experiments, 181, e62265. (doi: 10.3791/62265) (PMID:35377363)

Abstract

Approximately 40% of patients undergoing invasive coronary angiography for investigation of angina are found to have no obstructive coronary artery disease (ANOCA). Abnormal coronary function underlies coronary vasomotion syndromes including coronary endothelial dysfunction, microvascular angina, vasospastic angina, post-PCI angina and myocardial infarction with no obstructive coronary arteries (MINOCA). Each of these endotypes are distinct subgroups, characterized by specific disease mechanisms. Diagnostic criteria and linked therapy for these conditions are now established by expert consensus and clinical guidelines. Coronary function tests are performed as an adjunctive interventional diagnostic procedure (IDP) in appropriately selected patients during coronary angiography. This aids differentiation of patients according to endotype. The IDP includes two distinct components: a diagnostic guidewire test and a pharmacological coronary reactivity test. The tests last approximately 5 minutes for the former and 10-15 minutes for the latter. Patient safety and staff education are key. The diagnostic guidewire test measures parameters of coronary flow limitation (fractional flow reserve [FFR], coronary flow reserve [CFR], microvascular resistance [index of microvascular resistance (IMR)], basal resistance index, and vasodilator function [CFR, resistive reserve ratio (RRR)]). The pharmacological coronary reactivity test measures the vasodilator potential and propensity to vasospasm of both the main coronary arteries and the micro-vessels. It involves intra-coronary infusion of acetylcholine and glyceryl trinitrate (GTN). Acetylcholine is not licensed for parenteral use and is therefore prescribed on a named-patient basis. Vasodilatation is the normal, expected response to infusion of physiological concentrations of acetylcholine. Vascular spasm represents an abnormal response, which supports the diagnosis of vasospastic angina. The purpose of this practical guide is to provide information on the preparation and administration of the IDP in clinical practice. It discusses some key preparation and safety considerations, as well as tips for procedural success. The IDP supports stratified medicine for a personalized approach to health and wellbeing.

• Item Type: Articles
• Additional Information: Dr Berry receives research funding from the British Heart Foundation grant (RE/18/6134217), Chief Scientist Office, EPSRC (EP/R511705/1, EP/S030875/1), European Union (754946-2), Medical Research Council (MR/S018905/1) and UKRI (MC/PC/20014).
• Keywords: Coronary Vessels - diagnostic imaging, Heart, Microvascular Angina - therapy, Humans, Fractional Flow Reserve, Myocardial, Percutaneous Coronary Intervention
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Berry, Professor Colin and McEntegart, Dr Margaret and Ang, Dr Daniel and Sykes, Dr Robert and Morrow, Dr Andrew and Sidik, Ms Novalia
• Authors: Ang, D. T.Y., Sidik, N. P., Morrow, A. J., Sykes, R., McEntegart, M. B., and Berry, C.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Journal of Visualized Experiments
• Publisher: MyJove Corporation
• ISSN: 1940-087X
• ISSN (Online): 1940-087X
• Copyright Holders: Copyright: © 2022 JoVE
• First Published: First published in Journal of Visualized Experiments 181: e62265
• Publisher Policy: Reproduced under a Creative Commons licence