scholarly journals Microvascular Angina: Diagnosis and Management

2021 ◽  
Vol 16 ◽  
Author(s):  
Haider Aldiwani ◽  
Suzan Mahdai ◽  
Ghaith Alhatemi ◽  
C Noel Bairey Merz
Keyword(s):  
Obstructive Coronary Artery Disease ◽  
International Study ◽  
Evidence Based ◽  
Cardiac Events ◽  
Microvascular Angina ◽  
Coronary Vasomotion ◽  
Artery Disease ◽  
Criteria For Diagnosis ◽  
High Level ◽  
Evidence Based Guidelines

Recognition of suspected ischaemia with no obstructive coronary artery disease – termed INOCA – has increased over the past decades, with a key contributor being microvascular angina. Patients with microvascular angina are at higher risk for major adverse cardiac events including MI, stroke, heart failure with preserved ejection fraction and death but to date there are no clear evidence-based guidelines for diagnosis and treatment. Recently, the Coronary Vasomotion Disorders International Study Group proposed standardised criteria for diagnosis of microvascular angina using invasive and non-invasive approaches. The management strategy for remains empirical, largely due to the lack of high-level-evidence-based guidelines and clinical trials. In this review, the authors will illustrate the updated approach to diagnosis of microvascular angina and address evidence-based pharmacological and non-pharmacological treatments for patients with the condition.

scholarly journals Chest pain without obstructive coronary artery disease: a case series

2020 ◽  
Vol 4 (3) ◽  
pp. 1-6
Author(s):  
Novalia P Sidik ◽  
Michael McDermott ◽  
Margaret B McEntegart ◽  
Colin Berry
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Case Series ◽  
Vasospastic Angina ◽  
Microvascular Angina ◽  
Coronary Vasomotion ◽  
Case Summary ◽  
Artery Disease ◽  
Function Testing

Abstract Background Ischaemic heart disease is a leading cause of mortality in women. Even in those without obstructive coronary artery disease (CAD), women with angina continue to have increased mortality. There are gender differences in prevalence of different pathophysiologies, including functional disorders such as microvascular and vasospastic angina. Case summary We describe four cases of angina in women with no obstructive CAD, in whom coronary function testing was performed. These four patients were diagnosed with disorders of coronary vasomotion, including vasospastic angina and different endotypes of microvascular angina. Discussion This case series highlights the different mechanisms of ischaemia in the absence of obstructive CAD. Patients with angina and no obstructive CAD classified by computed tomography coronary angiography may have myocardial ischaemia due to microvascular angina, vasospastic angina, or both. Conventional investigations risk under-diagnosing, and as a consequence under-treating, patients with these conditions. Coronary function testing, in the form of diagnostic guidewire-based tests and adjunctive acetylcholine provocation, has proven to be critical in the accurate diagnoses and appropriate management of these patients.

Ischemia of Non-Obstructive Coronary Artery Disease: Need to Address in our Patient Population

2021 ◽  
Vol 13 (2) ◽  
pp. 217-222
Author(s):  
AHM Waliul Islam ◽  
AQM Reza ◽  
Shams Munwar ◽  
Shahabuddin Talukder ◽  
Tamzeed Ahmed ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Patient Population ◽  
Technical Assistance ◽  
Obstructive Coronary Artery Disease ◽  
Significant Proportion ◽  
Microvascular Angina ◽  
Essentially Normal ◽  
Doppler Study ◽  
Artery Disease

Ischemia of non-occlusive coronary artery disease (INOCA) not an uncommon phenomenon, exist in our patient population which did not address well. Many of the stable angina and or unstable angina patient, whose coronary angiogram revealed significant coronary stenosis (>70%) are being treated by PCI with drug eluting stent. On the contrary, quite a significant proportion of patient, who are found to have non-significant coronary lesion (<50%) or essentially normal epicardial coronaries. These group of patients with angiographic evidence of non-occlusive CAD, remain undiagnosed of their exact etiology of angina. As a result, recurrence of anginal chest pain leading to repeat hospitalization impaired quality of life and the expenditure. Women are significant number in this category, labelled as syndrome X. Many of the scientific literature, has labeled it as Ischemia of Non obstructive Coronary artery Disease. Notably, Microvascular angina is due to ischemia driven mismatch of demand and supply in the myocardium. Microvascular Dysfunction (MVD) and Coronary vascular spasm or Vasospastic Angina (VSA) are the main pathogenic causes of INOCA. With the advent of Imaging physiology, and its availability in Bangladesh, many of the center can assess INOCA and its severity by FFR, iFR, DFR and transthoracic Doppler study of the coronaries. Therefore, we recommend evaluating INOCA patient by available technical assistance and to address the issue and patients suffering with repeated hospitalization and financial expenditure. Cardiovasc. j. 2021; 13(2): 217-222

Oxford Textbook of Interventional Cardiology

2018 ◽  
Keyword(s):  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Western Society ◽  
Evidence Based ◽  
New Techniques ◽  
Novel Section ◽  
Percutaneous Coronary ◽  
Expert Team ◽  
Artery Disease ◽  
Evidence Based Guidelines

The Oxford Textbook of Interventional Cardiology is the definitive text, spanning the whole spectrum of interventional cardiology procedures, including management of patients with coronary artery disease, one of the leading killers in western society. This textbook, covering key procedures and fully revised and updated to include the latest trials, technology, and new techniques, is essential reading. The Oxford Textbook of Interventional Cardiology 2nd edition spans the whole spectrum of interventional cardiology procedures, including a novel section on the future of interventional cardiology, and multiple new chapters covering special devices in percutaneous coronary intervention. Written by an expert team of international authors, this book offers guidance on all aspects of interventional cardiology according to the European curriculum, and covers the evidence-based guidelines for a comprehensive view of the field.

scholarly journals Human Factors Contributions to the Development of Standards for Displays of Unmanned Aircraft Systems in Support of Detect-and-Avoid

2020 ◽  
Vol 62 (4) ◽  
pp. 505-515 ◽  
Author(s):  
Kim-Phuong L. Vu ◽  
Robert Conrad Rorie ◽  
Lisa Fern ◽  
Robert Jay Shively
Keyword(s):  
Human Factors ◽  
Unmanned Aircraft ◽  
Unmanned Aircraft Systems ◽  
Evidence Based ◽  
National Airspace System ◽  
Human In The Loop ◽  
Aircraft Systems ◽  
Human Systems Integration ◽  
High Level ◽  
Evidence Based Guidelines

Objective The aim is to provide a high-level synthesis of human factors research that contributed to the development of detect-and-avoid display requirements for unmanned aircraft systems (UAS). Background The integration of UAS into the U.S. National Airspace System is a priority under the Federal Aviation Administration’s Modernization and Reform Act. For UAS to have routine access to the National Airspace System, UAS must have detect-and-avoid capabilities. One human factors challenge is to determine how to display information effectively to remote pilots for performing detect-and-avoid tasks. Method A high-level review of research informing the display requirements for UAS detect-and-avoid is provided. In addition, description of the contributions of human factors researchers in the writing of the requirements is highlighted. Results Findings from human-in-the-loop simulations are used to illustrate how evidence-based guidelines and requirements were established for the display of information to assist pilots in performing detect-and-avoid. Implications for human factors are discussed. Conclusion Human factors researchers and engineers made many contributions to generate the data used to justify the detect-and-avoid display requirements. Human factors researchers must continue to be involved in the development of standards to ensure that requirements are evidence-based and take into account human operator performance and human factors principles and guidelines. Application The research presented in this paper is relevant to the design of UAS, the writing of standards and requirements, and the work in human–systems integration.

scholarly journals Prognostic Value of Atherosclerotic Extent in Diabetic Patients with Non-Obstructive Coronary Artery Disease

2020 ◽  
Author(s):  
Zinuan Liu ◽  
Yipu Ding ◽  
Guanhua Dou ◽  
Xia Yang ◽  
Xi Wang ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Sensitivity Analysis ◽  
Coronary Artery ◽  
Prognostic Value ◽  
Obstructive Coronary Artery Disease ◽  
Diabetic Patients ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Artery Disease

Abstract Background: The prognostic value of non-obstructive CAD has always been underestimated due to its moderate stenosis. Whether the atherosclerotic extent is related to the prognosis in this group of people is uncertain, especially in the presence of diabetes. We aim to investigate the prognostic value of atherosclerotic extent in diabetic patients with non-obstructive coronary artery disease (CAD).Method: The analysis was based on a single center cohort of diabetic patients referred for coronary computed tomography angiography (CCTA) due to suspect CAD. Major adverse cardiac events (MACEs) were recorded, including cardiovascular death, non-fatal myocardial infarction, stroke and unstable angina (UA) requiring hospitalization. Four groups were defined based on coronary stenosis combined with segment involvement score (SIS), a semiquantitative index of the extent of atherosclerosis, including normal, non-obstructive SIS<3, non-obstructive SIS≥3 and obstructive. Time to event was estimated by using multivariable Cox proportional hazards models. Leidon risk score was used to replace SIS for sensitivity analysis.Results: In total, 1241 patients were included (age 60.2±10.4 years, 54.1% male), experiencing 131 MACEs (10.6%) during a median follow-up of 2.6 years. Diabetic patients with non-obstructive CAD accounts for 50.2% of included population（N=623）. In multi-variate Cox model adjusting for age, gender, hyperlipidemia and presence of high-risk plaque, hazard ratio (HR) for SIS < 3 and SIS ≥ 3 in non-obstructive CAD were 1.84 (95%CI: 0.70-4.79) and 3.71 (95%CI: 1.37-10.00) respectively.The latter showed a higher risk of cardiac adverse events than the former group（HR：2.02 95%CI:1.11-3.68, p＝0.021）, while HR for obstructive CAD was 5.46 (95%CI: 2.18-13.69). Sensitivity analysis was performed using Leidon Risk Score instead of SIS. After adjustment, HR for Leidon ≥ 5 with non-obstructive disease was 1.92（95% CI: 1.06-3.48 p=0.032）in comparison to the non-obstructive group of Leidon < 5.Conclusion: In diabetic patients with non-obstructive CAD, atherosclerotic extent was associated with higher risk of major adverse cardiac events at long-term follow-up. Efforts should be made to determine risk stratification for the management of DM patients with non-obstructive CAD.

The coronary microcirculation and coronary microvascular dysfunction

2021 ◽  
pp. 18-21
Author(s):  
Romana Herscovici ◽  
C. Noel Bairey Merz
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Signs And Symptoms ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Microvascular Angina ◽  
Cardiac Syndrome ◽  
Artery Disease

The role of revascularization in the treatment of obstructive coronary artery disease is well established, and its impact on improving survival has been proven. Nevertheless, patients with signs and symptoms considered of cardiac origin but with no obstructive coronary artery disease on coronary angiography are increasingly seen. Initially described as a ‘paradox’ or cardiac syndrome X and subsequently defined as microvascular angina, angina-like chest pain and evidence of ischaemia with non-obstructive coronary artery disease, is the consequence of altered coronary microvascular response to various stimuli despite non-obstructed epicardial vessels.

scholarly journals Prevalence of Coronary Endothelial and Microvascular Dysfunction in Women with Symptoms of Ischemia and No Obstructive Coronary Artery Disease Is Confirmed by a New Cohort: The NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation–Coronary Vascular Dysfunction (WISE-CVD)

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
R. David Anderson ◽  
John W. Petersen ◽  
Puja K. Mehta ◽  
Janet Wei ◽  
B. Delia Johnson ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Vascular Dysfunction ◽  
Hormone Replacement ◽  
Obstructive Coronary Artery Disease ◽  
Signs And Symptoms ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Cardiac Events ◽  
Flow Reserve ◽  
Artery Disease

Objective. In a separate, contemporary cohort, we sought to confirm findings of the original Women’s Ischemia Syndrome Evaluation (WISE). Background. The original WISE observed a high prevalence of both invasively determined coronary endothelial and coronary microvascular dysfunction (CMD) that predicted adverse events in follow-up. Methods. We comparatively studied the WISE-Coronary Vascular Dysfunction (CVD) cohort (2009-2011), with signs and symptoms of ischemia but without significant CAD, to the original WISE (1997-2001) cohort. CMD was defined as coronary flow reserve (CFR) ≤2.5, or endothelial dysfunction as epicardial coronary artery constriction to acetylcholine (ACH), or <20% epicardial coronary dilation to nitroglycerin (NTG). Results. In WISE (n=181) and WISE-CVD (n=235) women, mean age in both was 54 years, and 83% were white (WISE) vs 74% (WISE-CVD, p=0.04). Use of hormone replacement therapy was less frequent in WISE-CVD vs WISE (46% vs 57%, p=0.026) as was presence of hypertension (40% vs 52%, p=0.013), hyperlipidemia (20% vs 46%, p<0.0001), and smoking (46% vs 56%, p=0.036). Similar rates were observed in WISE-CVD and WISE cohorts for CMD (mean CFR 2.7±0.6 vs 2.6±0.8, p=0.35), mean change in diameter with intracoronary ACH (0.2±10.0 vs 1.6±12.8 mm, p=0.34), and mean change in diameter with intracoronary NTG (9.7±13.0 vs 9.8±13.5 mm, p=0.94), respectively. Conclusions. This study confirms prevalence of CMD in the contemporary WISE-CVD cohort similar to that of the original WISE cohort, despite a lower risk factor burden in WISE-CVD. Because these coronary functional abnormalities predict major adverse cardiac events, clinical trials of therapies targeting these abnormalities are indicated.

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