Thomas J. Ford, MD, PhD Peter Ong, MD, PhD Udo Sechtem, MD John Beltrame, MD, PhD Paolo G. Camici, MD Filippo Crea, MD, PhD Juan-Carlos Kaski, MD, DSc C. Noel Bairey Merz, MD Carl J. Pepine, MD, PhD Hiroaki Shimokawa, MD, PhD Colin Berry, MD, PhD on behalf of the COVADIS Study Group
Ischemic heart disease secondary to coronary vascular dysfunction causes angina and impairs quality of life and prognosis. About one-half of patients with symptoms and signs of ischemia turn out not to have obstructive coronary artery disease, and coronary vascular dysfunction may be relevant. Adjunctive tests of coronary vasomotion include guidewire-based techniques with adenosine and reactivity testing, typically by intracoronary infusion of acetylcholine. The CorMicA (Coronary Microvascular Angina) trial provided evidence that routine management guided by an interventional diagnostic procedure and stratified therapy improves angina and quality of life in patients with angina but no obstructive coronary artery disease. In this paper, the COVADIS study group provide a comprehensive review of why, how, and when coronary vascular dysfunction should be assessed invasively. They discuss the rationale through a shared understanding of vascular pathophysiology and clinical evidence. They propose a consensus approach to how an interventional diagnostic procedure is performed with focus on practical aspects. Finally, the authors discuss the clinical scenarios in patients with stable and acute coronary syndromes in which measurement of coronary vascular function may be helpful for patient care.
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Authors: Thomas J. Ford, MD, PhD Peter Ong, MD, PhD Udo Sechtem, MD John Beltrame, MD, PhD Paolo G. Camici, MD Filippo Crea, MD, PhD Juan-Carlos Kaski, MD, DSc C. Noel Bairey Merz, MD Carl J. Pepine, MD, PhD Hiroaki Shimokawa, MD, PhD Colin Berry, MD, PhD on behalf of the COVADIS Study Group
Publication: Vol. 13, No. 16, 2020
Publisher: JACC: Cardiovascular Interventions
Date published: August 17th, 2020
Copyright © 2020, The Author. Published by Elsevier on Behalf of The American College of Cardiology Foundation. This is an Open Access Article under the CC BY-NC-ND License (http://creativecommons.org/licenses/by-nc-nd/4.0).
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