Principles and pitfalls in coronary vasomotor function testing

EuroIntervention 2022;17:1271-1280. DOI: 10.4244/EIJ-D-21-00402

Rutger G.T. Feenstra1, MD; Andreas Seitz2, MD; Coen K.M. Boerhout1, MD; Laura H. Bukkems3, PharmD; Valérie E. Stegehuis1, MD; Patty J.I. Teeuwisse3, PharmD; Robbert J. de Winter1, MD, PhD; Udo Sechtem2, MD; Jan J. Piek1, MD, PhD; Tim P. van de Hoef1, MD, PhD; Peter Ong2, MD; Marcel A.M. Beijk1, MD, PhD

1. Department of Clinical and Experimental Cardiology, Amsterdam UMC, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; 2. Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany; 3. Department of Clinical Pharmacy, Amsterdam UMC, Amsterdam, the Netherlands

Background

Coronary vasomotor dysfunction can be diagnosed in a large proportion of patients with angina in the presence of non-obstructive coronary artery disease (ANOCA) using comprehensive protocols for coronary vasomotor function testing (CFT). Although consensus on diagnostic criteria for endotypes of coronary vasomotor dysfunction has been published, consensus on a standardised study testing protocol is lacking.

Aims

In this review we provide an overview of the variations in CFT used and discuss the practical principles and pitfalls of CFT.

Methods

For the purposes of this review, we assessed study protocols that evaluate coronary vasomotor response as reported in the literature. We compared these protocols regarding a number of procedural aspects and chose six examples to highlight the differences and uniqueness.

Results

Currently, numerous protocols co-exist and vary in vascular domains tested, the manner in which to test these domains (e.g., preprocedural discontinuation of medication, provocative agent, solution, infusion time, and target artery) and techniques used for measurements (e.g., Doppler vs thermodilution technique).

Conclusions

This lack of consensus on a uniform functional testing protocol hampers both a broader clinical acceptance of the concepts of coronary vasomotor dysfunction, and the widespread adoption of such testing protocols in current clinical practice. Furthermore, the endotype of coronary vasomotor dysfunction might differ among the few specialised centres that perform CFT as a result of the use of different protocols.

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Authors: Rutger G.T. Feenstra, MD; Andreas Seitz, MD; Coen K.M. Boerhout, MD; Laura H. Bukkems, PharmD; Valérie E. Stegehuis, MD; Patty J.I. Teeuwisse, PharmD; Robbert J. de Winter, MD, PhD; Udo Sechtem, MD; Jan J. Piek, MD, PhD; Tim P. van de Hoef, MD, PhD; Peter Ong, MD; Marcel A.M. Beijk, MD, PhD

Publication: EuroIntervention

Publisher: EuroIntervention 2022

Date published: February 18th, 2022

 

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