Tag: angina

Research

Stratified treatment of myocardial infarction with non-obstructive coronary arteries: the...

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is associated with a significant risk of mortality, rehospitalization, and angina burden. Despite its clinical impact, no randomized clinical trials have hitherto evaluated optimal management strategy for MINOCA. The PROMISE trial was designed to assess whether a stratified treatment improves clinical outcomes in patients with MINOCA as compared to standard care.

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Research

Endotypes of angina with non-obstructive coronary arteries: a prospective multicentre...

Angina and/or myocardial ischaemia with non-obstructive coronary arteries (ANOCA/INOCA) affects more than one in three individuals with stable ischaemic heart disease, and women are more often affected. This high prevalence of ANOCA, its impact on health-related quality of life and prognosis, and evidence supporting the role of invasive coronary function tests in persistently symptomatic patients have led to a class I recommendation in international practice guidelines and a call for further research into the diagnosis of this condition. As underlined in these guidelines, ANOCA/INOCA is ‘rarely correctly diagnosed and no tailored therapy is prescribed for these patients.’

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Research

Functional Coronary Angiography for the Diagnosis of Coronary Vasomotor Disorders

Microvascular and/or vasospastic angina are two common forms of coronary vasomotor disorders that may occur in patients with ischaemia and non-obstructed coronary arteries (INOCA) or myocardial infarction with non-obstructive coronary arteries (MINOCA).

Functional coronary angiography involves invasive guidewire-based assessment of the coronary circulation using pharmacological vasoactive agents to assess small and large vasomotor dysfunction. Typically, responses to adenosine (microvascular vasodilator) and acetylcholine (large and small vessel vasospastic agent) are sequentially assessed.

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Research

Evaluating Ischemic Heart Disease in Women: Focus on Angina With...

Ischemic heart disease (IHD) is common in women, and cardiovascular disease is a leading cause of morbidity and mortality. While obstructive coronary artery disease is the most common form of IHD, millions of women suffer from angina with nonobstructive coronary arteries (ANOCA), an umbrella term encompassing multiple nonatherosclerotic disorders of the coronary tree.

The underlying pathology leading to ischemia in these syndromes may be challenging to diagnose, leaving many women without a diagnosis despite persistent symptoms that impact quality of life and adversely affect long-term cardiovascular prognosis. In the last decade, there have been significant advances in the recognition and diagnostic evaluation of ANOCA.

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Research

Characterizing Mechanisms of Ischemia in Patients With Myocardial Bridges

Myocardial bridges (MBs) are prevalent and can be associated with acute and chronic ischemic syndromes. We sought to determine the substrates for ischemia in patients with angina with nonobstructive coronary arteries and a MB in the left anterior descending artery.

Patients with angina with nonobstructive coronary arteries underwent the acquisition of intracoronary pressure and flow during rest, supine bicycle exercise, and adenosine infusion. Coronary wave intensity analysis was performed, with perfusion efficiency defined as accelerating wave energy/total wave energy (%).

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Research

Invasive Endotyping in Patients With Angina and No Obstructive Coronary...

We investigated the usefulness of invasive coronary function testing to diagnose the cause of angina in patients with no obstructive coronary arteries.

Outpatients referred for coronary computed tomography angiography in 3 hospitals in the United Kingdom were prospectively screened. After coronary computed tomography angiography, patients with unobstructed coronary arteries, and who consented, underwent invasive endotyping.

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Research

Coronary Slow Flow Is Not Diagnostic of Microvascular Dysfunction in...

Guidelines recommend that coronary slow flow phenomenon (CSFP), defined as corrected thrombolysis in myocardial infarction frame count (CTFC) >27, can diagnose coronary microvascular dysfunction (CMD) in patients with angina and nonobstructed coronary arteries.

CSFP has also historically been regarded as a sign of coronary endothelial dysfunction (CED). We sought to validate the utility of CTFC, as a binary classifier of CSFP and as a continuous variable, to diagnose CMD and CED.

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Research

Invasive coronary physiology in patients with angina and non-obstructive coronary...

Nearly half of all patients with angina have non-obstructive coronary artery disease (ANOCA); this is an umbrella term comprising heterogeneous vascular disorders, each with disparate pathophysiology and prognosis. Approximately two-thirds of patients with ANOCA have coronary microvascular disease (CMD). CMD can be secondary to architectural changes within the microcirculation or secondary to vasomotor dysfunction.

An inability of the coronary vasculature to augment blood flow in response to heightened myocardial demand is defined as an impaired coronary flow reserve (CFR), which can be measured non-invasively, using imaging, or invasively during cardiac catheterisation. Impaired CFR is associated with myocardial ischaemia and adverse cardiovascular outcomes.

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Research

Definitions and Epidemiology of Coronary Functional Abnormalities

Coronary functional abnormalities are frequent causes of angina pectoris, particularly in patients with unobstructed coronary arteries. There is a spectrum of endotypes of functional coronary abnormalities with different mechanisms of pathology including enhanced vasoconstriction (i.e. coronary artery spasm) or impaired vasodilatation, such as impaired coronary flow reserve or increased microvascular resistance.

These vasomotor abnormalities can affect various compartments of the coronary circulation such as the epicardial conduit arteries and/or the coronary microcirculation. Unequivocal categorisation and nomenclature of the broad spectrum of disease endotypes is crucial both in clinical practice as well as in clinical trials.

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Research

Small vessel disease

Small vessel disease is a condition in which the walls of the small arteries in the heart are damaged. The condition causes signs and symptoms of heart disease, such as chest pain (angina).

Small vessel disease is sometimes called coronary microvascular disease or small vessel heart disease. It’s often diagnosed after a doctor finds little or no narrowing in the main arteries of your heart, despite your having symptoms that suggest heart disease.

Small vessel disease is more common in women and in people who have diabetes or high blood pressure. The condition is treatable but can be difficult to detect.

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Research

Myocardial ischemia: From disease to syndrome

Although current guidelines on the management of stable coronary artery disease acknowledge that multiple mechanisms may precipitate myocardial ischemia, recommended diagnostic, prognostic and therapeutic algorithms are still focused on obstructive epicardial atherosclerotic lesions, and little progress has been made in identifying management strategies for non-atherosclerotic causes of myocardial ischemia.

The purpose of this consensus paper is three-fold: 1) to marshal scientific evidence that obstructive atherosclerosis can co-exist with other mechanisms of ischemic heart disease (IHD); 2) to explore how the awareness of multiple precipitating mechanisms could impact on pre-test probability, provocative test results and treatment strategies; and 3) to stimulate a more comprehensive approach to chronic myocardial ischemic syndromes, consistent with the new understanding of this condition.

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Research

Diagnosis of patients with angina and non-obstructive coronary disease in...

Around 40% of all patients undergoing angiography are found to have normal coronary arteries or non-obstructive coronary artery disease (NOCAD). Despite the high prevalence, this is a group who rarely receive a definitive diagnosis, are frequently labelled and managed inappropriately and by and large, continue to remain symptomatic.

Half of this group will have coronary microvascular dysfunction (CMD), associated with a higher rate of major adverse cardiovascular events; identifying CMD represents a therapeutic target of unmet need. As the pressure wire has revolutionised our ability to interrogate epicardial coronary disease during the time of angiography, measuring flow can similarly classify NOCAD during a single procedure.

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Around The World

Real Patient Stories

Natsuko’s story

At 4am, I woke up in the dark with crushing chest pain, nausea, shortness of breath, and pain radiating to my left arm and jaw. I was terrified. You would think that such symptoms would lead to a quick diagnosis. But as a young woman in my 20s who looked “healthy,” my journey to finally being diagnosed with Microvascular Angina was anything but easy.

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Jennifer’s story

Hello! My name is Jennifer, a 41-year-old mother of 5 and a nurse. My husband and I have been married nearly 15 years. Before I share my story, I’d like to share that I had never been on any medications other than Lexapro for mild depression and anxiety. I did not have heart problems or even high blood pressure. December 9, 2023, was the beginning of a life changing event leading to the diagnosis of Coronary Artery Spasm, also known as Prinzmetal Angina.

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Dima’s story

March 3rd, 2021 was the day that changed everything. At 55, I had a busy counselling practice and a few other projects on the go. The pandemic was causing anxiety for many of my clients and in my private life. I had a lot of stress of my own: there were safety issues in the building where I lived, and I was looking for a new apt. Despite this, I thought I was handling it well. I was fairly healthy, I walked daily, ate well, meditated and didn’t smoke or drink.

I started to experience heavy fatigue towards the end of 2020 but told myself it was normal considering all that was going on in the world.

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