Insights to advance our management of myocardial ischemia: From obstructive epicardial disease to functional coronary alterations

Autor: C. Noel Bairey Merz, John F. Beltrame, Colin Berry, William E. Boden, Paolo G. Camici, Filippo Crea, Judith S. Hochman, Juan Carlos Kaski, Patrick T. O'Gara, Peter Ong, Carl J. Pepine, Hiroaki Shimokawa, Udo Sechtem, Gregg W. Stone
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Zdroj: American Heart Journal Plus, Vol 11, Iss , Pp 100060- (2021)
Druh dokumentu: article
ISSN: 2666-6022
DOI: 10.1016/j.ahjo.2021.100060
Popis: Study objective: The Coronary Vasomotor Disorders International Study Group (COVADIS) invited leading experts to address strategies to enhance our clinical understanding of INOCA with an emphasis on the management of coronary vasomotor disorders. Design: Under-recognition of coronary vasomotor disorders, distinguishing different presentations of angina due to vasospasm and/or abnormal microvascular vasodilatation, developing invasive/non-invasive testing and treatment protocols, integrating diagnostic protocols into cardiologists' workflow and trials to inform guideline development were identified as key knowledge gaps and will be briefly addressed in this Viewpoint article. Setting: Virtual international meeting. Participants: Leading international experts in ischemic heart disease with no obstructive coronary artery disease. Interventions: None. Main outcome measures: None. Results: Topics discussed include: 1. Obstructive epicardial disease, functional vasospasm and microvascular disorders; 2. Under-recognition of coronary vasomotor disorders in clinical practice; 3. Complexity of coronary vasomotor disorders; 4. Understanding different presentations - vasospastic disease and microvascular angina; 5. Invasive/noninvasive testing and treatment protocols for vasospasm and microvascular angina assessment; 6. Treatment challenges; 7. Integrating diagnostic protocols into cardiologists' workflow; 8. The path forward to advance our approach to managing myocardial ischemia. Conclusions: Obstructive epicardial disease, functional vasospasm and microvascular disorders often co-exist and contribute to myocardial ischemia. Under-recognition, the complexity of coronary vasomotor disorders, understanding different presentations, testing and treatment protocols, treatment challenges, and integrating diagnostic protocols into cardiologists' workflow all contribute to the path forward to advance our management of myocardial ischemia for improved patient outcomes.
Databáze: Directory of Open Access Journals