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Phenotype-based management of coronary microvascular dysfunction.

Ang, DTY; Berry, C; Kaski, J-C (2022) Phenotype-based management of coronary microvascular dysfunction. J Nucl Cardiol, 29 (6). pp. 3332-3340. ISSN 1532-6551 https://doi.org/10.1007/s12350-022-03000-w
SGUL Authors: Kaski, Juan Carlos

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Abstract

40-70% of patients undergoing invasive coronary angiography with signs and symptoms of ischemia are found to have no obstructive coronary artery disease (INOCA). When this heterogeneous group undergo coronary function testing, approximately two-thirds have demonstrable coronary microvascular dysfunction (CMD), which is independently associated with adverse prognosis. There are four distinct phenotypes, or subgroups, each with unique pathophysiological mechanisms and responses to therapies. The clinical phenotypes are microvascular angina, vasospastic angina, mixed (microvascular and vasospastic), and non-cardiac symptoms (reclassification as non-INOCA). The Coronary Vasomotor Disorders International Study Group (COVADIS) have proposed standardized criteria for diagnosis. There is growing awareness of these conditions among clinicians and within guidelines. Testing for CMD can be done using invasive or non-invasive modalities. The CorMicA study advocates the concept of 'functional angiography' to guide stratified medical therapy. Therapies broadly fall into two categories: those that modulate cardiovascular risk and those to alleviate angina. Management should be tailored to the individual, with periodic reassessment for efficacy. Phenotype-based management is a worthy endeavor for both patients and clinicians, aligning with the concept of 'precision medicine' to improve prognosis, symptom burden, and quality of life. Here, we present a contemporary approach to the phenotype-based management of patients with INOCA.

Item Type: Article
Additional Information: Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Keywords: CAD, Microvascular dysfunction, diagnostic and prognostic application, myocardial blood flow, myocardial ischemia and infarction, vasodilators, Microvascular dysfunction, myocardial blood flow, diagnostic and prognostic application, vasodilators, CAD, myocardial ischemia and infarction, CAD, diagnostic and prognostic application, Microvascular dysfunction, myocardial blood flow, myocardial ischemia and infarction, vasodilators, 1102 Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: J Nucl Cardiol
ISSN: 1532-6551
Language: eng
Dates:
DateEvent
December 2022Published
7 June 2022Published Online
10 April 2022Accepted
Publisher License: Creative Commons: Attribution 4.0
PubMed ID: 35672569
Web of Science ID: WOS:000807319000001
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/114601
Publisher's version: https://doi.org/10.1007/s12350-022-03000-w

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