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Exploring Functional Coronary Disease Beyond Obstructive Lesions
Session:
SESSÃO DE POSTERS 40 - INTERVENÇÃO CORONÁRIA
Speaker:
Joana Reis Pereira
Congress:
CPC 2025
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.3 Coronary Artery Disease – Diagnostic Methods
Session Type:
Cartazes
FP Number:
---
Authors:
Joana Pereira; Mónica Amado; André Martins; Adriana Vazão; Carolina Gonçalves; Francisco Soares; Davide Severino; Hélia Martins
Abstract
<p>Introduction:</p> <p>Patients exhibiting symptoms of angina and/or signs of ischemia in the absence of obstructive coronary disease (INOCA - Ischemia and No Obstructive Coronary Arteries) present a considerable diagnostic and therapeutic challenge. Consequently, it is essential to distinguish between patients with functional coronary disease, such as vasospastic and microvascular diseases, and those whose pain is attributed to non-coronary causes. This study descriptively analyzes patients who underwent assessment of coronary flow reserve (CFR), index of microcirculatory resistance (IMR), followed by vasoreactivity testing with acetylcholine in a tertiary care center.</p> <p>Objective:</p> <p>To understand the relevance of microvascular and vasoreactivity testing by characterizing a sample subjected to these tests. The goal is to categorize patients according to their respective diagnoses of non-coronary thoracic pain, vasospastic angina, and microvascular disease, and to provide appropriate treatment accordingly.</p> <p> </p> <p>Metodology:</p> <p>We analyzed 17 patients who underwent cardiac catheterization, which confirmed the absence of significant obstructive coronary disease. Our center's protocol was applied to these patients, including the administration of adenosine and acetylcholine to calculate the coronary flow reserve (CFR), index of microcirculatory resistance (IMR), and to detect vasospasm.</p> <p>The CFR (normal ≥2.0) and IMR (normal ≤25) were acessed as well as vasorreativity following administration of acetylcoline.</p> <p> </p> <p>Following the testing, patients were categorized into four groups:</p> <p>1. Microvascular Angina: Classified if CFR <2 and/or IMR >25 and/or evidence of microvascular spasm.</p> <p>2. Vasospastic Angina: Classified if both CFR and IMR are normal, but epicardial spasm is present.</p> <p>3. Microvascular and Vasospastic Angina: Identified if there is evidence of both microvascular dysfunction and epicardial spasm.</p> <p>4. Non-cardiac Thoracic Pain: Identified if no abnormalities are detected.</p> <p>Results:</p> <p>(See anexed item)</p> <p> </p> <p>Of the 6 patients who underwent therapeutic changes, 5 were contacted, and of those, 4 patients (80%) reported a marked subjective improvement in symptoms and quality of life.</p> <p>Discussion and Conclusions:</p> <p>Patients with angina and no obstructive coronary disease present a diagnostic and therapeutic challenge.</p> <p>Catheterization combined with these special tests identifies functional coronary disease, facilitating pertinent treatment changes to improve patient outcomes, symptoms, and quality of life.</p> <p>Patients without coronary disease who can be safely discharged are identified.</p> <p>Further studies and additional tests of this nature are required.</p>
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