SPC365

Ischemic Heart Disease: looking beyond coronary stenosis

Session: Comunicações Orais (Sessão 9) - Intervenção Cardíaca Coronária e Estrutural 2 - Vários Tópicos
Speaker: Vera Vaz Ferreira

Congress: CPC 2022
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.1 Invasive Imaging and Functional Assessment
Session Type: Comunicações Orais
FP Number: ---
Authors: Vera Ferreira; Ruben Ramos; Tiago Mendonça; Luís Almeida Morais; Tiago Pereira-Da-Silva; Eunice Oliveira; Cristina Fondinho; Alexandra Castelo; José Viegas; Duarte Cacela; Rui Cruz Ferreira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> About 50% of patients referred for invasive coronary angiography (ICA) because of angina and/or myocardial ischemia are found to have non-obstructive coronary artery disease (NOCAD). The role of coronary vasomotion disorders (CVD), namely microvascular angina (MVA) and vasospastic angina (VSA), as mechanisms of ischemic heart disease are becoming increasingly recognized. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose:</strong> Our aim was to describe coronary physiology and microvascular function in patients with angina and NOCAD referred to ICA applying a pre-approved, multi-parametric and sequential protocol covering the coronary functional testing&nbsp;whole spectrum. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: Patients with persistent angina referred for ICA and found to have NOCAD, were included in this single centre prospective study and underwent our protocol for coronary function test (CFT) in last 10 months.&nbsp;</span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Our protocol comprises assessment of coronary circulation vasorelaxation using invasive coronary physiology at rest and with hyperaemia and assessment of the propensity of the coronary circulation to excessive vasoconstriction using intra-coronary acetylcholine (Ach).&nbsp;</span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Fractional flow reserve, coronary flow reserve (CFR) and index of myocardial resistance (IMR) were recorded, using last generation software devices. CVD were diagnosed based on the criteria proposed by the Coronary Vasomotor Disorders International Study Group.</span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">&nbsp;</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>A total of 20 patients were included, mean age was 63&plusmn;13 years and half were females. Hypertension and dyslipidemia were the most frequent cardiovascular risk factors (75% and 65%, respectively), and 20% had known ischemic heart disease with a previous percutaneous coronary intervention. Most patients (75%) had typical angina with median duration of 16 months before CFT. At baseline, 59% of patients had CCS class II angina and 55% had previous ICA/computed tomography due to typical anginal symptoms. Of patients who underwent non-invasive stress testing (80%), the majority had evidence of ischemia (75%). </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Our protocol was successfully and totally completed in all subjects without serious complications. Isolated MVA was found in 5&nbsp;(25%), isolated VSA in 8&nbsp;(40%), both conditions in 2 (10%), and noncardiac chest pain in 5 (25%) patients. Four patients had CFR&lt;2.0 and six had IMR&ge;25. According to the diagnosis obtained in our protocol, antianginal therapy was modified in 70% of patients.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:&nbsp;</strong></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In patients with persistent angina and NOCAD, coronary functional abnormalities, including coronary spasm, impaired microvascular vasodilatation and resistance, are prevalent and frequently coexist. A predefined, standardized, multi-parametric protocol is feasible and safe in clinical practice, providing us definitive diagnosis for the underlying cause of angina, and more importantly, allowing a stratified treatment of the distinct CVD entities.</span></span></p>