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FBX 2017 Et Covadis 2017.zip

microvascular angina is an important cause of exercise-induced angina. although invasive coronary angiography is needed for definite diagnosis, the epicardial anatomy does not usually correlate with angina symptoms. intracoronary adenosine vasodilator testing has been shown to be superior to the usual nitrate-based functional testing in patients with suspected vasospastic angina. introduction of intracoronary adenosine has been proposed as a diagnostic tool for patients with angina pectoris and effort angina with a normal coronary angiogram to predict the presence of vasospastic angina. in this paper, we review the evidence for the use of intracoronary adenosine and the proposed role of this drug within a stepwise diagnostic algorithm for vasospastic angina.

coronary microvascular dysfunction (cmd) is a proposed cause of myocardial ischemia at rest in the absence of obstructive coronary artery disease. cmd can occur in the setting of coronary artery disease and is estimated to affect as many as 5% of symptomatic patients with coronary artery disease. however, due to limited awareness of cmd, there is a very limited knowledge about epidemiology and risk factors and the long-term outcome in patients with cmd. this review highlights some of the scientific gaps and challenges in studying cmd. the basis of diagnosis, end points, and prognostic factors for cmd are different than those for traditional coronary artery disease. the majority of studies are performed in small, selected populations that lack uniform definitions of cmd that may also be confounded by the inclusion of patients with other diseases. importantly, the natural history of cmd is unknown. several therapeutic approaches have been tested for cmd and their efficacy may require the use of larger trial populations. thus, there is an urgent need for more rigorous studies with larger, controlled, randomised clinical trials. we conclude that cmd is a potential contributor to unexplained chest pain, similar to obstructive cad. cmd may be identified by coronary vasomotor testing, which provides a non-invasive approach that could be used to focus care of patients with unexplained ischemic heart disease. a recent proposal for coronary vasomotor testing is the cormica (coronary microvascular angina) trial, which is an ongoing randomised trial using intracoronary adenosine in the investigation of unexplained ischemic heart disease. the coronaromyography study group provide guidance on the implementation of an intracoronary adenosine vasomotor testing protocol for this trial.

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