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An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries, 2020, Kunadian et al

Discussion in 'Other health news and research' started by SNT Gatchaman, Mar 3, 2023.

  1. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

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    An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group
    Vijay Kunadian, Alaide Chieffo, Paolo G Camici, Colin Berry, Javier Escaned, Angela H E M Maas, Eva Prescott, Nicole Karam, Yolande Appelman, Chiara Fraccaro, Gill Louise Buchanan, Stephane Manzo-Silberman, Rasha Al-Lamee, Evelyn Regar, Alexandra Lansky, J Dawn Abbott, Lina Badimon, Dirk J Duncker, Roxana Mehran, Davide Capodanno, Andreas Baumbach

    Abstract
    This consensus document, a summary of the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI), appraises the importance of ischaemia with non-obstructive coronary arteries (INOCA).

    Angina pectoris affects approximately 112 million people globally. Up to 70% of patients undergoing invasive angiography do not have obstructive coronary artery disease, more common in women than in men, and a large proportion have INOCA as a cause of their symptoms. INOCA patients present with a wide spectrum of symptoms and signs that are often misdiagnosed as non-cardiac leading to under-diagnosis/investigation and under-treatment. INOCA can result from heterogeneous mechanism including coronary vasospasm and microvascular dysfunction and is not a benign condition. Compared to asymptomatic individuals, INOCA is associated with increased incidence of cardiovascular events, repeated hospital admissions, as well as impaired quality of life and associated increased health care costs.

    This consensus document provides a definition of INOCA and guidance to the community on the diagnostic approach and management of INOCA based on existing evidence from research and best available clinical practice; noting gaps in knowledge and potential areas for further investigation.

    Link | PDF (Eur Heart J)
     
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  2. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

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    Posting in relation to more generalised endothelial dysfunction as a proposed downstream mechanism in ME/CFS and LC. For LC, chest pain that is often diagnosed as non-cardiac is a recognised symptom, per the WHO clinical case definition.

    CAD = coronary artery disease
    CMD = coronary microvascular dysfunction
    IHD = ischaemic heart disease
    INOCA = ischaemia with non-obstructive coronary arteries
    MVA = microvascular angina
     
    Last edited: Mar 4, 2023
  3. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

    Messages:
    4,256
    Location:
    Aotearoa New Zealand
     
  4. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

    Messages:
    4,256
    Location:
    Aotearoa New Zealand
     
  5. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

    Messages:
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    Location:
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    See also case report of 23 yo female Angina Simultaneously Diagnosed with the Recurrence of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (2021, Diagnostics).

     
  6. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

    Messages:
    4,256
    Location:
    Aotearoa New Zealand
  7. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

    Messages:
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    Location:
    Aotearoa New Zealand
    Rethinking False Positive Exercise Electrocardiographic Stress Tests by Assessing Coronary Microvascular Function
    Sinha; Dutta; Demir; De Silva; Ellis; Belford; Ogden; Li Kam Wa; Morgan; Shah; Chiribiri; Webb; Marber; Rahman; Perera

    BACKGROUND
    Exercise electrocardiographic stress testing (EST) has historically been validated against the demonstration of obstructive coronary artery disease. However, myocardial ischemia can occur because of coronary microvascular dysfunction (CMD) in the absence of obstructive coronary artery disease.

    OBJECTIVES
    The aim of this study was to assess the specificity of EST to detect an ischemic substrate against the reference standard of coronary endothelium-independent and endothelium-dependent microvascular function in patients with angina with nonobstructive coronary arteries (ANOCA).

    METHODS
    Patients with ANOCA underwent invasive coronary physiological assessment using adenosine and acetylcholine. CMD was defined as impaired endothelium-independent and/or endothelium-dependent function. EST was performed using a standard Bruce treadmill protocol, with ischemia defined as the appearance of ≥0.1-mV ST-segment depression 80 ms from the J-point on electrocardiography. The study was powered to detect specificity of ≥91%.

    RESULTS
    A total of 102 patients were enrolled (65% women, mean age 60 ± 8 years). Thirty-two patients developed ischemia (ischemic group) during EST, whereas 70 patients did not (nonischemic group); both groups were phenotypically similar. Ischemia during EST was 100% specific for CMD. Acetylcholine flow reserve was the strongest predictor of ischemia during exercise. Using endothelium-independent and endothelium-dependent microvascular dysfunction as the reference standard, the false positive rate of EST dropped to 0%.

    CONCLUSIONS
    In patients with ANOCA, ischemia on EST was highly specific of an underlying ischemic substrate. These findings challenge the traditional belief that EST has a high false positive rate.

    Link | PDF (Journal of the American College of Cardiology)


     
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