Coronary vascular dysfunction : diagnostic evaluation and therapeutic modification
2019
Hochschulschrift
Zugriff:
Introduction: There is a stenosis-centred concept of myocardial ischaemia, whereby angina pectoris is the consequence of obstructive epicardial coronary artery disease (CAD) that reduces myocardial blood flow (MBF) due to supply-demand mismatch. In clinical practice, the diagnostic management of patients with angina focusses on testing for epicardial CAD. This clinical paradigm fails to account for the approximately one-third of patients who suffer from angina and non-obstructive coronary artery disease (ANOCA). Similarly, patients with obstructive epicardial CAD may have recurrent symptoms following myocardial revascularisation. The management of this cohort of patients in heterogeneous. Patients may fail to have a diagnosis made for the aetiology of their symptoms, receive no further diagnostic work-up, and have no therapeutic intervention. Microvascular angina and vasospastic angina secondary to coronary vascular dysfunction may be relevant. I aimed to investigate the diagnostic role of invasive and non-invasive vascular function testing in patients presenting with stable angina, and the role of therapeutic interventions which may modulate coronary vascular function: 1. The proportion of abnormal invasive parameters of coronary vascular function in patients with both ANOCA and obstructive epicardial CAD. 2. The proportion of abnormal myocardial perfusion (as revealed by perfusion cardiac magnetic resonance (CMR) imaging) in patients with ANOCA. 3. The associations between baseline characteristics and coronary vascular dysfunction. 4. To determine whether remote ischaemic preconditioning (RIPC) might enhance endothelium-dependent and -independent coronary vascular function in patients with stable angina. 5. To evaluate the effects of recombinant relaxin-2 (serelaxin) on coronary microvascular and systemic macrovascular function in patients with stable angina. Methods: I performed two studies of diagnostic testing of vascular function, and two mechanistic trials of novel therapeutic modifications of coronary vascular function: 1. Clinical evaluation of magnetic resonance imaging in coronary heart disease 2 (CE-MARC 2) Coronary Physiology sub-study (NCT01664858): a pre-specified sub-study of a UK prospective multicentre randomised controlled trial of patients presenting with stable angina undergoing invasive coronary angiography (n=67). All patients undergoing invasive diagnostic coronary angiography had invasive parameters of coronary microvascular function measured. The primary outcome was the proportion of patients with coronary vascular dysfunction as defined by abnormal invasive tests (reduced coronary flow reserve (CFR, < 2.0), increased index of microcirculatory resistance (IMR, ≥25 U), and reduced resistance reserve ratio (RRR,
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Coronary vascular dysfunction : diagnostic evaluation and therapeutic modification
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Autor/in / Beteiligte Person: | Corcoran, David |
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Veröffentlichung: | 2019 |
Medientyp: | Hochschulschrift |
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