The role of coronary reactivity testing in women with no obstructive coronary artery disease

• Type of Material: Article
• Authors: Ahmed AlBadri, Emory University; Kreton Mavromatis, Emory University; C. Noel Bairey Merz, Cedars Sinai Smidt Heart Institute
• Language: English
• Date: 2019-11-01
• Publisher: Lippincott Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 Wolters Kluwer Health, Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/HCO.0000000000000682
• Title of Journal or Parent Work: Current Opinion in Cardiology
• Volume: 34
• Issue: 6
• Start Page: 656
• End Page: 662
• Grant/Funding Information: Ahmed AlBadri is supported by American Heart Association Postdoctoral Fellowship Award Grant (18POST34080330).; Linda Joy Pollin Women’s Heart Health Program, and the Erika Glazer Women’s Heart Health Project, all in the Barbra Streisand Women’s Heart Center at the Cedars-Sinai Smidt Heart Institute, Los Angeles, California.; This work was also supported by contracts from the National Heart, Lung, and Blood Institutes nos. N01-HV-68161, N01-HV-68162, N01-HV-68163, N01-HV-68164, grants U0164829, U01 HL649141, U01 HL649241, K23HL105787, T32HL69751, R01 HL090957, 1R03AG032631 from the National Institute on Aging,; GCRC grant M01-RR00425 from the National Center for Research Resources, the National Center for Advancing Translational Sciences Grant UL1TR000124 and UL1TR001427, and the Edythe L. Broad and the Constance Austin Women’s Heart Research Fellowships, the Barbra Streisand Women’s Cardiovascular Research and Education Program,
• Keywords: Myocardial ischemia; Cardiovascular events; Life Sciences & Biomedicine; National heart; microvasculature; Flow reserve; cardiovascular outcome; coronary flow reserve; endothelial function; Invasive evaluation; coronary reactivity; Cardiovascular System & Cardiology; Science & Technology; Diagnostic Imaging; Microvascular dysfunction; Prognostic impact; Chest pain; International standardization; Cardiac & Cardiovascular Systems
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery; Health Sciences, Health Care Management

Abstract

Purpose of the review: Two-thirds of women with signs and symptoms of ischemia and no obstructive coronary artery disease have abnormal coronary reactivity. These women are challenging to assess, diagnose and manage because of a lack of evidence-based guidelines. Furthermore, they are considered to be at “low risk” by most physicians, often receive no specific therapy and tend to be dismissed from sub-specialty care. Recent findings: Coronary reactivity testing is considered the reference-standard for evaluation of epicardial and microvascular coronary function in response to various vasoactive agents. It provides a comprehensive vascular function assessment for diagnosis, a guide for management, and has prognostic benefit that outweigh the risk of the procedure. We recently demonstrated the prognostic value of assessing coronary vascular reactivity in women with signs and symptoms of ischemia, especially those with no obstructive CAD. Summary: Invasive CRT is a feasible, useful method to identify CMD and risk stratify women with INOCA. It has a comparable safety record to other invasive procedures. Future research is directed at optimizing patient selection, streamlining of invasive CRT methods using user-friendly catheters to enhance feasibility in the routine clinical setting, and optimizing treatment protocols, with clinical trials designed to evaluate outcomes.