PT  - JOURNAL ARTICLE
AU  - Haseeb Rahman
AU  - David Corcoran
AU  - Muhammad Aetesam-ur-Rahman
AU  - Stephen P Hoole
AU  - Colin Berry
AU  - Divaka Perera
TI  - Diagnosis of patients with angina and non-obstructive coronary disease in the catheter laboratory
AID  - 10.1136/heartjnl-2019-315042
DP  - 2019 Oct 01
TA  - Heart
PG  - 1536--1542
VI  - 105
IP  - 20
4099  - http://heart.bmj.com/content/105/20/1536.short
4100  - http://heart.bmj.com/content/105/20/1536.full
SO  - Heart2019 Oct 01; 105
AB  - Around 40% of all patients undergoing angiography are found to have normal coronary arteries or non-obstructive coronary artery disease (NOCAD). Despite the high prevalence, this is a group who rarely receive a definitive diagnosis, are frequently labelled and managed inappropriately and by and large, continue to remain symptomatic. Half of this group will have coronary microvascular dysfunction (CMD), associated with a higher rate of major adverse cardiovascular events; identifying CMD represents a therapeutic target of unmet need. As the pressure wire has revolutionised our ability to interrogate epicardial coronary disease during the time of angiography, measuring flow can similarly classify NOCAD during a single procedure. Assessment of flow is a function that is already integral to some pressure wires and furthermore, the familiarity and usage of the combined Doppler and pressure wire is rapidly increasing—these are techniques that readily lend themselves to the skillset of a practising interventional cardiologist. We present a structured algorithm designed for cardiologists who frequently encounter NOCAD in the catheter laboratory, identifying specific disease phenotypes within this heterogeneous population with linked therapy. This review paper clearly explains the rationale for this algorithm and outlines its applicability to routine clinical practice and also, the importance of phenotyping for future research. Ultimately, personalised therapy could improve outcomes for both patients and healthcare providers; while these approaches in turn will need robust evaluation to ensure that they improve both clinical outcomes and health economic benefits, this proposal will provide a framework for future trials and evaluations.