RT Journal Article SR Electronic T1 Diagnosis of patients with angina and non-obstructive coronary disease in the catheter laboratory JF Heart JO Heart FD BMJ Publishing Group Ltd and British Cardiovascular Society SP 1536 OP 1542 DO 10.1136/heartjnl-2019-315042 VO 105 IS 20 A1 Haseeb Rahman A1 David Corcoran A1 Muhammad Aetesam-ur-Rahman A1 Stephen P Hoole A1 Colin Berry A1 Divaka Perera YR 2019 UL http://heart.bmj.com/content/105/20/1536.abstract 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.