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Diagnosis of patients with angina and non-obstructive coronary disease in the catheter laboratory

Research output: Contribution to journalReview article

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Diagnosis of patients with angina and non-obstructive coronary disease in the catheter laboratory. / Rahman, Haseeb; Corcoran, David; Aetesam-Ur-Rahman, Muhammad; Hoole, Stephen P.; Berry, Colin; Perera, Divaka.

In: Heart (British Cardiac Society), Vol. 105, No. 20, 10.2019, p. 1536-1542.

Research output: Contribution to journalReview article

Harvard

Rahman, H, Corcoran, D, Aetesam-Ur-Rahman, M, Hoole, SP, Berry, C & Perera, D 2019, 'Diagnosis of patients with angina and non-obstructive coronary disease in the catheter laboratory', Heart (British Cardiac Society), vol. 105, no. 20, pp. 1536-1542. https://doi.org/10.1136/heartjnl-2019-315042

APA

Rahman, H., Corcoran, D., Aetesam-Ur-Rahman, M., Hoole, S. P., Berry, C., & Perera, D. (2019). Diagnosis of patients with angina and non-obstructive coronary disease in the catheter laboratory. Heart (British Cardiac Society), 105(20), 1536-1542. https://doi.org/10.1136/heartjnl-2019-315042

Vancouver

Rahman H, Corcoran D, Aetesam-Ur-Rahman M, Hoole SP, Berry C, Perera D. Diagnosis of patients with angina and non-obstructive coronary disease in the catheter laboratory. Heart (British Cardiac Society). 2019 Oct;105(20):1536-1542. https://doi.org/10.1136/heartjnl-2019-315042

Author

Rahman, Haseeb ; Corcoran, David ; Aetesam-Ur-Rahman, Muhammad ; Hoole, Stephen P. ; Berry, Colin ; Perera, Divaka. / Diagnosis of patients with angina and non-obstructive coronary disease in the catheter laboratory. In: Heart (British Cardiac Society). 2019 ; Vol. 105, No. 20. pp. 1536-1542.

Bibtex Download

@article{3c94c14261f649cda2f11cffadfee00a,
title = "Diagnosis of patients with angina and non-obstructive coronary disease in the catheter laboratory",
abstract = "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.",
keywords = "cardiac catheterization and angiography, chronic coronary disease, quality and outcomes of care",
author = "Haseeb Rahman and David Corcoran and Muhammad Aetesam-Ur-Rahman and Hoole, {Stephen P.} and Colin Berry and Divaka Perera",
year = "2019",
month = oct,
doi = "10.1136/heartjnl-2019-315042",
language = "English",
volume = "105",
pages = "1536--1542",
journal = "Heart",
issn = "1355-6037",
publisher = "BMJ Publishing Group Ltd",
number = "20",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Diagnosis of patients with angina and non-obstructive coronary disease in the catheter laboratory

AU - Rahman, Haseeb

AU - Corcoran, David

AU - Aetesam-Ur-Rahman, Muhammad

AU - Hoole, Stephen P.

AU - Berry, Colin

AU - Perera, Divaka

PY - 2019/10

Y1 - 2019/10

N2 - 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.

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.

KW - cardiac catheterization and angiography

KW - chronic coronary disease

KW - quality and outcomes of care

UR - http://www.scopus.com/inward/record.url?scp=85072717018&partnerID=8YFLogxK

U2 - 10.1136/heartjnl-2019-315042

DO - 10.1136/heartjnl-2019-315042

M3 - Review article

C2 - 31366574

AN - SCOPUS:85072717018

VL - 105

SP - 1536

EP - 1542

JO - Heart

JF - Heart

SN - 1355-6037

IS - 20

ER -

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