Thread by @CardioOBDoc

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Very important descriptive study 👇 expanding our understanding of burden of #CMD + endothelial dysfunction in #INOCA (angina) by @TomJFord @ColinBerryMD
@CircIntv

⚡️ Let’s have a short #Tweetorial ⚡️

https://twitter.com/CoronaryDoc/status/1206041505430999042

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Pre-specified analysis of CorMicA
onlinejacc.org/content/72/23_…

Pts undergoing clinically indicated elective coronary angiography for angina & had definite (typical) or probable (atypical) angina based on Rose angina questionnaire

391 pts ➡ angiography:
47% #INOCA
53% #CAD

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✅ microvascular angina (MVA) = coronary microvascular dysfunction (#CMD) both endothelial independent (CFR/IMR) + endothelial dependent (ACh) (combined)

✅ vasospastic angina (VSA) = epicardial coronary endothelial dysfunction (ACh)

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Coronary vascular function (reactivity testing) was done (LAD only) in 151 of 185 #INOCA participants (74% 🙎‍♀️)

Abnl test 89%:
CMD only 51%
Endothelial dysfxn only 17%
Both 21%

Normal test 11% (non-cardiac CP)

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Quality of Life Differences between MVA & VSA:
VSA group had almost 20% lower overall angina summary score (SAQ) compared with MVA

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Take Home Message:

>1/3 of pts with symptom/signs of INOCA have identifiable disorders of coronary vasomotion including MVA and/or VSA

Traditional CV scores do not predict risk of these disorders

Pts with #INOCA have similar angina burden but worse QoL than obstructive CAD

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There is significant overlap between epicardial & microvascular dysfunction. We know this from at least 2 previous publications👇

However, this @CircIntv study is the first study covering all phenotypes of epicardial & microvascular dysfunction in setting of #INOCA

@ColinBerryMD @Michel_CorbanMD @ahmedalbadrimd #CircIntvJC
I believe prevalence of epi endo dysfn in this study may be underestimated because you used a very strict definition of >20% constriction to define it. While debatable, some use <0% constriction or even <20% vasodilation