Prof Chris P Gale Profile picture
Aug 19, 2020 18 tweets 4 min read Read on X
~1/2 patients undergoing coronary angiography for known or suspected #angina have nonobstructed epicardial coronary arteries, & microvascular angina &/or vasospastic angina may be relevant by ⁦@ColinBerryMD
@JACCJournalsinterventions.onlinejacc.org/content/13/16/…
Patients with symptoms of ischaemia with nonobstructive coronary arteries (INOCA) can have treatable coronary vasomotion disorders.
Epicardial & microvascular vasospasm may cause #heartattack with no obstructive coronary artery disease & and type 2 MI.
Invasive physiological testing (functional coronary angiography) helps exclude, diagnose & treat these conditions.
Image
‘... in an undifferentiated population of patients undergoing invasive management during daily practice, an interventional diagnostic procedure empowers cardiologists to make the correct diagnosis with linked therapy’
Coronary angiography is the standard-of-care test for identifying obstructive CAD either by anatomic imaging using noninvasive computed tomographic coronary angiography (CTCA) or invasive coronary angiography
Yet, invasive coronary angiography has a spatial resolution of approximately 0.5 mm, & evaluation is determined by subjective visual interpretation.
The limited spatial resolution of angiography does not allow visualization of the resistance arterioles (20 to 400 μm) that largely govern myocardial blood flow
Patients with undiagnosed chest pain (including those who have undergone cardiac investigations) are at increased risk for cardiovascular events for at least 5 years.
#Women with #angina appear to be particularly burdened by symptoms & morbidity even after reassuringly “normal” findings on invasive coronary angiography.
An increasing proportion of patients who undergo invasive coronary angiography have not undergone functional stress testing, meaning that information on ischemia is often lacking at the time of anatomic testing with either invasive or noninvasive angiography.
This gap presents new challenges for decision making in patients with INOCA.
Coronary vascular function reflects contributions from the epicardial conduit coronary arteries, its intramyocardial branches, and the microcirculation.
Image
The coronary sinus reducer stent (which is being researched) aims to induce a controlled increase in coronary sinus blood pressure, thereby increasing retrograde myocardial perfusion to reduce the propensity to myocardial ischemia. Clinical evidence from RCTs is awaited.
Potential (future/theoretical) indications include: Image
Read the full (freely available) review here @JACCJournals interventions.onlinejacc.org/content/13/16/…

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More from @cpgale3

Sep 28, 2020
This nationwide complete analysis of all adult deaths in #England & #Wales has found that the #COVID pandemic has resulted in an abrupt inflation in acute #cardiovascular deaths above that expected for the time of year. heart.bmj.com/content/early/…
That is, about 2000 additional deaths over a 4 month period.
Nearly half of the deaths occurred outside of the #hospital setting, either at #home or in #carehomes.
Read 23 tweets
Sep 23, 2020
Emerging data from @PHE_uk suggests a synergistic detrimental effect of co-infection with #SARS_CoV_2 & #flu viruses. The preprint (not peer reviewed) article is available here medrxiv.org/content/10.110…
‘The risk of testing positive for #SARS_CoV_2 was 68% lower among #influenza positive cases, suggesting possible pathogenic competition between the two viruses.’
However, ‘Patients with a coinfection had a risk of death of 5.92 (95% CI, 3.21-10.91) times greater than among those with neither influenza nor SARS-CoV-2 suggesting possible synergistic effects in coinfected individuals.’
Read 7 tweets
Sep 20, 2020
Advances in #cancer treatment have improved clinical outcomes, leading to an increasing population of cancer survivors. Yet, this success is associated with high rates of short‐ & long‐term #cardiovascular toxicities. The Cancer Patient and Cardiology onlinelibrary.wiley.com/doi/abs/10.100…
The number & variety of #cancer drugs & #cardiovascular toxicity types make long‐term care a complex undertaking.
This requires a multidisciplinary approach including expertise from #oncology, #cardiology, & other related specialties, & has led to the development of the cardio‐oncology subspecialty.
Read 10 tweets
Sep 20, 2020
The rise in admissions with #COVID19 does not mean that you shouldn’t attend hospital if you have a medical emergency #heartattack Image
During the first peak, admissions with #heartatrack declined & was of grave concern : COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England @TheLancet thelancet.com/journals/lance…
Yet, hospitals provided high quality care for those who did attend: Patient response, treatments and mortality for acute myocardial infarction during the COVID-19 pandemic @ESC_Journals #EHJQCCO academic.oup.com/ehjqcco/advanc…
Read 6 tweets
Sep 19, 2020
Subsequent to #Surgisphere, all @TheLancet journals will now introduce additional peer-review requirements for papers based on large, real-world #datasets. thelancet.com/journals/lance…
@TheLancet journals now require all #research papers, irrespective of method, to include a data-sharing statement that details what #data will be shared, whether additional documents will be shared, when data will become available & by what access criteria data will be shared.
All @TheLancet journals will now introduce additional peer-review requirements for papers based on large, real-world datasets.
Read 10 tweets
Sep 19, 2020
Patients with mitral annular disjunction present with frequent premature ventricular contractions; in this study, one-third had ventricular arrhythmias & one-tenth had severe arrhythmic events. @JACCJournals onlinejacc.org/content/72/14/…
A total of 82 (71%) patients reported #palpitations, 47 (41%) patients reported previous pre-syncope, 40 (34%) had ventricular arrhythmia, 15 (13%) had experienced #syncope, & 14 (12%) patients had experienced a severe arrhythmic event prior to inclusion
Mitral valve prolapse was present in 90 (78%) patients
Read 10 tweets

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