In the past, heart disease was defined and determined by the presence of atherosclerosis and obstruction of coronary arteries. Recent studies have challenged this notion, and a new consensus has emerged:
Patient prognosis is primarily determined by ischemia as opposed to atherosclerotic burden, and functional information is required to understand the potential benefit of planned intervention.
Compared to an obsolete standard of care that emphasizes anatomical disease alone, the detection and treatment of ischemia is vital in properly treating patients suffering from ischemic heart disease (IHD).
The diagnostic process and prognosis for these patients suspected of ischemia with no obstructed coronary arteries (INOCA) is measurably worse when compared to otherwise healthy patients.
The Evolving Role of Coronary Microvascular Dysfunction from CMD patients.
Angina and anginal equivalents remain common complaints among patients, but increasingly, functionally significant coronary lesions are not being found within the catheterization lab.
Our current standard of care, primarily focused on identifying angiographic evidence of obstructive epicardial disease, regrettably results in a significant number of "inconclusive" or "intermediate" findings in symptomatic patients.
Far too often, our care pathways treat patients based on our own clinical limitations, instead of the latest findings in clinical literature. Nowhere is that more the case than in our current clinical approach to ischemia.
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Detecting functionally significant ischemia is important, but doing so in clinical practice isn't always easy.
Odayme Quesada, MD
MD, MHS, FACC, FAHA Medical Director, The Christ Hospital Women’s Heart Center
