TY - JOUR JO - EuroIntervention TI - The functional assessment of patients with non-obstructive coronary artery disease: expert review from an international microcirculation working group AB - <p class="text-1er-paragraph">Symptomatic non-obstructive coronary artery disease (NOCAD) is an increasingly recognised entity that is associated with poor cardiovascular outcomes. Nearly half of those undergoing coronary angiography for appropriate indications, such as typical angina, or a positive stress test have no obstructive lesion. There are no guideline recommendations as to how to care properly for these patients. Physiologic assessment of the coronary arteries beyond two-dimensional angiography is not standardised, yet it can provide valuable information in patients presenting with typical angina in the setting of NOCAD. In this consensus document, we detail steps for the interventional cardiologist to evaluate the patient with symptomatic NOCAD in the cardiac catheterisation laboratory, first with the assessment of coronary flow reserve (CFR), and then with delineation of deficiencies in non-endothelium-dependent CFR (CFRne) versus endothelium-dependent CFR (CFRe) using provocative agents such as adenosine and acetylcholine, respectively, followed by the evaluation of smooth muscle function with nitroglycerine (NTG). Once the mechanism behind the anginal symptoms is established, one can identify the appropriate treatment strategies to address the physiologic deficiency that is present. Despite an established safety profile, a comprehensive assessment may be considered for selected patients which requires an understanding of the appropriate invasive evaluation by the practising interventional cardiologist when evaluating not only patients with obstructive CAD but also those with NOCAD.</p> AU - Widmer Robert J. AU - Samuels Bruce AU - Samady Habib AU - Price J. Matthew AU - Jeremias Allen AU - Anderson R. David AU - Jaffer A. Farouc AU - Escaned Javier AU - Davies E. Justin AU - Prasad Megha AU - Grines Cindy L. AU - Lerman Amir VL - 14 IS - 16 Y1 - 20/03/2019 Y1 - 2019 DOI - 10.4244/EIJ-D-18-00982 SP - 1694 EP - 1702 KW - coronary interventions KW - fractional flow reserve KW - miscellaneous KW - stable angina PB - Europa Digital & Publishing SE - CORONARY INTERVENTIONS UR - https://eurointervention.pcronline.com/article/the-functional-assessment-of-patients-with-non-obstructive-coronary-artery-disease-expert-review-from-an-international-microcirculation-working-group SN - 1774-024X ER -