Merz CNB, Beltrame JF, Berry C, Boden WE, Camici PG, Crea F, Hochman JS, Kaski JC, O'Gara PT, Ong P, Pepine CJ, Shimokawa H, Sechtem U, and Stone GW
Study Objective: The Coronary Vasomotor Disorders International Study Group (COVADIS) invited leading experts to address strategies to enhance our clinical understanding of INOCA with an emphasis on the management of coronary vasomotor disorders., Design: Under-recognition of coronary vasomotor disorders, distinguishing different presentations of angina due to vasospasm and/or abnormal microvascular vasodilatation, developing invasive/non-invasive testing and treatment protocols, integrating diagnostic protocols into cardiologists' workflow and trials to inform guideline development were identified as key knowledge gaps and will be briefly addressed in this Viewpoint article., Setting: Virtual international meeting., Participants: Leading international experts in ischemic heart disease with no obstructive coronary artery disease., Interventions: None., Main Outcome Measures: None., Results: Topics discussed include: 1. Obstructive epicardial disease, functional vasospasm and microvascular disorders; 2. Under-recognition of coronary vasomotor disorders in clinical practice; 3. Complexity of coronary vasomotor disorders; 4. Understanding different presentations - vasospastic disease and microvascular angina; 5. Invasive/noninvasive testing and treatment protocols for vasospasm and microvascular angina assessment; 6. Treatment challenges; 7. Integrating diagnostic protocols into cardiologists' workflow; 8. The path forward to advance our approach to managing myocardial ischemia., Conclusions: Obstructive epicardial disease, functional vasospasm and microvascular disorders often co-exist and contribute to myocardial ischemia. Under-recognition, the complexity of coronary vasomotor disorders, understanding different presentations, testing and treatment protocols, treatment challenges, and integrating diagnostic protocols into cardiologists' workflow all contribute to the path forward to advance our management of myocardial ischemia for improved patient outcomes., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Pepine receives funding support from the National Center for Advancing Translational Sciences under the University of Florida Clinical and Translational Sciences award UL1TR001427. Bairey Merz, Beltrame, Boden, Camici, Kaski, O'Gara and Pepine report no relevant financial disclosures. Berry reports he is employed by the University of Glasgow which holds consultancy and/or research agreements with Abbott Vascular, AstraZeneca, Boehringer Ingelheim, Farmaceutica, GlaxoSmithKline, HeartFlow, Menarini Opsens, Philips and Siemens Healthcare. Crea reports he received speaker fees from Amgen, AstraZeneca, Bristol-Myers Squibb and Servier and serves on an advisory board for GlyCardial Diagnostics. Hochman reports she received research support from Abbott, Amgen, Arbor Pharmaceuticals, AstraZeneca, Medtronic, Merck Sharpe and Dohme, Omron, St. Jude Medical and Volcano. Ong reports he has received speaker honoraria from Bayer Healthcare, Pfizer, Philips and Volcano. Sechtem reports he has in the past 3 years received speaker honoraria from Abbott, Amgen, AstraZeneca, Pfizer and Servier. Shimokawa reports he received research support from the Japan Heart Foundation. Stone reports he receives speaker honoraria from Cook; consults for Abiomed, Ablative Solutions, Ancora, Cardiomech, Gore, HeartFlow, Miracor, Neovasc, Robocath, TherOx, Valfix and Vectorious; and has equity/options from Ancora, Applied Therapeutics, Aria, Biostar family of funds, Cagent, Cardiac Success, Orchestra Biomed, Qool Therapeutics, SpectraWave and Valfix., (© 2021 The Authors.)