Developments and New Insights in Coronary Physiology and Microvascular Disease

Chest pain caused by ischaemic heart disease is one of most common medical presentations. Whilst anatomical assessment of coronary arteries remains important and necessary, it is increasingly recognised the significance of coronary disease is not determined just by the degree of luminal stenosis but also the extent of ischaemia. Coronary physiology with pressure wire (PW) based assessment of coronary ischaemia has become the cornerstone for guiding revascularisation however, despite the wealth of evidence, in a survey in 2014, operators still made decisions on 71% of cases based on angiography alone and selected PW in only 21% of cases. Furthermore, 39% of patients with angina do not have obstructive coronary disease on coronary angiography. Many of these patients may have Ischaemia with non-obstructive (<50% stenosis) coronary arteries (INOCA). INOCA is not benign and carries increased risks of mortality, morbidity and recurrent admissions with repeat coronary angiograms and associated healthcare costs.

This Research Topic will improve the understanding of coronary physiology especially new developments and technologies that would improve utilisation in the catheter lab and provide new insights in the understanding of the mechanisms and treatment of microvascular disease and INOCA. Led by a team of subject experts, this Research Topic will explore the field of coronary physiology from both the invasive and non-invasive community.

Sub-themes for this Research Topic may include, but are not limited to:
1) New developments or technology in invasive or non-invasive coronary physiology.
2) Methods or insights to improve utilization of coronary physiology.
3) Mechanisms of microvascular disease.
4) Diagnosis and treatment of INOCA.