Test for diagnosis and treatment of angina 'flawed'
Sunday 09 June 2013
A commonly used test for diagnosis and treatment of angina is flawed in at least a quarter of cases when used on its own, a leading heart specialist claimed today.
The condition, which is characterised by a painful tightening of the chest when a build-up of fatty substances blocks or interrupts the blood supply to the heart, is diagnosed using coronary angiography.
These are X-rays taken via tubes which are put in the wrist or groin to inject dye into the coronary arteries to highlight narrowings. This is considered the “gold standard” method for diagnosing angina.
But Professor Nick Curzen, a consultant cardiologist at Southampton General Hospital, said angiograms would be more accurate if combined with a pressure wire to assess the severity of blockages at the diagnostic stage after 200 angina patients were examined in a study in 10 locations across the UK.
Used in conjunction with angiography, the additional test, known as fractional flow reserve (FFR), would allow doctors to choose the most appropriate management plan for their patients, which could be medical management, the insertion of a stent (angioplasty) or coronary artery bypass graft surgery.
The tiny wire, which is passed into individual major arteries to measure pressure within the vessel, gives a precise reading of whether blood flow is significantly restricted through the coronary artery, which is vital in deciding if the artery needs either a stent or surgery.
In the study, Prof Curzen found more than a quarter (26%) of stable heart disease patients would have had the wrong treatment plan based on angiogram alone.
The findings could be important because coronary artery disease is the most common cause of angina and heart attacks and responsible for 82,000 deaths in the UK every year.
As part of the project, cardiologists performed diagnostic angiograms on the patients with stable chest pain and drew up their treatment plans based on the initial assessment before leaving the room to allow a second cardiologist to carry out the pressure test.
Results were shared with each patient's original doctor - those who performed the initial angiograms - to give them an opportunity to see if the additional information would alter their decisions.
In 26% of the 200 cases, the management plan changed after the cardiologist had seen the FFR information and further analysis showed the pressure wire measurement changed cardiologists' opinion on whether individual coronary arteries had “significant” narrowings in almost a third of vessels (32%).
“Although this was a proof-of-concept study, the results indicate management of patients with stable angina by angiogram alone is probably flawed and treatment would be much more tailored to the individual through routine use of a FFR pressure test at the diagnostic stage,” said Prof Curzen.
“Not only did we see a quarter of treatment plans change, decisions on the significance of a patient's disease changed in a third of patients following the inclusion of FFR information, which suggests there is real need for the specialty to rethink the most effective universal approach.”
Prof Curzen said a large randomised trial comparing angiography and FFR-guided assessment and management of patients with stable angina was needed to provide comprehensive data on cost as well as clinical outcomes.
He added: “We are now working with collaborators to design such a trial and attract funding for it and, if this large scale study is positive, it could lead to a major change in practice in this area of medicine.”
Life & Style blogs
YouTube star Loey Lane hits back at hateful comments about ‘fat girls in bikinis’ and how plus-size women promote obesity
Sugary drinks are killing 184,000 adults around the world every year, says study
The age of inactivity: How laziness is killing us
What do the emojis on Snapchat mean?
iPhone 7: Force Touch phones are being prepared for launch, say reports
- 1 Kim Jong-un shows off airport designed by architect he likely had executed
- 2 Michael Douglas regrets 'embarrassing' Catherine Zeta-Jones with oral sex comments
- 3 Tunisia hotel attack: Locals form 'human shield' to protect hotel from gunman Seifeddine Rezgui
- 4 Tunisian builder has been hailed a hero after knocking gunman to the ground with roof tiles
- 5 German ethics council calls for incest between siblings to be legalised by Government
£15000 per annum: Recruitment Genius: One of the largest hospitality companies...
£28000 - £32000 per annum: Recruitment Genius: As a result of significant cont...
£16575 - £19000 per annum: Recruitment Genius: An excellent opportunity is ava...
£30000 - £35000 per annum: Recruitment Genius: This leading and innovative con...