TY - JOUR
T1 - Refractory Angina
T2 - From Pathophysiology to New Therapeutic Nonpharmacological Technologies
AU - Gallone, Guglielmo
AU - Baldetti, Luca
AU - Tzanis, Georgios
AU - Gramegna, Mario
AU - Latib, Azeem
AU - Colombo, Antonio
AU - Henry, Timothy D.
AU - Giannini, Francesco
N1 - Funding Information:
The authors thank Viola Ranotti for her outstanding illustration sketches.
Publisher Copyright:
© 2020
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2020/1/13
Y1 - 2020/1/13
N2 - Despite optimal combination of guideline-directed anti-ischemic therapies and myocardial revascularization, a substantial proportion of patients with stable coronary artery disease continues to experience disabling symptoms and is often referred as “no-option.” The appraisal of the pathways linking ischemia to symptom perception indicates a complex model of heart-brain interactions in the generation of the subjective anginal experience and inspired novel approaches that may be clinically effective in alleviating the angina burden of this population. Conversely, the prevailing ischemia-centered view of angina, with the focus on traditional myocardial revascularization as the sole option to address ischemia on top of medical therapy, hinders the experimental characterization and broad-scale clinical implementation of strongly needed therapeutic options. The interventionist, often the first physician to establish the diagnosis of refractory angina pectoris (RAP) following coronary angiography, should be aware of the numerous emerging technologies with the potential to improve quality of life in the growing population of RAP patients. This review describes the current landscape and the future perspectives on nonpharmacological treatment technologies for patients with RAP, with a view on the underlying physiopathological rationale and current clinical evidence.
AB - Despite optimal combination of guideline-directed anti-ischemic therapies and myocardial revascularization, a substantial proportion of patients with stable coronary artery disease continues to experience disabling symptoms and is often referred as “no-option.” The appraisal of the pathways linking ischemia to symptom perception indicates a complex model of heart-brain interactions in the generation of the subjective anginal experience and inspired novel approaches that may be clinically effective in alleviating the angina burden of this population. Conversely, the prevailing ischemia-centered view of angina, with the focus on traditional myocardial revascularization as the sole option to address ischemia on top of medical therapy, hinders the experimental characterization and broad-scale clinical implementation of strongly needed therapeutic options. The interventionist, often the first physician to establish the diagnosis of refractory angina pectoris (RAP) following coronary angiography, should be aware of the numerous emerging technologies with the potential to improve quality of life in the growing population of RAP patients. This review describes the current landscape and the future perspectives on nonpharmacological treatment technologies for patients with RAP, with a view on the underlying physiopathological rationale and current clinical evidence.
KW - cell therapy
KW - coronary sinus reducer
KW - enhanced external counterpulsation
KW - extracorporeal shockwave myocardial revascularization
KW - neuromodulation
KW - refractory angina
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U2 - 10.1016/j.jcin.2019.08.055
DO - 10.1016/j.jcin.2019.08.055
M3 - Review article
C2 - 31918927
AN - SCOPUS:85076677834
VL - 13
SP - 1
EP - 19
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
SN - 1936-8798
IS - 1
ER -