背景:功能性冠状动脉造影(FCA)用于内型表征(血管痉挛型心绞痛[VSA],冠状动脉微血管疾病或混合)建议在非阻塞性冠状动脉心绞痛患者中使用。虽然VSA和CMD有明确的诊断标准,没有标准化的FCA协议。测试方案的变化可能会限制测试的广泛采用,结果的概括性,以及合作研究的扩展。目前,没有描述整个地理区域的协议变化的数据。因此,我们旨在了解澳大利亚和新西兰目前在FCA方法中的实践差异,以改善冠状动脉血管舒缩障碍诊断的获取和标准化.
方法:在2022年7月至2023年7月之间,我们对澳大利亚和新西兰的所有中心进行了一项全国性调查,并实施了积极的FCA计划。该调查记录了澳大利亚和新西兰33家医院对FCA的态度以及用于诊断冠状动脉血管舒缩障碍的方案。
结果:调查来自33个中心的39名临床医生,澳大利亚所有州和地区以及新西兰南北群岛的中心都有代表。共有21个中心被确定为具有积极的FCA计划。总的来说,受访者认为全面的生理检查有助于指导临床管理.计划扩展的障碍包括成本,额外的导管实验室时间,以及缺乏商定的国家议定书。在整个临床场所,测试方案有很大差异,包括使用的技术(多普勒与热稀释),测试顺序(首先是高血病抵抗指数,首先是血管舒缩功能测试),乙酰胆碱给药的速率和剂量,临时起搏导线的常规使用,以及常规的单血管和多血管测试。总的来说,测试相对不经常进行,很少有后续的FCA表演,尽管几乎所有受访者都认为这在临床上有用。
结论:这项调查表明,第一次,FCA协议在整个两个国家的测试中心之间的变化。此外,虽然FCA被认为是临床重要的,测试的频率相对较低,很少或没有后续测试.制定和采用标准化的国家FCA协议可能有助于改善患者获得测试的机会,并促进澳大利亚和新西兰的进一步合作研究。
BACKGROUND: Functional coronary angiography (FCA) for endotype characterisation (vasospastic angina [VSA], coronary microvascular disease [CMD], or mixed) is recommended among patients with angina with non-obstructive coronary arteries. Whilst clear diagnostic criteria for VSA and CMD exist, there is no standardised FCA protocol. Variations in testing protocol may limit the widespread uptake of testing, generalisability of results, and expansion of collaborative research. At present, there are no data describing protocol variation across an entire geographic region. Therefore, we aimed to capture current practice variations in the approach to FCA to improve access and standardisation for diagnosis of coronary vasomotor disorders in Australia and New Zealand.
METHODS: Between July 2022 and July 2023, we conducted a national survey across all centres in Australia and New Zealand with an active FCA program. The survey captured attitudes towards FCA and protocols used for diagnosis of coronary vasomotor disorders at 33 hospitals across Australia and New Zealand.
RESULTS: Survey responses were received from 39 clinicians from 33 centres, with representation from centres within all Australian states and territories and both North and South Islands of New Zealand. A total of 21 centres were identified as having an active FCA program. In general, respondents agreed that comprehensive physiology testing helped inform clinical management. Barriers to program expansion included cost, additional catheter laboratory time, and the absence of an agreed-upon national protocol. Across the clinical sites, there were significant variations in testing protocol, including the technique used (Doppler vs thermodilution), order of testing (hyperaemia resistance indices first vs vasomotor function testing first), rate and dose of
acetylcholine administration, routine use of temporary pacing wire, and routine single vs multivessel testing. Overall, testing was performed relatively infrequently, with very little follow-on FCA performed, despite nearly all respondents believing this would be clinically useful.
CONCLUSIONS: This survey demonstrates, for the first time, variations in FCA protocol among testing centres across two entire countries. Furthermore, whilst FCA was deemed clinically important, testing was performed relatively infrequently with little or no follow-on testing. Development and adoption of a standardised national FCA protocol may help improve patient access to testing and facilitate further collaborative research within Australia and New Zealand.