Characterising disease mechanisms in coronary microvascular disease
Research type
Research Study
Full title
Characterising disease mechanisms in patients with coronary microvascular disease
IRAS ID
288132
Contact name
Divaka Perera
Contact email
Sponsor organisation
King's College London
Duration of Study in the UK
2 years, 11 months, 31 days
Research summary
Angina is the term used to describe chest pain that is caused by an imbalance between the supply and demand of blood to the heart muscle. The coronary circulation supplies the heart muscle with its blood supply and is made up of large arteries (visible on a special x-ray test called an angiogram) and small arteries (the microvasculature, not visible on an angiogram). Up to 30% of patients with angina have no detectable narrowings in their large arteries but have disease of the small arteries; this is known as coronary microvascular disease (CMD). CMD is associated with poor quality of life, adverse clinical outcomes and an increased cost to the healthcare and social system. It is now possible to assess the small arteries using special techniques during an angiogram. Using these techniques, our group has shown that there may be two distinct subtypes of CMD. Patients with either subtype suffer from an inability to dilate their small arteries in response to stress; this leads to a supply:demand mismatch, leading to angina. However, they have distinct differences in their disease mechanisms.
In this study, we will investigate the disease mechanisms underlying the different CMD subtypes using coronary angiogram with special small vessel assessment. We will test our hypothesis of whether one of the CMD subtypes have an inability to augment their blood flow due to dysfunction of enzymes that normally lead to dilation of small arteries. We will also test the utility of our disease characterisation in predicting response to common antianginal therapy in patients with angina and small vessel disease; therefore, assessing the clinical translation of our catheter lab based measurements.
This study will provide a better understanding of the mechanisms that lead to CMD. This knowledge can be used to develop novel therapeutic targets in the future.
REC name
London - Bromley Research Ethics Committee
REC reference
20/LO/1294
Date of REC Opinion
17 Dec 2020
REC opinion
Further Information Favourable Opinion