The Treatment of Stable Angina – Pressure Wires

When reading through November’s issue of the BMJ, I came across an editorial entitled, ‘Assessing flow limitation in stable angina’. While admittedly, the first time I read it it made very little sense to me, after a little research and a couple of rereads, the adaptation of cardiology services in order to make the advances in the assessment of stable angina accurate became increasingly apparent.

Stable angina occurs when the heart muscle is deprived from blood and consequently oxygen, and causing uncomfortable pain in the chest, occasionally neck, shoulders and back. It’s the term used to describe discomfort due to coronary heart disease. [1]

As stated in the BMJ, currently stable angina is assessed using an initial angiographic assessment, although studies have shown that flow limitation can be accurately assessed by using a pressure wire to measure the fractional flow reserve. This is because stable angina is often caused by the narrowing of arteries, for instance, this may be due to the build up of fat or cholesterol, or a blood clot.

With such advances in the assessment of stable angina, it became clear to me, that the issue in implementing the use of a pressure wire is widely due to the amount of interventional cardiologists within the UK – around 740. With an estimated 247,000 angiograms completed annually, it currently does not seem to be feasible to implement the use of a pressure wire, as it requires the immediate option of stenting, incase a problem arises.

However, there are huge advantages in the use of a pressure wire. Not all lesions reduce blood flow, some are merely present with no impact on the flow of blood towards the heart, or around the body. Angiograms do not currently make it clear which of these lesions is disruptive. Currently, the measurement of fractional flow reserve, what I understand to be the ratio of distal (situated away from the centre of the body) to proximal pressures (pressures near to the centre of the body) is the only measure which assesses both multiple lesions and vessels. What could this mean? That those people with lesions which reduce blood flow could receive treatment quickly, and those with lesions with no impact on blood flow do not need to undertake the risk of surgery.

This article showed me that the new treatment provides the opportunity to specify the treatment of stable angina further, potentially reducing the amount of patients who go under the knife and thus undergo the risks of surgery. However, it presents new issues in terms of resources and the numbers of cardiologists able to complete the procedure – highlighting again the necessity of adapting cardiology departments, and increasing the numbers of medical professionals.

Sources: [1] and The BMJ November Issue


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