The October 25, 2022, Yale Cardiovascular Medicine Grand Rounds, “Seeing the Invisible: Ischemia and No Obstructive Coronary Artery Disease,” was presented by Samit Shah, MD, PhD, assistant professor of medicine and director of VA Connecticut Cardiac Catheterization Laboratory.
Shah, an interventional cardiologist, conducts research related to coronary interventions, which includes both long-term outcomes investigations and physiology research related to non-atherosclerotic causes of chest pain.
INOCA (ischemia and no obstructive coronary artery disease) is a common, but often overlooked ischemic heart disease typically caused by coronary vascular dysfunction. Shah shared the rationale for a pilot study of stable patients with INOCA. The goal of the prospective, multicenter, registry called DISCOVER INOCA is to better understand the causes of shortness of breath, chest pain, and other well-recognized symptoms of a heart attack in people who don't have cholesterol blockages in their blood vessels.
Shah received the Wendy U. and Thomas C. Naratil Pioneer Award from Women's Health Research at Yale for his efforts to improve the diagnosis of women with ischemia who show no evidence of obstructive coronary artery disease.
“Patients can present with unstable angina and Non-ST-elevation myocardial infarction (NSTEMI), and the term is myocardial infarction or heart attack and non-obstructive coronary artery disease. INOCA is frequently due to coronary dysfunction, coronary artery spasm, myocardial bridges, or other disorders of ordinary physiology,” he said. “Whereas MI with non-obstructive coronary arteries (MINOCA) is due to plaque rupture, plaque erosion, and other potential underlying causes such as cardiomyopathies.”
Shah concluded his presentation by adding that there have been tremendous technological advances over the last few decades. For example, coronary angiogram, a procedure in which a catheter is used to inject an X-ray dye directly into the heart’s blood vessels was developed in 1958. He added: “We're just beginning to understand the prognostic value of invasive physiology testing.”
We're just beginning to understand the prognostic value of invasive physiology testing.
Samit Shah, MD, PhD
To learn more about Shah’s research, watch the recording on YouTube.