Angina test flawed according to leading heart specialist

When used on its own, a commonly used test for diagnosis and treatment of angina can be flawed, a leading heart specialist claimed today. The condition, characterized by a painful tightening of the chest when a build-up of fatty substances blocks the blood supply to the heart, is diagnosed using coronary angiography.

In the “gold standard” method to detect angina, X-rays taken via tubes which are put in the wrist or groin to inject dye into the coronary arteries to highlight narrowing. Professor Nick Curzen, a consultant cardiologist at Southampton General Hospital, feels angiograms would be more accurate if combined with a pressure wire to assess the severity of blockages at the diagnostic stage.

Used in conjunction with angiography, the additional test, known as fractional flow reserve (FFR), allows doctors to choose the most appropriate management plan for their patients, which could be medical management, the insertion of a stent (angioplasty) or coronary artery bypass graft surgery.

The tiny wire, passed into individual major arteries to measure pressure within the vessel, gives a precise reading of whether blood flow is significantly restricted through the coronary artery, vital in deciding if the artery needs a stent or surgery.

In the study, Prof Curzen found more than a quarter (26%) of stable heart disease patients would have had the wrong treatment plan based on angiogram alone. The findings could be important because coronary artery disease is the most common cause of angina and heart attacks and responsible for 82,000 deaths in the UK every year.

As part of the project, cardiologists performed diagnostic angiograms on the patients, drew up their treatment plans based on the initial assessment. A second cardiologist carried out the pressure test in 26 percent of the 200 cases, the management plan changed after the cardiologist had seen the FFR information.