The Quo Vadis for COVADIS Diagnostic Criteria.

Abstract

The Coronary Vasomotor Disorders International Study group (COVADIS) developed the diagnostic criteria for vasospastic angina and microvascular angina more than 8 years ago. This article critically reappraises these criteria (Latin: quid fecisti - what has been done) and proposes the strategies for their advancement (Latin: Quo Vadis - where are you are going?). Although the criteria have some limitations, they remain relevant considering their multifaceted clinical perspective including the presence of symptoms, myocardial ischaemia and objective evidence of coronary vasomotor dysfunction. To improve the criteria, the following strategic directions (Quo Vadis) are proposed, (1) optimising invasive functional coronary angiography assessment - the benchmark diagnostic investigation for coronary vasomotor disorders, (2) diagnosing mixed macrovascular and microvascular coronary vasomotor disorders, (3) advancing non-invasive coronary vasomotor assessment methods, (4) linking coronary vasomotor disorder criteria to clinical outcomes, (5) evaluating coronary vasomotor disorders in the presence of obstructive coronary artery disease, and (6) global partnering of coronary vasomotor disorder initiatives in national networks and patient forums. These strategies will improve the diagnostic approaches to coronary vasomotor disorders thereby facilitating the evolution of the COVADIS Diagnostic Criteria and thus management of these elusive disorders.