Determining the Physiological Threshold for Angina (ORBITA-FIRE): A Double-Blind, Randomized, Placebo-Controlled Study
BACKGROUND: ) at rest and during exercise remain undefined. METHODS: values were recorded at symptom onset. The protocol was repeated during low- and high-intensity exercise to assess changes in angina thresholds with increasing cardiac workload. RESULTS: >0.999). CONCLUSIONS: ) are highly individualized, vary with cardiac workload, and are consistently lower than the universal ischemia-based thresholds used to guide revascularization. These findings support integrating personalized, symptom-linked physiology to refine patient selection and to improve symptomatic response to PCI.
Authors
- Shah Mohdnazri (ORCID: https://orcid.org/0000-0002-6055-5361)
- Sannidhya Misra (ORCID: https://orcid.org/0000-0002-5442-5659)
- Rupert Williams
- Klio Konstantinou
- Florentina Simader (ORCID: https://orcid.org/0000-0002-5329-6525)
- Jason N. Dungu (ORCID: https://orcid.org/0000-0002-6086-6813)
- Henry Seligman (ORCID: https://orcid.org/0000-0002-4244-860X)
- Jehangir Din (ORCID: https://orcid.org/0000-0003-4146-7769)
- James C. Spratt
- Krzysztof Macierzanka (ORCID: https://orcid.org/0009-0007-9021-4334)
- Gerald Clesham
- Peter Haworth (ORCID: https://orcid.org/0009-0004-2762-0127)
- Danqi Wang
- Sukhjinder S. Nijjer
- Matthew J. Shun-Shin
- James P. Howard
- Daniel Knight
- Darrel P. Francis (ORCID: https://orcid.org/0000-0002-3410-0814)
- Kayla Chiew (ORCID: https://orcid.org/0000-0002-9694-2494)
- Shayna Chotai (ORCID: https://orcid.org/0000-0002-6823-7309)
- Frank E. Harrell (ORCID: https://orcid.org/0000-0002-8271-5493)
- Fiyyaz Ahmed-Jushuf
- Christopher A. Rajkumar (ORCID: https://orcid.org/0000-0002-0086-1113)
- Tushar Kotecha (ORCID: https://orcid.org/0000-0003-0059-4817)
- Jonathan Hinton (ORCID: https://orcid.org/0000-0003-1670-5550)
- Peter D. O’Kane (ORCID: https://orcid.org/0000-0001-5245-4547)
- Thomas R. Keeble (ORCID: https://orcid.org/0000-0001-8695-7994)
- Rasha K. Al-Lamee (ORCID: https://orcid.org/0000-0003-3752-5532)
- Michael J. Foley (ORCID: https://orcid.org/0000-0002-0330-5542)
- John R. Davies (ORCID: https://orcid.org/0000-0003-2693-5114)
Institutions
- Dorset HealthCare University NHS Foundation Trust (GB)
- Imperial College Healthcare NHS Trust (GB)
- Royal Free London NHS Foundation Trust (GB)
- Vanderbilt University (US)
- St George’s University Hospitals NHS Foundation Trust (GB)
- Portsmouth Hospitals NHS Trust (GB)
- Lung Institute (US)
- Essex Cardiothoracic Centre (GB)
- University College London (GB)
- Anglia Ruskin University (GB)
Publication Details
- Journal
- Circulation
- Published
- 2026-05-08
- DOI
- https://doi.org/10.1161/circulationaha.125.078738
- Primary Topic
- Cardiac Imaging and Diagnostics
- Type
- article
- Field-Weighted Citation Impact
- 0.00