TY - JOUR
T1 - The role of non-invasive stress testing in the diagnosis of coronary microvascular disease
AU - Shetrit, Aviel
AU - Zornitzki, Lior
AU - Banai, Ariel
AU - Freund, Ophir
AU - Shamir, Reut Amar
AU - Ben-Shoshan, Jeremy
AU - Szekely, Yishay
AU - Arbel, Yaron
AU - Banai, Shmuel
AU - Konigstein, Maayan
N1 - Publisher Copyright:
© 2024 Elsevier Inc.
PY - 2025
Y1 - 2025
N2 - Background: Angina with non-obstructive coronary artery disease (ANOCA) is commonly observed in patients with stable angina undergoing coronary angiography. Current guidelines recommend non-invasive stress testing as the first step in diagnosing coronary microvascular disease (CMD). This study aims to evaluate the diagnostic value of non-invasive stress testing in patients invasively diagnosed with CMD. Methods: We conducted a retrospective analysis of prospectively collected data. Eligible subjects were patients with angina who underwent NIST evaluation (echocardiography/ electrocardiography stress test or single-photon emission computerized tomography) prior to coronary angiography. All patients underwent invasive evaluation of microvascular function, which included the assessment of Coronary Flow Reserve, Index of Microcirculatory Resistance, and Resistive Reserve Ratio. Results: Overall, 140 patients (77 women, 67 ± 10 y/o) underwent NIST evaluation prior to coronary angiography, of whom 81 % were positive for ischemia. There was no difference in the prevalence of positive NIST between patients with abnormal compared with normal microvascular function tested invasively (81 % vs 82 %, p = 0.94). The prevalence of CMD was similar between patients with positive versus negative NIST (51 % vs 50 %, p = 0.94). Among 114 patients with positive NIST, 56 (49.2 %) had normal microvascular function, regardless of the type of stress test used (p = 0.94), the suspected territory of ischemia (p = 0.15), or the estimated severity of the ischemia (p = 0.63). Conclusion: Non-invasive stress testing may have a limited predictive value in the diagnosis of CMD in ANOCA patients. Larger prospective studies are required for better understanding of the role these tests in the diagnosis and definition of CMD.
AB - Background: Angina with non-obstructive coronary artery disease (ANOCA) is commonly observed in patients with stable angina undergoing coronary angiography. Current guidelines recommend non-invasive stress testing as the first step in diagnosing coronary microvascular disease (CMD). This study aims to evaluate the diagnostic value of non-invasive stress testing in patients invasively diagnosed with CMD. Methods: We conducted a retrospective analysis of prospectively collected data. Eligible subjects were patients with angina who underwent NIST evaluation (echocardiography/ electrocardiography stress test or single-photon emission computerized tomography) prior to coronary angiography. All patients underwent invasive evaluation of microvascular function, which included the assessment of Coronary Flow Reserve, Index of Microcirculatory Resistance, and Resistive Reserve Ratio. Results: Overall, 140 patients (77 women, 67 ± 10 y/o) underwent NIST evaluation prior to coronary angiography, of whom 81 % were positive for ischemia. There was no difference in the prevalence of positive NIST between patients with abnormal compared with normal microvascular function tested invasively (81 % vs 82 %, p = 0.94). The prevalence of CMD was similar between patients with positive versus negative NIST (51 % vs 50 %, p = 0.94). Among 114 patients with positive NIST, 56 (49.2 %) had normal microvascular function, regardless of the type of stress test used (p = 0.94), the suspected territory of ischemia (p = 0.15), or the estimated severity of the ischemia (p = 0.63). Conclusion: Non-invasive stress testing may have a limited predictive value in the diagnosis of CMD in ANOCA patients. Larger prospective studies are required for better understanding of the role these tests in the diagnosis and definition of CMD.
KW - Angina
KW - CMD
KW - Evaluation
KW - Interventional cardiology
KW - Microvascular
KW - Non-invasive
UR - http://www.scopus.com/inward/record.url?scp=85213958764&partnerID=8YFLogxK
U2 - 10.1016/j.carrev.2024.12.005
DO - 10.1016/j.carrev.2024.12.005
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C2 - 39753394
AN - SCOPUS:85213958764
SN - 1553-8389
JO - Cardiovascular Revascularization Medicine
JF - Cardiovascular Revascularization Medicine
ER -