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Lack of correlation between noninvasive stress tests and invasive coronary vasomotor dysfunction in patients with

Andrew Cassar1, Panithaya Chareonthaitawee, Charanjit S Rihal

  • 1Department of Internal Medicine, Mayo College of Medicine, Rochester, MN 55905, USA.

Circulation. Cardiovascular Interventions
|December 25, 2009
PubMed

Insights

Noninvasive stress tests have limited accuracy in detecting coronary vasomotor dysfunction in patients with nonobstructive coronary artery disease. A negative stress test does not rule out this condition, indicating a need for invasive assessment.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Imaging

Background:

  • Many patients with normal coronary angiograms exhibit abnormal coronary vasomotor responses.
  • The diagnostic capability of noninvasive stress tests for coronary vasomotor dysfunction in nonobstructive coronary artery disease is not well-established.

Purpose of the Study:

  • To evaluate the accuracy of noninvasive stress tests in predicting coronary vasomotor dysfunction in patients with nonobstructive coronary artery disease.

Main Methods:

  • Retrospective analysis of 376 patients with nonobstructive coronary artery disease who underwent invasive coronary vasomotor assessment and noninvasive stress testing.
  • Coronary vasomotor dysfunction defined by response to acetylcholine and adenosine.
  • Sensitivity and specificity of exercise ECG, stress echocardiography, and stress nuclear imaging were determined.

Main Results:

  • Coronary vasomotor dysfunction was present in 63% of patients.
  • Noninvasive stress tests showed limited diagnostic accuracy: 41% sensitivity and 57% specificity for overall dysfunction.
  • Exercise ECG was more specific but less sensitive than imaging tests.

Conclusions:

  • Negative noninvasive stress tests do not exclude coronary vasomotor dysfunction in symptomatic patients with nonobstructive coronary artery disease.
  • Invasive assessment or novel, more sensitive noninvasive imaging is necessary for accurate diagnosis.
Abstract

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