A Reminder That Stress Echocardiography Is Useful in Diagnosing Myocardial Ischemia in Nonobstructive Coronary Artery Disease: Case Series

Area of Science:

• Cardiology
• Diagnostic Imaging
• Physiology

Background:

• Ischemia identification is crucial for patients with atypical symptoms or coronary artery disease (CAD).
• Current imaging guidelines may not fully address microvascular dysfunction (MVD) in the absence of epicardial stenosis.
• Stress echocardiography (SE) is often not recommended for MVD assessment in these specific cases.

Observation:

• Three cases demonstrate the effectiveness of SE in identifying MVD.
• Mechanistic explanations are provided for SE's utility in these scenarios.
• SE identified MVD when traditional methods might be insufficient.

Findings:

• SE can detect microvascular dysfunction (MVD) in patients presenting with symptoms suggestive of ischemia.
• The study provides evidence that SE is a valuable tool for diagnosing MVD, even when epicardial coronary artery disease (CAD) is not evident.
• Mechanistic insights explain how SE reveals MVD.

Implications:

• Stress echocardiography (SE) should be reconsidered as a diagnostic tool for microvascular dysfunction (MVD).
• SE offers potential utility beyond diagnosing coronary artery disease (CAD) and pre-surgical evaluations.
• Clinicians should consider SE for patients with suspected MVD, particularly when epicardial stenosis is absent.