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Updated: Jun 28, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
From chest pain to coronary functional testing: Clinical and economic impact of coronary microvascular dysfunction
Ilan Merdler1, Ryan Wallace1, Andrew P Hill1
1Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
Insights
Diagnosing coronary microvascular dysfunction (CMD) involves a lengthy patient journey with multiple tests and high costs. Early CMD diagnosis can reduce emergency visits, procedures, and healthcare expenses.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Medicine
Background:
- Coronary microvascular dysfunction (CMD) diagnosis via functional testing reduces cardiovascular events and angina.
- Patients with CMD experience a complex diagnostic journey from initial chest pain to diagnosis.
Purpose of the Study:
- To investigate the patient journey from chest pain onset to coronary microvascular dysfunction diagnosis.
- To analyze the diagnostic process, healthcare utilization, and costs associated with CMD.
Main Methods:
- Analysis of data from the Coronary Microvascular Disease Registry (CMDR) including 61 patients with CMD.
- Evaluation of time to diagnosis, emergency department visits, hospitalizations, and diagnostic tests.
- Estimation of total healthcare costs per patient.
Main Results:
- Median time from chest pain to CMD diagnosis was 0.62 years, involving numerous tests and emergency visits.
- Many patients underwent invasive procedures like left heart catheterization without functional testing.
- Significant healthcare utilization included referrals to other specialties and substantial costs (~$2000/patient).
Conclusions:
- Timely identification of CMD is crucial for symptom relief.
- Prompt diagnosis can decrease emergency department visits, cardiovascular testing, and invasive procedures.
- Early CMD diagnosis leads to reduced healthcare expenses.
Background:
Coronary functional testing to formally diagnose coronary microvascular dysfunction (CMD) reduces cardiovascular events and alleviates angina. This study aims to investigate the extensive and complex journey that patients with CMD undergo, from the onset of chest pain to eventual diagnosis.
Methods:
Data from the Coronary Microvascular Disease Registry (CMDR) were analyzed, including information on the date of first documentation of chest pain, number of non-invasive and invasive tests the patient underwent, emergency department visits, and hospitalizations. In addition, we estimated the total cost per patient. A total of 61 patients with CMD diagnosis were included in this analysis.
Results:
Most patients in our cohort were older than 50 years of age. The median time from initial chest pain symptoms to diagnosis was 0.62 (interquartile range [IQR]: 0.06-2.96) years. During this period, patients visited the emergency department a median of 1.0 (IQR: 0.0-2.0) times. Diagnostic tests included 3.0 (IQR: 2.0-6.0) electrocardiograms, 3.0 (IQR: 0.0-6.0) high-sensitivity troponin tests, and 1.0 (IQR: 1.0-2.0) echocardiograms. Prior to diagnosis of CMD, 13 (21.3 %) patients had left heart catheterization without coronary functional testing. Non-invasive testing for ischemia was conducted in 43 (70.5 %) patients. Alternative non-cardiac diagnoses were given to 11 (18.0 %) patients during the diagnostic process, with referrals made to gastroenterology for 16 (26.2 %) and pulmonology for 10 (16.4 %) patients. The cost was almost $2000/patient.
Conclusion:
Timely identification of CMD offers promising opportunities for prompt symptom alleviation, accompanied by reduced visits to the emergency department, cardiovascular testing, invasive medical procedures, and consequently reduced healthcare expenses.
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