Multivessel Coronary Function Testing Increases Diagnostic Yield in Patients With Angina and Nonobstructive Coronary Arteries
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Updated: Jun 26, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Rajan Rehan1, Christopher C Y Wong2, James Weaver1
1Royal Prince Alfred Hospital, Sydney, Australia.
Insights
Multivessel invasive coronary function testing (CFT) significantly increases the diagnosis of coronary vasomotor dysfunction in patients with angina and nonobstructive coronary arteries (ANOCA) compared to single-vessel testing.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Interventional Cardiology
Background:
- Invasive coronary function testing (CFT) is standard for diagnosing coronary vasomotor dysfunction in angina with nonobstructive coronary arteries (ANOCA).
- Current practice often limits CFT to the left coronary circulation, leaving the diagnostic yield of multivessel testing unknown.
Purpose of the Study:
- To compare the diagnostic yield of multivessel versus single-vessel invasive CFT in ANOCA patients.
- To evaluate the effectiveness of assessing multiple coronary territories for diagnosing coronary vasomotor dysfunction.
Main Methods:
- Systematic performance of multivessel CFT in suspected ANOCA patients.
- Acetylcholine provocation for vasoreactivity testing in left and right coronary arteries.
- Utilized a pressure-temperature sensor guidewire for coronary physiology assessment across all three epicardial vessels.
Main Results:
- Multivessel CFT diagnosed significantly more patients with coronary vasomotor dysfunction (86.3% vs 68.8%), coronary artery spasm (60.0% vs 47.5%), and coronary microvascular dysfunction (CMD) (62.5% vs 36.3%) compared to single-vessel CFT.
- Coronary artery spasm occurred in the left system but isolated right coronary spasm was noted in 20.8% of cases.
- CMD was prevalent (62.5%) and distributed similarly across all three major coronary vessel territories (LAD, LCx, RCA).
Conclusions:
- Multivessel CFT demonstrates a higher diagnostic yield in ANOCA patients compared to single-vessel testing.
- These findings support the inclusion of multivessel CFT in the management strategy for ANOCA patients.
Background:
Invasive CFT is the gold standard for diagnosing coronary vasomotor dysfunction in patients with ANOCA. Most institutions recommend only testing the left coronary circulation. Therefore, it is unknown whether testing multiple coronary territories would increase diagnostic yield.
Objectives:
The aim of this study was to evaluate the diagnostic yield of multivessel, compared with single-vessel, invasive coronary function testing (CFT) in patients with angina and nonobstructive coronary arteries (ANOCA).
Methods:
Multivessel CFT was systematically performed in patients with suspected ANOCA. Vasoreactivity testing was performed using acetylcholine provocation in the left (20 to 200 μg) and right (20 to 80μg) coronary arteries. A pressure-temperature sensor guidewire was used for coronary physiology assessment in all three epicardial vessels.
Results:
This multicenter study included a total of 228 vessels from 80 patients (57.8 ± 11.8 years of age, 60% women). Compared with single-vessel CFT, multivessel testing resulted in more patients diagnosed with coronary vasomotor dysfunction (86.3% vs 68.8%; P = 0.0005), coronary artery spasm (60.0% vs 47.5%; P = 0.004), and CMD (62.5% vs 36.3%; P < 0.001). Coronary artery spasm (n = 48) predominated in the left coronary system (n = 38), though isolated right coronary spasm was noted in 20.8% (n = 10). Coronary microvascular dysfunction (CMD), defined by abnormal index of microcirculatory resistance and/or coronary flow reserve, was present 62.5% of the cohort (n = 50). Among the cohort with CMD, 27 patients (33.8%) had 1-vessel CMD, 15 patients (18.8%) had 2-vessel CMD, and 8 patients (10%) had 3-vessel CMD. CMD was observed at a similar rate in the territories supplied by all 3 major coronary vessels (left anterior descending coronary artery = 36.3%, left circumflex coronary artery = 33.8%, right coronary artery = 31.3%; P = 0.486).
Conclusions:
Multivessel CFT resulted in an increased diagnostic yield in patients with ANOCA compared with single-vessel testing. The results of this study suggest that multivessel CFT has a role in the management of patients with ANOCA.
