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Updated: Jun 12, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Diagnostic Yield and Clinical Utility of Coronary Angiography Versus Coronary Function Testing in Women With Angina
Natasha Cigarroa1, Nida Latif2, Marah Maayah3
1Yale New Haven Hospital New Haven New Haven CT.
Insights
Coronary function testing (CFT) in women with angina and nonobstructive coronary arteries yields specific diagnoses in over 80% of cases. This contrasts with coronary angiography alone, which primarily provides an anatomic diagnosis, leading to improved antianginal therapy management.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Many women referred for invasive coronary angiography present with angina and nonobstructive coronary arteries.
- This group often has underlying coronary microvascular dysfunction, vasospastic angina, or other vasomotor disorders.
- The diagnostic yield of current invasive methods in this population requires further real-world evaluation.
Purpose of the Study:
- To assess the diagnostic yield of invasive coronary angiography (CA) versus coronary function testing (CFT) in women with angina and nonobstructive coronary arteries.
- To compare the rates of specific vasomotor disorder diagnoses between CA alone and CFT.
- To evaluate the impact of diagnostic strategy on subsequent antianginal therapy management.
Main Methods:
- A cohort of 198 women with angina and nonobstructive coronary arteries were enrolled between 2018 and 2023.
- Participants underwent either coronary angiography (CA) alone (n=99) or coronary function testing (CFT; n=99).
- Diagnostic findings and medication changes were compared between the two groups.
Main Results:
- Coronary angiography alone identified nonobstructive coronary artery disease in 79% of cases, while CFT identified specific vasomotor disorders in 82% of women.
- Diagnoses via CFT included coronary microvascular dysfunction (27%), vasospastic angina (32%), and mixed disorders (16%).
- Women undergoing CFT showed significantly more frequent medication changes and intensification of antianginal therapy, including increased calcium channel blocker use.
Conclusions:
- Coronary angiography alone provides an anatomic diagnosis but misses functional vasomotor disorders common in women with angina.
- Coronary function testing offers a specific diagnosis for over 80% of these women, enabling targeted treatment.
- CFT leads to more effective management and intensification of antianginal therapy compared to CA alone.
Background:
Approximately 50% of women referred for invasive coronary angiography have angina and nonobstructive coronary arteries, which includes coronary microvascular dysfunction, vasospastic angina, and other vasomotor disorders. We sought to determine the real-world diagnostic yield of invasive coronary angiography and coronary function testing in women with angina and nonobstructive coronary arteries.
Methods And Results:
From 2018 to 2023, we enrolled 198 women who underwent either coronary angiography (CA) alone (n=99) or coronary function testing (CFT; n=99). Mean±SD age was 62±10 years (CA alone) compared with 57±10 years (CFT). Coronary angiography was interpreted as nonobstructive coronary artery disease more frequently after CA alone (79% versus 52%). Of the women who underwent CFT, 82% (N=81) were found to have vasomotor disorders, including coronary microvascular dysfunction (27%), vasospastic angina (32%), mixed coronary microvascular dysfunction/vasospastic angina (16%), endothelial dysfunction (10%; without spasm), elevated resting flow (2%), or symptomatic myocardial bridging (4%). Compared with women undergoing CA alone, medications were changed more frequently after CFT at 24 hours (41% versus 65%; P=0.001) and between 24 hours and 30 days (30% versus 44%; P=0.04) with intensification of antianginal therapy (79% versus 92%; P<0.0001) and increased use of calcium channel blockers (36% versus 63%; P<0.0001).
Conclusions:
Our findings demonstrate that women presenting with suspected ischemic heart disease undergoing CA alone only received an anatomic diagnosis, whereas >80% of women undergoing CFT received a specific diagnosis of a coronary vasomotor disorder and greater intensification of antianginal therapy.
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