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Ischemia during exercise stress testing, an indication of coronary vasomotor dysfunction?
Diantha J M Schipaanboord1, Tijn P J Jansen2, Luuk Scherpenhuijzen2
1Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
International Journal of Cardiology. Heart & Vasculature
|January 14, 2025
Summary
Exercise electrocardiographic stress testing (EST) is highly specific for diagnosing coronary vasomotor dysfunction (CVDys) in patients with angina and non-obstructive coronary artery disease. It is a valuable indicator for coronary artery spasm (CAS) and, to a lesser extent, for coronary microvascular dysfunction (CMD).
Area of Science:
- Cardiology
- Diagnostic Imaging
- Vascular Medicine
Background:
- Coronary microvascular dysfunction (CMD) may contribute to false positives in exercise stress testing (EST).
- Patients with angina and non-obstructive coronary artery disease (ANOCA) exhibit diverse coronary vasomotor dysfunction (CVDys), including coronary artery spasm (CAS) and CMD.
- The diagnostic utility of EST across the full spectrum of CVDys requires investigation.
Purpose of the Study:
- To evaluate the diagnostic value of exercise electrocardiographic stress testing (EST) for the entire spectrum of coronary vasomotor dysfunction (CVDys).
- To assess EST's accuracy in identifying specific endotypes of CVDys, namely coronary artery spasm (CAS) and coronary microvascular dysfunction (CMD).
Main Methods:
- Retrospective analysis of 105 patients who underwent coronary function testing (CFT) and EST.
- EST reports were reviewed, with ischemia defined by significant ST-segment depression.
- Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for CVDys and its endotypes.
Main Results:
- Of 105 patients, 22% experienced ischemia during EST. CVDys was diagnosed in 90%, with isolated CAS in 51 patients and CMD in 7.
- EST-induced ischemia demonstrated high specificity (100%) and PPV (100%) for overall CVDys.
- Specificity and PPV for CAS were high (94.4% and 95.5%, respectively), while for CMD, they were lower (85.5% and 59.1%, respectively).
Conclusions:
- Ischemia during EST is highly specific for diagnosing coronary vasomotor dysfunction (CVDys) in patients with ANOCA.
- EST serves as a reliable indicator for coronary artery spasm (CAS).
- EST is less specific but still valuable for identifying coronary microvascular dysfunction (CMD) in this patient group.
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