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Updated: Sep 10, 2025

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function

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Diagnostic performance of exercise stress testing findings and coronary microvascular dysfunction in patients with

Tsung-Ying Tsai1,2, Ali Aldujeli1,3,4, Ayman Haq5

  • 1CORRIB Research Centre for Advanced Imaging and Core Lab, University of Galway, Galway, Ireland.

Heart (British Cardiac Society)
|August 27, 2025
PubMed

Insights

Exercise stress testing (EST) accurately identifies coronary microvascular dysfunction (CMD), especially structural CMD. Ischaemic ECG changes during EST are highly sensitive and specific for diagnosing CMD in patients with angina and non-obstructive coronary artery disease.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Imaging

Background:

  • Coronary microvascular dysfunction (CMD) is prevalent in angina with non-obstructive coronary artery disease (ANOCA) patients, impacting clinical outcomes.
  • Exercise stress testing (EST) shows high specificity for CMD detection, but its link to specific CMD endotypes and invasive parameters is unclear.

Purpose of the Study:

  • To investigate the diagnostic accuracy of EST findings for CMD in ANOCA patients.
  • To correlate EST results with invasive physiological parameters and identify CMD endotypes.

Main Methods:

  • A prospective cohort study of 117 ANOCA patients undergoing EST before invasive coronary angiography.
  • Functional assessment included coronary flow reserve (CFR), index of microvascular resistance (IMR), and microvascular resistance reserve (MRR).
  • CMD was classified using MRR <3.0, CFR <2.5, or CFR <2.0/IMR ≥25; diagnostic accuracy of EST findings was evaluated.

Main Results:

  • Ischaemic ECG changes during EST demonstrated 86.3% diagnostic accuracy for CMD (86.2% sensitivity, 86.4% specificity).
  • Exercise-induced chest discomfort had 76.1% accuracy but provided no added value with ECG changes.
  • EST preferentially identified structural CMD, while functional CMD was often missed.

Conclusions:

  • Ischaemic ECG changes during EST are highly accurate for detecting CMD in ANOCA patients.
  • EST is particularly effective for identifying the structural endotype of CMD prior to invasive assessment.
Abstract

Keywords:
BiomarkersCarotid Artery DiseasesCohort StudiesMicrovascular Angina

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