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Updated: Mar 25, 2026

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Enhancing invasive coronary function testing: Multivessel assessment of coronary microvascular dysfunction in
Andreas Tzoumas1, Danielle N Tapp2, Namrita Ashokprabu2
1Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, OH; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH; Division of Cardiovascular Health and Disease, University of Cincinnati Medical Center, Cincinnati, OH.
Background:
Invasive coronary function testing (ICFT) is the gold standard for diagnosing coronary microvascular dysfunction (CMD) and is predominantly performed in the left anterior descending coronary artery (LAD). However, it is unclear whether multivessel testing has additional diagnostic yield.
Methods:
We analyzed a prospective registry of 231 patients with angina and no obstructive coronary artery disease (ANOCA) who underwent consecutive ICFT using the Doppler method in both the proximal LAD and the left circumflex (LCx) arteries for assessment of coronary flow reserve (CFR).
Results:
231 ANOCA patients with a median age of 59 (49,67) years were included in this analysis. ICFT with multivessel CFR assessment that included the LCx in addition to the LAD identified an additional 10% of patients with CMD (CFR ≤ 2.5) that would have been missed by LAD assessment only. Patients with multivessel CMD had statistically significant lower CFR in the LAD (1.9 vs 2.7, P < .001) and the LCx (1.9 vs 2.4, P < .001) compared to patients with single vessel CMD.
Conclusion:
Among ANOCA patients ICFT with multivessel CFR assessment identified an additional 10% of patients with CMD only seen in the LCx. Future studies are needed to elucidate the role of multivessel CMD assessment in the management of patients with ANOCA.
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Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes