American heart journal · 2026
Enhancing invasive coronary function testing: Multivessel assessment of coronary microvascular dysfunction in patients with angina and no obstructive coronary artery disease (ANOCA).
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Tzoumas Andreas, Tapp Danielle N, Ashokprabhu Namrita, Schmidt Christian W, Kaur Sukhleen, Carnesi Jane, Hanycz Claire, Lakhia Evan, Davis Jacob T, Wilson Kamryn, Baker Audrey, Almanzar Anibelky, Zhang Jenny, Mahbub Elnaz, Rai Somesh, Mohan Ayushi, Quesada Odayme, Henry Timothy D
Аннотация
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.
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.