Diagnostic performance of exercise stress testing findings and coronary microvascular dysfunction in patients with angina with non-obstructive coronary artery disease
Authors' conclusion
Ischaemic ECG changes during EST performed immediately before invasive functional assessment demonstrated excellent diagnostic accuracy for identifying patients with CMD, particularly the structural endotype.
Study context
- Population
- Patients with angina with non-obstructive coronary artery disease (ANOCA) who underwent exercise stress testing (EST) prior to invasive coronary angiography with functional assessmentpatients with ANOCA enrolled
- Participants
- 117 patients
- Exposure
- EST findings against coronary microvascular dysfunction (CMD) by invasive functional assessment
- Outcome
- Prevalence of CMD under the three definitions
Main finding
As reported in the abstract
- The prevalence of CMD was similar under all three definitions
- Structural CMD was more common using microvascular resistance reserve (MRR) <3.0
Observational data: associations, not effects.
Further findings
Ischaemic ECG changes during EST for detecting CMD
- Diagnostic accuracy
- 86.3% (78.7-92.0%)
- Sensitivity
- 86.2% (68.3-96.1%)
- Specificity
- 86.4% (77.4-92.8%)
Exercise-induced chest discomfort for detecting CMD
- Diagnostic accuracy
- 76.1% (95% CI 67.3% to 83.5%)
- No additional value when added to ischaemic ECG changes
CMD endotype identified by EST
- EST preferentially identified structural CMD, while functional CMD was more frequently missed
Original publication
Diagnostic performance of exercise stress testing findings and coronary microvascular dysfunction in patients with angina with non-obstructive coronary artery disease. Heart. Published 27 August 2025. doi:10.
Summarised from the published abstract; every number is checked against it