Shetrit Aviel, Zornitzki Lior, Banai Ariel, Freund Ophir, Shamir Reut Amar, Ben-Shoshan Jeremy, Szekely Yishay, Arbel Yaron, Banai Shmuel, Konigstein Maayan
Department of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with the School of Medicine, Tel Aviv University, Israel.
Department of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with the School of Medicine, Tel Aviv University, Israel.
Cardiovasc Revasc Med. 2025 Feb;71:38-42. doi: 10.1016/j.carrev.2024.12.005. Epub 2024 Dec 19.
Angina with non-obstructive coronary artery disease (ANOCA) is commonly observed in patients with stable angina undergoing coronary angiography. Current guidelines recommend non-invasive stress testing as the first step in diagnosing coronary microvascular disease (CMD). This study aims to evaluate the diagnostic value of non-invasive stress testing in patients invasively diagnosed with CMD.
We conducted a retrospective analysis of prospectively collected data. Eligible subjects were patients with angina who underwent NIST evaluation (echocardiography/ electrocardiography stress test or single-photon emission computerized tomography) prior to coronary angiography. All patients underwent invasive evaluation of microvascular function, which included the assessment of Coronary Flow Reserve, Index of Microcirculatory Resistance, and Resistive Reserve Ratio.
Overall, 140 patients (77 women, 67 ± 10 y/o) underwent NIST evaluation prior to coronary angiography, of whom 81 % were positive for ischemia. There was no difference in the prevalence of positive NIST between patients with abnormal compared with normal microvascular function tested invasively (81 % vs 82 %, p = 0.94). The prevalence of CMD was similar between patients with positive versus negative NIST (51 % vs 50 %, p = 0.94). Among 114 patients with positive NIST, 56 (49.2 %) had normal microvascular function, regardless of the type of stress test used (p = 0.94), the suspected territory of ischemia (p = 0.15), or the estimated severity of the ischemia (p = 0.63).
Non-invasive stress testing may have a limited predictive value in the diagnosis of CMD in ANOCA patients. Larger prospective studies are required for better understanding of the role these tests in the diagnosis and definition of CMD.
在接受冠状动脉造影的稳定型心绞痛患者中，常观察到非阻塞性冠状动脉疾病（ANOCA）相关的心绞痛。当前指南推荐将无创性负荷试验作为诊断冠状动脉微血管疾病（CMD）的第一步。本研究旨在评估无创性负荷试验在经侵入性诊断为CMD的患者中的诊断价值。
我们对前瞻性收集的数据进行了回顾性分析。符合条件的受试者为在冠状动脉造影前接受过无创性负荷试验评估（超声心动图/心电图负荷试验或单光子发射计算机断层扫描）的心绞痛患者。所有患者均接受了微血管功能的侵入性评估，包括冠状动脉血流储备、微循环阻力指数和阻力储备比的评估。
总体而言，140例患者（77例女性，67±10岁）在冠状动脉造影前接受了无创性负荷试验评估，其中81%的患者缺血试验结果为阳性。经侵入性检测，微血管功能异常与正常的患者之间，无创性负荷试验阳性率无差异（81%对82%，p = 0.94）。无创性负荷试验结果阳性与阴性的患者之间，CMD的患病率相似（51%对50%，p = 0.94）。在114例无创性负荷试验结果阳性的患者中，56例（49.2%）微血管功能正常，无论使用的负荷试验类型（p = 0.94）、可疑缺血区域（p = 0.15）或估计的缺血严重程度（p = 0.63）如何。
无创性负荷试验在ANOCA患者CMD诊断中的预测价值可能有限。需要开展更大规模的前瞻性研究，以更好地了解这些试验在CMD诊断和定义中的作用。
