Combined assessment using angiography and D-SPECT diagnosed microvascular dysfunction (caIMR 40.6, global CFR 2.18) in a 69-year-old female with INOCA, enabling targeted therapy and symptom relief.
Case Report (n=1)
Integrating coronary angiography-derived physiological indices with D-SPECT provides a comprehensive framework for diagnosing and managing coronary microvascular dysfunction in patients with INOCA.
Ischemia with non-obstructive coronary artery disease (INOCA) is frequently driven by coronary microvascular dysfunction (CMD) but remains difficult to diagnose using conventional angiography alone. A 69-year-old female presented with typical chest pain. Coronary angiography (CAG) revealed no stenosis ≥ 50%, with slow flow in the right coronary artery (RCA). Functional assessment showed a coronary angiography-derived fractional flow reserve (caFFR) of 0.97 and a coronary angiography-derived index of microcirculatory resistance (caIMR) of 40.6 in the RCA. Cadmium-zinc-telluride single-photon emission computed tomography (D-SPECT) showed normal myocardial perfusion (summed stress score SSS = 0, summed difference score SDS = 0), while global coronary flow reserve (CFR) was 2.18 (left anterior descending LAD: 1.78, left circumflex LCX: 2.69, RCA: 2.46), indicating impaired microcirculatory function. The combined assessment established a framework integrating coronary anatomical, left ventricle (LV) function, and CMD. This approach enabled individualized pharmacological treatment targeting microcirculation and anti-ischemia therapy, resulting in symptomatic relief. This strategy precisely reveals ischemic mechanisms in the absence of significant stenosis, optimizing diagnosis, treatment, and prognostic assessment.
Wang et al. (2026) conducted a case report in Ischemia with non-obstructive coronary artery disease (INOCA) (n=1). Combined assessment using coronary angiography (caFFR, caIMR) and D-SPECT was evaluated. Combined assessment using angiography and D-SPECT diagnosed microvascular dysfunction (caIMR 40.6, global CFR 2.18) in a 69-year-old female with INOCA, enabling targeted therapy and symptom relief.