The Value of Post-Exercise Electrocardiography and Troponin I Serum Level in Women with Angina with Non Obstructive Coronary Artery Disease

Background: Angina with non-obstructive coronary artery disease (ANOCA) is increasingly recognized as a cause of chest pain. Post-exercise electrocardiography (ECG) and serum cardiac biomarkers such as troponin I may provide additional value in detecting myocardial ischemia and stratifying risk in this population. So, Our goal was to determine whether myocardial damage was present in women with non-obstructive CAD based on elevated troponin-I levels and how it related to coronary flow and left ventricular longitudinal strain. Methods: This prospective cohort study was conducted at department of Cardiology, Faculty of Medicine, Zagazig University on women presented for coronary angiography due typical angina chest pain and documented to have normal coronary or non-significant coronary stenosis. Post-exercise electrocardiography and troponin-I were measured in all patients. Results: In this study, women with subclinical systolic dysfunction (mean age 52.00±6.81 years) had higher diabetes prevalence (55.6% vs. 25.0%, p=0.036), greater basal DBP (p=0.023), higher peak HR (p=0.008), larger LAVI (33.64±6.42 vs. 28.30±7.37 mL/m², p=0.011), increased E/e′ ratio (13.36±3.99 vs. 9.77±4.70, p=0.007), and reduced GLS (14.22±1.48% vs. 21.10±2.22%, p < 0.001). Post-exercise hs-TnT was elevated (20.68±9.20 vs. 12.23±8.30 ng/L, p=0.002). Troponin increase predicted dysfunction (AUC=0.743, 95% CI: 0.594–0.859; cutoff >12.6 ng/L; sensitivity 70.37%, specificity 75.00%; p=0.0015). Conclusion: Subclinical systolic dysfunction in women with non-obstructive CAD is strongly linked to post-exercise troponin elevation, predicting dysfunction with good diagnostic accuracy. Integrating troponin testing with strain imaging enhances early detection, risk stratification, and timely management in women with angina and preserved ejection fraction.