Does symptom phenotype correlate with invasive indices of coronary microvascular dysfunction in patients with non-obstructive coronary artery disease?
Symptom assessment alone has limited reliability for detecting coronary microvascular dysfunction in patients with non-obstructive coronary artery disease, underscoring the need for objective physiological evaluation.
Study objective: To examine the relationship between coronary microvascular dysfunction (CMD) indices and chest pain presentation in patients with non-obstructive coronary artery disease (NOCA). Design and setting: Retrospective, single-center observational study. Participants: Patients with angiographically intermediate left anterior descending artery (LAD) stenosis and preserved epicardial physiology (fraction flow reserve, FFR >0.80), with no significant stenosis in vessels other than the LAD. Interventions: Invasive CMD assessment using coronary flow reserve (CFR), index of microcirculatory resistance (IMR), and myocardial resistance reserve (MRR). Main outcome measures: Associations between symptom phenotypes and physiological indices, and the diagnostic performance of symptom-based assessment for detecting CMD. Results: = 0.003), but not with IMR. Symptom-based assessment showed higher specificity than sensitivity across CMD definitions and performed best for impaired MRR (sensitivity 60.9 %, specificity 80.6 %). Functional CMD was observed even in asymptomatic patients. Conclusion: In patients with NOCA, coronary microvascular vasodilatory reserve varies according to symptom phenotype, highlighting the limited reliability of symptom assessment alone and underscoring the importance of objective physiological evaluation for characterizing CMD.
Matsumoto et al. (Thu,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: