Feasibility and Impact of Invasive Coronary Function Testing in Ischemia and No Obstructive Coronary Arteries: A Single-Center Study

Q: What are the key findings of this study?

Coronary function testing significantly increased the use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers from 39.5% to 55.8% in patients with coronary microvascular disease at 30 days post-procedure.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Ischemia and no obstructive coronary arteries (INOCA) (n=71). Intervention: Coronary function testing (CFT). Primary outcome: Changes in medication use after coronary function testing (P = .008, p=.008).

Q: What does this research mean for the field?

Coronary function testing (CFT) is feasible and positively impacts medication management in patients with ischemia and no obstructive coronary arteries (INOCA). Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Deeksha N. Acharya; Yulith Roca Alvarez; Bruce Samuels; Janet Wei; Ana Iribarren; Galen Cook-Wiens; Paulina Skaff; Sachini Ranasinghe; Jenna Maughan; M Nakamura; Tarun Chakravarty; Aakriti Gupta; Babak Azarbal; C. Noel Bairey Merz; Martha Gulati

doi:10.1016/j.jscai.2026.104272

March 1, 2026Journal of the Society for Cardiovascular Angiography & InterventionsOpen Access

Feasibility and Impact of Invasive Coronary Function Testing in Ischemia and No Obstructive Coronary Arteries: A Single-Center Study

View Full Paper

Ask AI

Bookmark

Share

Key result

Coronary function testing linked to a ~41% increase in ACEi/ARB use for CMD.

P = .008
P=.008
n=71

Why the study?

Despite guideline support for coronary function testing to identify endotypes in suspected INOCA, its adoption remains limited.

Does invasive coronary function testing impact medication management in patients with suspected ischemia and no obstructive coronary arteries?

Key Points

To evaluate the procedural feasibility, safety, and diagnostic value of invasive coronary function testing (CFT) and determine its impact on subsequent medical therapy in patients with suspected ischemia and no obstructive coronary arteries (INOCA).
Conducted a single-center, prospective study between 2020 and 2025 evaluating 71 patients undergoing clinically indicated CFT.
Collected 71 postprocedure surveys from 5 interventional cardiologists to evaluate preparation, lab support, procedural ease, and diagnostic value.
Categorized CFT results into coronary microvascular disease (CMD), vasospastic angina (VA), mixed disease (MD), or no vasomotor diagnosis, and compared medication classes between baseline and 30-day follow-up.
Interventional cardiologists rated preparation, training, procedural ease, and diagnostic value as above average in 98% of surveys, with an average procedure time of 19 minutes, 7 seconds.
Adverse events occurred in 10 of 71 (14%) procedures, of which 90% were brief, self-limited, and required no intervention.
Endotype distribution comprised 60.6% CMD, 26.8% VA, and 22.5% MD; CMD patients had significant increases in ACE-I/ARB use (39.5% to 55.8%, P = .008) and statin use (53.5% to 65.1%, P = .02), whereas VA patients had an increase in calcium channel blocker use (68.4% to 89.5%, P = .10).

Study Design

Type

Observational (n=71)

Multicenter

No

Structured PICO

Does invasive coronary function testing impact medication management in patients with suspected ischemia and no obstructive coronary arteries?

P

Population

71 patients with suspected ischemia and no obstructive coronary arteries (INOCA) defined as <50% stenosis on coronary angiography, mean age 56.6, 71.8% women.

I

Intervention

Invasive coronary function testing (CFT) with adenosine and acetylcholine to identify INOCA endotypes (coronary microvascular disease, vasospastic angina, mixed disease, or no vasomotor diagnosis) to guide medical therapy.

C

Comparator

Baseline medication use prior to coronary function testing.

O

Outcome

Feasibility of CFT (assessed via interventionalist surveys, procedural time, and adverse events) and impact on medication management at 30 days post-CFT.

Main Result

Effect estimate: P = .008

Absolute Event Rate: 55.8% vs 39.5%

p-value: p=.008

Invasive coronary function testing is feasible, safe, and leads to targeted medication changes in patients with suspected ischemia and no obstructive coronary arteries.

Limitations

Small sample size
Short-term follow-up
Single-center study
Slow enrollment due to COVID-19 and insurance denials
National shortage of acetylcholine
Lack of quality of life and angina symptom assessment

Implication

Supports coronary function testing to guide therapy in INOCA; reinforces guidelines and extends prior endotype evidence.

Abstract

Background:In patients with suspected ischemia and no obstructive coronary arteries (INOCA), coronary function testing (CFT) helps identify underlying endotypes.Despite guideline support, adoption of CFT remains limited.This study assessed the feasibility of CFT and its impact on medical management.Methods: This single-center, prospective study (2020-2025) evaluated CFT implementation and subsequent medication changes in patients with clinically indicated CFT.Interventional cardiologists completed postprocedure surveys rating CFT feasibility, preparation, lab support, and diagnostic value.CFT results were categorized into coronary microvascular disease (CMD), (coronary flow reserve <2.5 in response to adenosine and/or endothelial dysfunction indicated by abnormal epicardial coronary response to acetylcholine without evidence of ischemia); vasospastic angina (VA)-ischemic ECG changes with or without angina in response to acetylcholine together with either: (1) epicardial VA (>75% epicardial constriction), or (2) microvascular VA (<75% epicardial constriction); mixed disease (MD) (CMD and VA), and no vasomotor diagnosis (no CMD or VA).Medication use was compared at baseline and 30 days after CFT.Results: Five of the 10 interventional cardiologists completed 71 surveys.Overall, 98% rated preparation, training, procedural ease, and diagnostic value as "above average" and would recommend CFT to peers.Mean procedural time was 19 minutes, 7 seconds.There were 10 (14%) adverse events, of which 90% were self-limited.Among 71 patients, 60.6% had CMD, 26.8% VA, and 22.5% MD.CMD patients showed increased angiotensin converting enzyme inhibitor/angiotensin receptor blocker use (39.5% to 55.8%, P = .008)and statin use (53.5% to 65.1%, P = .02).VA patients had increased calcium channel blocker use (68.4% to 89.5%, P = .10).MD and no vasomotor diagnosis had no significant medication changes.Conclusions: CFT was rated highly for feasibility, safety, and clinical value by the interventional cardiologists.CFT appeared to impact the medication management of INOCA endotypes.

Discussion

No takes yet. Share an insight, caveat, or question.

Figures from the paper

Published by Journal of the Society for Cardiovascular Angiography & Interventions · CC BY-NC-ND

Cite This Study

Acharya et al. (2026) conducted an observational in Ischemia and no obstructive coronary arteries (INOCA) (n=71). Coronary function testing (CFT) was evaluated on Changes in medication use after coronary function testing (P = .008, p=.008). Coronary function testing significantly increased the use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers from 39.5% to 55.8% in patients with coronary microvascular disease at 30 days post-procedure.

synapsesocial.com/papers/69b3ab3c02a1e69014ccbe1d https://doi.org/10.1016/j.jscai.2026.104272

View Full Paper

Ask AI

Bookmark

Share

Feasibility and Impact of Invasive Coronary Function Testing in Ischemia and No Obstructive Coronary Arteries: A Single-Center Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Feasibility and Impact of Invasive Coronary Function Testing in Ischemia and No Obstructive Coronary Arteries: A Single-Center Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Keep reading

Keep reading