Key result
Combined angiography and D-SPECT enables targeted therapy and symptom relief in an INOCA case.
Why the study?
INOCA is frequently driven by coronary microvascular dysfunction but remains difficult to diagnose using conventional angiography alone.
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.
May support nuclear imaging for CMD in INOCA beyond angiography alone; leaves open broader adoption pending prospective validation.
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.
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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.
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