Key result
Among 726 women with suspected CAD undergoing cardiac SPECT, 17.2% had true myocardial perfusion defects, of which 56.0% had no epicardial atherosclerosis on angiography, indicating INOCA.
Why the study?
In women with perfusion defects on SPECT, many have no obstructive CAD (INOCA), and INOCA endotypes are rarely correctly diagnosed, leaving patients without tailored therapy.
What is the prevalence of INOCA versus obstructive CAD in women with suspected CAD and perfusion defects on SPECT?
Observational (n=726)
No
What is the prevalence of INOCA versus obstructive CAD in women with suspected CAD and perfusion defects on SPECT?
A single-center registry demonstrates that over half of women with suspected CAD and perfusion defects on SPECT have INOCA, emphasizing the need for invasive microvascular testing.
Supports considering INOCA in women with SPECT defects; this Level 3 cohort leaves open whether routine microvascular testing improves outcomes.
Background and objectives: Myocardial perfusion imaging with cardiac single-photon emission tomography (SPECT) is widely available for the detection of coronary artery disease (CAD) with high diagnostic and prognostic accuracy for women. A large proportion of symptomatic women with true myocardial perfusion defects in SPECT referred to coronary angiography have an absence of CAD—a condition named INOCA (ischemia with nonobstructive CAD). Additionally, the INOCA endotypes are rarely correctly diagnosed, and therefore, no tailored therapy is prescribed. Materials and methods: The cardiac SPECT for women was performed from 2018 to 2021. Patients with perfusion defect were analyzed according to further prescribed diagnostic tests used to diagnose CAD. According to the diagnostic criteria, patients with INOCA were selected as candidates for invasive microvascular physiology measurements. The correlation was calculated between SPECT results and clinical characteristics, symptoms, and risk factors. Results: A total of 726 women with suspected CAD were analyzed. True myocardial perfusion defects were detected in 125 patients (17.2%). During coronary angiography in 70 (56.0%) women, atherosclerosis in epicardial arteries was not observed. In 17 (20.9%) patients, obstructive CAD was present. Correlation was found between perfusion defect in SPECT and cardiovascular risk factors, including overweight, obesity, arterial hypertension, and dyslipidemia. Women with typical angina were more likely to have INOCA, but with “noncardiac” symptoms—CAD. In total, 68 female patients met three inclusion criteria for INOCA and were selected as candidates for invasive diagnostic testing. Conclusions: The created registry proves the important role of cardiac SPECT and great need for the development of invasively detected physiological measurements. The combination of both interventions could significantly change the future directions for INOCA patients, improving treatment strategies and clinical outcomes, especially knowing the number of risk factors and varying clinical presentation. The study will be continued by performing invasive testing of coronary microvascular function to expand the competence about what is known about INOCA patients.
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Vītola et al. (2022) conducted an observational in Suspected coronary artery disease (n=726). Cardiac single-photon emission tomography (SPECT) was evaluated on True myocardial perfusion defects. Among 726 women with suspected CAD undergoing cardiac SPECT, 17.2% had true myocardial perfusion defects, of which 56.0% had no epicardial atherosclerosis on angiography, indicating INOCA.
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