Clinical Effects of Supervised Cardiac Rehabilitation in Patients With Angina and Non-Obstructive Coronary Artery Disease and Impaired Myocardial Flow Reserve Assessed Using ¹³N-Ammonia Positron Emission Tomography

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Angina and non-obstructive coronary artery disease (ANOCA) with impaired myocardial flow reserve (n=29). Intervention: Supervised exercise-based cardiac rehabilitation vs. Non-complete cardiac rehabilitation. Primary outcome: Myocardial flow reserve (MFR) at 5 months (p=0.01).

Shiro Miura; Atsutaka Okizaki; Hiraku Kumamaru; Osamu Manabe; Chihoko Miyazaki; Takehiro Yamashita

doi:10.1253/circj.cj-24-0128

April 28, 2025Circulation JournalOpen Access

Clinical Effects of Supervised Cardiac Rehabilitation in Patients With Angina and Non-Obstructive Coronary Artery Disease and Impaired Myocardial Flow Reserve Assessed Using ¹³N-Ammonia Positron Emission Tomography

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Key result

Supervised CR linked to better myocardial flow reserve, symptoms, and exercise capacity in ANOCA.

P=0.01
n=29

Why the study?

The efficacy of exercise-based cardiac rehabilitation in patients with angina and non-obstructive coronary artery disease remains unclear.

Does a 5-month supervised exercise-based cardiac rehabilitation program improve myocardial flow reserve, symptom status, and exercise capacity in patients with ANOCA and impaired MFR?

Study Design

Type

Observational (n=29)

Multicenter

No

Structured PICO

Does a 5-month supervised exercise-based cardiac rehabilitation program improve myocardial flow reserve, symptom status, and exercise capacity in patients with ANOCA and impaired MFR?

P

Population

29 patients (median age 75, 52% female) with angina and non-obstructive coronary artery disease (ANOCA) and impaired myocardial flow reserve followed for 5 months.

E

Exposure

5-month supervised exercise-based cardiac rehabilitation (CR) program, including individualized aerobic exercise (20-30 min/day at anaerobic threshold) and resistance training, twice weekly.

C

Comparator

Non-complete CR group (patients who did not complete the CR program, median attendance 0%, receiving standard multidisciplinary guidance on ANOCA management).

O

Outcome

Change in myocardial flow reserve (MFR), symptom status (Seattle Angina Questionnaire-7), and exercise capacity (peak oxygen consumption) from baseline to 5-month follow-up.surrogate

Main Result

Absolute Event Rate: 2.09% vs 1.92%

p-value: p=0.01

Limitations

Single-center retrospective observational study with relatively small sample size
Selection bias as patients completing CR may adopt other healthy behaviors
Lack of information on changes in treatment regimens during follow-up
Did not fully investigate other definitions of coronary microvascular dysfunction
Defining the complete CR group can be challenging

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Implication

A 5-month supervised exercise-based cardiac rehabilitation program significantly improves myocardial flow reserve, exercise capacity, and angina symptoms in patients with ANOCA and impaired microvascular function.

Abstract

BACKGROUND: The efficacy of exercise-based cardiac rehabilitation (CR) in patients with angina and non-obstructive coronary artery disease (ANOCA) remains unclear. This study investigated whether a multidisciplinary CR program improves myocardial flow reserve (MFR), symptom status, and exercise capacity in patients with ANOCA. METHODS AND RESULTS: (P=0.27) in the non-complete CR group. CONCLUSIONS: The 5-month exercise-based CR significantly improved MFR, symptom status, and exercise capacity in patients with ANOCA and impaired MFR.

Discussion

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Cite This Study

Miura et al. (2025) conducted an observational in Angina and non-obstructive coronary artery disease (ANOCA) with impaired myocardial flow reserve (n=29). Supervised exercise-based cardiac rehabilitation vs. Non-complete cardiac rehabilitation was evaluated on Myocardial flow reserve (MFR) at 5 months (p=0.01). A 5-month supervised exercise-based cardiac rehabilitation program significantly improved myocardial flow reserve, symptom status, and exercise capacity in patients with angina and non-obstructive coronary artery disease.

synapsesocial.com/papers/6a20b7830379358411e51fae https://doi.org/10.1253/circj.cj-24-0128

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Clinical Effects of Supervised Cardiac Rehabilitation in Patients With Angina and Non-Obstructive Coronary Artery Disease and Impaired Myocardial Flow Reserve Assessed Using ¹³N-Ammonia Positron Emission Tomography

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Clinical Effects of Supervised Cardiac Rehabilitation in Patients With Angina and Non-Obstructive Coronary Artery Disease and Impaired Myocardial Flow Reserve Assessed Using ¹³N-Ammonia Positron Emission Tomography

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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