The Complex and Incomplete Relationship Between Exercise Stress Testing and Coronary Microvascular Dysfunction

“These findings have significant implications for the way in which we view the diagnostic accuracy of all non-invasive tests. Should all non-invasive modalities now be validated against the contemporary reference standard of comprehensive coronary physiology assessment? This study has far-reaching implications as it may make a currently difficult to diagnose condition far easier to identify and, subsequently, treat. These hypotheses warrant further randomized trials to answer them.”

“We went in with the hypothesis that a good proportion of patients who have an abnormal exercise test but unobstructed coronary arteries would have some microvascular dysfunction.... What I didn't expect was that every patient who had an abnormal exercise test turned out to have microvascular dysfunction—that was really surprising.”