Enhancing invasive coronary function testing: Multivessel assessment of coronary microvascular dysfunction in patients with angina and no obstructive coronary artery disease (ANOCA) - 30/04/26

Doi : 10.1016/j.ahj.2026.107429

Andreas Tzoumas, MD ^a,^b,^c, Danielle N. Tapp, PhD ^a,^b, Namrita Ashokprabhu, BS ^a,^b, Christian W. Schmidt, PhD ^a,^b, Sukhleen Kaur, BS ^a,^b, Jane Carnesi, BS ^a,^b, Claire Hanycz, BS ^a,^b, Evan Lakhia, BS ^a,^b, Jacob T. Davis, BA ^a,^b, Kamryn Wilson, BS ^a,^b, Audrey Baker, BS ^a,^b, Anibelky Almanzar, MD ^a,^b, Jenny Zhang, BA ^a,^b, Elnaz Mahbub, DO ^a,^b, Somesh Rai, MS ^a,^b, Ayushi Mohan, MD ^a,^b, Odayme Quesada, MD ^a,^b,^c,^⁎,^{^{#
Denotes co-senior authors.}} , Timothy D. Henry, MD ^a,^b,^{^{#
Denotes co-senior authors.}}

^a Women’s Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, OH

^b The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH

^c Division of Cardiovascular Health and Disease, University of Cincinnati Medical Center, Cincinnati, OH

^⁎ Reprint requests: Odayme Quesada MD, The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Health Network, 2123 Auburn Avenue Suite 424 Cincinnati, OH, 45219. The Carl and Edyth Lindner Center for Research and Education The Christ Hospital Health Network, 2123 Auburn Avenue Suite 424 Cincinnati OH 45219

ABSTRACT

Background

Invasive coronary function testing (ICFT) is the gold standard for diagnosing coronary microvascular dysfunction (CMD) and is predominantly performed in the left anterior descending coronary artery (LAD). However, it is unclear whether multivessel testing has additional diagnostic yield.

Methods

We analyzed a prospective registry of 231 patients with angina and no obstructive coronary artery disease (ANOCA) who underwent consecutive ICFT using the Doppler method in both the proximal LAD and the left circumflex (LCx) arteries for assessment of coronary flow reserve (CFR).

Results

231 ANOCA patients with a median age of 59 (49,67) years were included in this analysis. ICFT with multivessel CFR assessment that included the LCx in addition to the LAD identified an additional 10% of patients with CMD (CFR ≤ 2.5) that would have been missed by LAD assessment only. Patients with multivessel CMD had statistically significant lower CFR in the LAD (1.9 vs 2.7, P < .001) and the LCx (1.9 vs 2.4, P < .001) compared to patients with single vessel CMD.

Conclusion

Among ANOCA patients ICFT with multivessel CFR assessment identified an additional 10% of patients with CMD only seen in the LCx. Future studies are needed to elucidate the role of multivessel CMD assessment in the management of patients with ANOCA.

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