Chest pain is one of the most common symptoms that prompt patients to seek medical attention. Often, patients and medical providers rush to look for blockages in the heart’s blood vessels, the coronary arteries, that could cause a heart attack. However, instead of blockages, women are equally likely to suffer from angina and nonobstructive coronary arteries (ANOCA), which is a condition that is characterized by the heart muscle not receiving adequate oxygen or blood supply due to problems with the regulation of blood flow to the heart muscle. Unlike coronary artery disease (or atherosclerosis), ANOCA occurs in the absence of cholesterol plaques that limit blood flow to the heart. Recent Yale research published in the Journal of the American Heart Association in September 2024 illuminates the changes in care that occur when women undergo advanced testing to get to the bottom of their heart problems.
This study, led by Samit Shah, MD, PhD, assistant professor of medicine (cardiovascular medicine), examined the diagnoses given to women with suspected ischemic heart disease who underwent routine care compared to advanced diagnostic testing, referred to as coronary function testing. The routine care group underwent invasive coronary angiography alone, which involves taking X-ray pictures of the blood vessels in the heart with contrast dye. Coronary function testing adds additional testing with pharmacologic stimuli and the use of a wire that is 14/1000ths of an inch in diameter to measure the pressure, flow, and resistance in the blood vessels.
The researchers found that women who solely underwent coronary angiography were more likely to receive a rudimentary description of the blood vessels, such as normal blood vessels or non-significant coronary artery disease. However, those who underwent combined coronary angiography with coronary function testing were more likely to receive a specific diagnosis such as coronary microvascular dysfunction, coronary vasospasm, myocardial bridging, or other diagnosis. The individuals who received a clear underlying diagnosis were more likely to receive medication changes immediately after their diagnosis and at 30 days during outpatient follow-up.
This study illuminates the utility of coronary function testing in women with suspected ischemic heart disease and ANOCA. The authors anticipate that increased use of coronary function testing will lead to more specific treatments for stable ischemic heart disease, which remains a leading cause of morbidity and mortality in women. Shah’s work was funded by Women’s Health Research at Yale, an interdisciplinary research center within Yale School of Medicine, to examine sex differences in cardiovascular disease.
To learn more, read the paper “Diagnostic Yield and Clinical Utility of Coronary Angiography Versus Coronary Function Testing in Women With Angina and Nonobstructive Coronary Arteries.”
Cigarroa N, Latif N, Maayah M, Khokhar A, Kunnirickal S, Schwann A, Maciejewski KR, Odanovic N, Mazure CM, Spatz E, Pfau S, Lansky A, Shah SM. Diagnostic Yield and Clinical Utility of Coronary Angiography Versus Coronary Function Testing in Women With Angina and Nonobstructive Coronary Arteries. J Am Heart Assoc. 2024 Oct;13(19):e035852. doi: 10.1161/JAHA.124.035852. Epub 2024 Sep 18. PMID: 39291500.