SC Connecticut News

Chest pain often leads patients to seek medical attention, with a focus on detecting blockages in coronary arteries. However, women are equally likely to experience angina and nonobstructive coronary arteries (ANOCA), where the heart muscle does not receive adequate oxygen or blood supply due to blood flow regulation issues. Unlike coronary artery disease, ANOCA occurs without cholesterol plaques obstructing blood flow.

Recent research from Yale, published in the Journal of the American Heart Association in September 2024, highlights changes in care for women undergoing advanced testing for heart problems. The study was led by Samit Shah, MD, PhD, assistant professor of medicine (cardiovascular medicine). It compared diagnoses given to women with suspected ischemic heart disease who received routine care versus those who underwent advanced diagnostic testing known as coronary function testing.

The routine care group had invasive coronary angiography alone, involving X-ray imaging of heart blood vessels using contrast dye. Coronary function testing includes additional tests with pharmacologic stimuli and uses a wire measuring 14/1000ths of an inch in diameter to assess pressure, flow, and resistance in blood vessels.

Researchers found that women who only underwent coronary angiography were more likely to receive general descriptions such as normal blood vessels or non-significant coronary artery disease. In contrast, those receiving combined coronary angiography and function testing were more likely to be diagnosed with conditions like coronary microvascular dysfunction or myocardial bridging. Patients with clear diagnoses were more likely to have medication adjustments immediately after diagnosis and at 30-day outpatient follow-ups.

This study underscores the value of coronary function testing for women with suspected ischemic heart disease and ANOCA. The authors anticipate that increased use will lead to more specific treatments for stable ischemic heart disease—a leading cause of morbidity and mortality among women. Shah's work was supported by Women's Health Research at Yale, focusing on sex differences in cardiovascular disease.

For further details, refer to 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.