ArticleJACC. Cardiovascular imaging2022
Role of Exercise Treadmill Testing in the Assessment of Coronary Microvascular Disease.
Article in JACC. Cardiovascular imaging, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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17 citing papers in PubMed, 1 synthesis or guideline pooled it, 27 citations in OpenAlex.
- The Diagnostic Value of ECG Characteristics for Vasospastic and Microvascular Angina: A Systematic Review.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2024Pooled it
- Diagnostic performance of exercise stress testing findings and coronary microvascular dysfunction in patients with angina with non-obstructive coronary artery disease.Heart (British Cardiac Society) · 2026Article
- Impact of Coronary Microvascular Dysfunction on Left Ventricular Function After Percutaneous Coronary Intervention: Assessment With Combined Dipyridamole-Exercise Stress and Myocardial Strain/Work.Echocardiography (Mount Kisco, N.Y.) · 2026Article
- Multimodality Imaging for Diagnosis of Ischemic Heart Disease in Latin American Women from IAEA (International Atomic Energy Agency) Collaboratory.Current cardiology reports · 2025Review
- Exercise electrocardiography stress testing in suspected angina and non-obstructive coronary arteries.European heart journal · 2025Article
- Expanding diagnostic horizons: the role of multivessel coronary function testing in angina with non-obstructive coronary arteries.Cardiovascular diagnosis and therapy · 2025Article
- A multimodal dataset for coronary microvascular disease biomarker discovery.Scientific data · 2025Article
- Evolution of Coronary Microvascular Dysfunction Prevalence over Time and Across Diagnostic Modalities in Patients with ANOCA: A Systematic Review.Journal of clinical medicine · 2025Review
- Sex differences of sequential changes in coronary blood flow and microvascular function in patients with suspected angina.Clinical research in cardiology : official journal of the German Cardiac Society · 2024Article
- Correlation between coronary microvascular dysfunction and cardiorespiratory fitness in patients with ST-segment elevation myocardial infarction.Scientific reports · 2024Article
- Skin sympathetic nerve activity and ST-segment depression in women.Heart rhythm O2 · 2024Article
- Rethinking False Positive Exercise Electrocardiographic Stress Tests by Assessing Coronary Microvascular Function.Journal of the American College of Cardiology · 2024Article
- Association of abnormal electrocardiography response on dobutamine stress echocardiogram with longer-term major adverse cardiovascular events in women with symptoms of ischemic heart disease.Cardiovascular diagnosis and therapy · 2023Article
- ResETTing the diagnostic utility of exercise tolerance testing for INOCA.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2023Article
- Coronary Arterial Function and Disease in Women With No Obstructive Coronary Arteries.Circulation research · 2022Review
- Traditional chinese medicine in coronary microvascular disease.Frontiers in pharmacology · 2022Review
- Sixty years of the Bruce protocol: reappraising the contemporary role of exercise stress testing with electrocardiographic monitoring.Porto biomedical journalReview
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13 authors at 2 institutions in 1 country.
Funding
Abstract
objectivesThe authors aimed to study the sensitivity and specificity of exercise treadmill testing (ETT) in the diagnosis of coronary microvascular disease (CMD), as well as the prognostic implications of ETT results in patients with CMD.
backgroundETT is validated to evaluate for flow-limiting coronary artery disease (CAD), however, little is known about its use for evaluating CMD.
methodsWe retrospectively studied 249 consecutive patients between 2006 and 2016 who underwent ETT and positron emission tomography within 12 months. Patients with obstructive CAD or left ventricular systolic dysfunction were excluded. CMD was defined as a coronary flow reserve <2. Patients were followed for the occurrence of a first major adverse event (composite of death or hospitalization for myocardial infarction or heart failure).
resultsThe sensitivity and specificity of a positive ETT to detect CMD were 34.7% (95% CI: 25.4%-45.0%) and 64.9% (95% CI: 56.7%-72.5%), respectively. The specificity of a positive ETT to detect CMD increased to 86.8% (95% CI: 80.3%-91.7%) when only classifying studies with ischemic electrocardiogram changes that lasted at least 1 minute into recovery as positive, although at a cost of lower sensitivity (15.3%; 95% CI: 8.8%-24.0%). Over a median follow-up of 6.9 years (IQR: 5.1-8.2 years), 30 (12.1%) patients met the composite endpoint, including 13 (13.3%) with CMD (n = 98). In patients with CMD, ETT result was not associated with the composite endpoint (P = 0.076).
conclusionsOur data suggest limited sensitivity of ETT to detect CMD. However, a positive ETT with ischemic changes that persist at least 1 minute into recovery in the absence of obstructive CAD should raise suspicion for the presence of CMD given a high specificity. Further study is needed with larger patient sample sizes to assess the association between ETT results and outcomes in patients with CMD.
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