ArticleEuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology2023
Diagnostic performance of exercise stress tests for detection of epicardial and microvascular coronary artery disease: the UZ Clear study.
Article in EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 16 citations in OpenAlex.
- Exercise electrocardiography stress testing in suspected angina and non-obstructive coronary arteries.European heart journal · 2025Article
- A multimodal dataset for coronary microvascular disease biomarker discovery.Scientific data · 2025Article
- Ischemia with no obstructed coronary arteries and microvascular testing procedures: a review of utility, pharmacotherapy, and current challenges.Frontiers in cardiovascular medicine · 2025Review
- Correlation between coronary microvascular dysfunction and cardiorespiratory fitness in patients with ST-segment elevation myocardial infarction.Scientific reports · 2024Article
- Management of Coronary Artery Diseases in Systemic Vasculitides: Complications and Strategies.Medicina (Kaunas, Lithuania) · 2024Review
- Rethinking False Positive Exercise Electrocardiographic Stress Tests by Assessing Coronary Microvascular Function.Journal of the American College of Cardiology · 2024Article
- 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
- Article
- Sex differences in contributors to coronary microvascular dysfunction.Frontiers in cardiovascular medicine · 2023Article
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Authors and funding
28 authors at 7 institutions in 6 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCardiac stress tests remain the cornerstone for evaluating patients suspected of having obstructive coronary artery disease (CAD). Coronary microvascular dysfunction (CMD) can lead to abnormal non-invasive tests.
aimsWe sought to assess the diagnostic performance of exercise stress tests with indexes of epicardial and microvascular resistance as reference.
methodsThis was a prospective, single-arm, multicentre study of patients with an intermediate pretest probability of CAD and positive exercise stress tests who were referred for invasive angiography. Patients underwent an invasive diagnostic procedure (IDP) with measurement of fractional flow reserve (FFR) and index of microvascular resistance (IMR) in at least one coronary vessel. Obstructive CAD was defined as diameter stenosis (DS) >50% by quantitative coronary angiography (QCA). The objective was to determine the false discovery rate (FDR) of cardiac exercise stress tests with both FFR and IMR as references.
resultsOne hundred and seven patients (137 vessels) were studied. The mean age was 62.1±8.7, and 27.1% were female. The mean diameter stenosis was 37.2±27.5%, FFR was 0.84±0.10, coronary flow reserve was 2.74±2.07, and IMR 20.3±11.9. Obstructive CAD was present in 39.3%, whereas CMD was detected in 20.6%. The FDR was 60.7% and 62.6% with QCA and FFR as references (p-value=0.803). The combination of FFR and IMR as clinical reference reduced the FDR by 25% compared to QCA (45.8% vs 60.7%; p-value=0.006).
conclusionsIn patients with evidence of ischaemia, an invasive functional assessment accounting for the epicardial and microvascular compartments led to an improvement in the diagnostic performance of exercise tests, driven by a significant FDR reduction.
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