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Invasive coronary functional testing: insights from a single centre
Session:
Sessão de Posters 34 - INOCA, MINOCA e a zona cinzenta da doença coronária
Speaker:
Mariana Rodrigues Simões
Congress:
CPC 2026
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.1 Coronary Artery Disease – Pathophysiology and Mechanisms
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Mariana Rodrigues Simões; Gonçalo Terleira Batista; Tomás Miguel; Manuel Santos; Luís Paiva; Marco Costa; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Introduction: </span></strong></span></span><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Arial",sans-serif">Growing evidence has shown that structural and functional abnormalities of the coronary microvasculature are highly prevalent and are associated with an increased burden of cardiovascular disease. </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Methods and purpose</span></strong><span style="font-family:"Arial",sans-serif">: </span><span style="font-family:"Arial",sans-serif">We conducted a single-centre, retrospective, observational study of patients with ischemia with no obstructive coronary arteries (INOCA) or angina with no obstructive coronary arteries (ANOCA) </span><span style="font-family:"Arial",sans-serif">who underwent invasive coronary functional testing with an</span><span style="font-family:"Arial",sans-serif"> acetylcholine- </span><span style="font-family:"Arial",sans-serif">and adenosine-based protocol between November 2022 and November 2025. We assessed testing results and long-term outcomes, including symptoms, emergency department (ED) visits, and repeat angiography. </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Arial",sans-serif"><strong>Results:</strong> A total of 43 patients were included (23 men and 20 women), with a median age of 60 years (IQR 17) and a mean follow-up time of 16.3</span><span style="font-family:Symbol">±</span><span style="font-family:"Arial",sans-serif"> 11.6 months. Twenty-seven patients had an INOCA diagnosis and 16 had ANOCA. Hypertension was present in 25 patients, hyperlipidemia in 31, diabetes mellitus in 7, and 6 reported past or current smoking. Invasive functional testing was positive in 27 patients (63%): 15 demonstrated macrovascular vasospasm, 8 had coronary microvascular dysfunction, and 4 exhibited both mechanisms. Electrocardiographic (ECG) changes occurred in 11 patients (10 with a ST-segment depression and 1 with ventricular tachycardia (VT)). The VT episode occurred in a patient with macrovascular vasospasm; among the remaining ECG changes, 7 occurred in patients with vasospasm, 1 with microvascular dysfunction, and 2 in those with both mechanisms. Eighteen patients reported chest pain during testing, but only 15 had disease: 10 with macrovascular spasm, 1 with microvascular dysfunction, and 4 with both. Positive test rates were similar between ANOCA (62%) vs INOCA (63%) patients (p=0.967). By the end of follow-up, 10 patients reported exertional chest pain of those, 8 had a positive test (3 with vasospasm, 2 with microvascular dysfunction, and 3 with both). Six patients presented to the ED with chest pain: all with positive testing- 2 with microvascular dysfunction, 2 with vasospasm, and 2 with both). </span></span></span><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Arial",sans-serif">Two patients (one with vasospasm and one with combined mechanisms) underwent repeat coronary angiography, with no progression of obstructive coronary disease. </span></span></span></p> <p style="text-align:justify"><strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Arial",sans-serif">Conclusion: </span></span></span></strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Arial",sans-serif">In patients with ANOCA/INOCA, invasive functional testing identifies the underlying mechanisms. Larger patients’ cohorts may further clarify how each mechanism contributes to different clinical outcomes. </span></span></span></p>
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