A Yale School of Medicine team presents a study showing that women who underwent a procedure called coronary angiography (CA) had a better chance of receiving the right diagnosis when the doctor used coronary function tests (CFT), as reported in the Journal of the American Heart Association. According to their results, they pointed out that CFT has better diagnostic yield since it identifies the precise cause of the cardiac symptoms and therefore allows for more rational re-optimization of medical therapy.
The Yale team recruited 198 patients with breast cancer who participated in the trial either of CA alone or combined with CFT. Investigators stated that more than 80% of the women who underwent CFT were diagnosed with coronary vasomotor diseases which included CMD or coronary vasospasm. However, when performed independently, CA led to a diagnosis of nonobstructive CAD. This important distinction affects the further management of the patient and the therapeutic approaches available for enhancing patients’ outcomes.
The patient population was recruited from a local database of women with known or suspected ischemic heart disease scheduled to undergo coronary angiography with fractional flow reserve assessment at the Yale New Haven Hospital, between February 2018 and March 2023.
Scientists employed a purposeful sampling technique to recruit a comparison group who went through coronary angiography without CFT, known as the CA alone group. The study population consisted of women with cardiac symptoms who underwent clinically indicated CCTA for the assessment of SIHD. SIHD was defined as patients with suspected cardiac ischemia without unstable symptoms or evidence of acute coronary syndrome.
“Each year about 1% of all American citizens undergo heart catheterization procedures; however, women are less likely than men to find respite through the procedure,” said Samit Shah, MD, Assistant Professor in the Department of Internal Medicine and the study senior author. Apart from this, it strengthens coronary function testing as it will enable women to get the right diagnosis, more aggressive medical treatment on cardiac medication, and a better result.
This study also revealed that 65% of patients who underwent CFT had changes in medical therapy after the procedure compared to 41 percent of patients who underwent CA alone group. This trend was evident in disappearance at the 30-day follow-up where 44% of the CFT group received further therapy adjustments compared to 30% of the CA alone group. “Our work demonstrated that CFT can diagnose ischemic heart disease in more than 80% of women and leads to targeted changes in cardiac medications,” Dr Shah said.
Reference: Cigarroa N, Latif N, Maayah M, et al. 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;13(19):e035852. doi:10.1161/JAHA.124.035852
