28 Aug 2025 • In patients with angina and non-obstructive coronary artery disease (ANOCA), exercise stress testing (EST) proved highly effective in detecting coronary microvascular dysfunction (CMD), particularly the structural subtype.

CMD prevalence was consistent across invasive definitions, but structural CMD was more frequently identified using microvascular resistance reserve (MRR <3.0).

Ischemic ECG changes during EST showed excellent diagnostic accuracy (86.3%; sensitivity 86.2%, specificity 86.4%), outperforming exercise-induced chest discomfort (76.1%), with no added value from combining both.

These findings highlight EST—especially ECG-based markers—as a simple, accurate tool for CMD detection, though functional CMD remains harder to capture.

Source: BMJ Journals | Read Full Story