{
  "abstract": "Background\n\nAngina and/or ischaemia with nonobstructive coronary arteries (ANOCA/INOCA) is common, particularly in women, and is most frequently attributable to coronary microvascular dysfunction (CMD), rather than representing a benign finding after exclusion of epicardial stenosis.Case summary\n\nA 55-year-old woman with cardiometabolic risk factors had recurrent angina and reversible ischaemia on stress single-photon emission computed tomography. Coronary angiography showed no obstructive disease. Doppler-based coronary function testing in the left anterior descending coronary artery demonstrated reduced coronary flow velocity reserve (1.99) with normal hyperaemic microvascular resistance (1.31 mmHg·s·cm⁻¹), suggesting functional CMD. Wave intensity analysis showed high resting accelerating wave energy proportion without hyperaemic augmentation, and intracoronary electrocardiogram (ECG) during adenosine hyperaemia revealed ischaemic ST-segment shifts concordant with perfusion imaging.Discussion\n\nMultimodal invasive assessment can phenotype the INOCA endotypes and provide real-time ischaemia confirmation. This case highlights the added value of combining intracoronary ECG with wave intensity analysis for real-time ischaemia verification in INOCA, supporting a shift from anatomical exclusion to integrated physiological diagnosis of CMD. Vasoreactivity testing was not performed; therefore, a coexisting vasospastic endotype was not excluded.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Cardiology, Amsterdam UMC, Heart Centre, Amsterdam Cardiovascular Sciences, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.",
    "Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istasyon Mah., Turgut Ozal Bulvari No: 11, 34303 Kucukcekmece, Istanbul, Turkey.",
    "Faculty of Medicine, Istanbul University, Turgut Ozal Millet Cad., 34093 Fatih, Istanbul, Turkey.",
    "Department of Cardiology, Koc University School of Medicine, Davutpasa Cad. No: 4, Topkapi, 34010 Zeytinburnu, Istanbul, Turkey.",
    "Department of Cardiology, Istanbul University Faculty of Medicine, Turgut Ozal Millet Cad., 34093 Fatih, Istanbul, Turkey.",
    "Department of Cardiology, Prof. Dr. Cemil Tascioglu City Hospital, Kaptanpasa Mah., Darulaceze Cad., 34384 Sisli, Istanbul, Turkey.",
    "Department of Nuclear Medicine, Istanbul University, Turgut Ozal Millet Cad., 34093 Fatih, Istanbul, Turkey.",
    "Department of Cardiology, Acibadem International Hospital, Istanbul Cad. No: 82, Yesilkoy, 34149 Bakirkoy, Istanbul, Turkey."
  ],
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      "orcid": "0000-0002-6204-2391"
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        5
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      "name": "Erdem Cevik"
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      "name": "Sabahattin Umman",
      "orcid": "0000-0001-7995-1711"
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        4,
        7
      ],
      "name": "Murat Sezer",
      "orcid": "0000-0001-9614-1614"
    }
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  "published": "2026-10-01",
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  "title": "Intracoronary electrocardiogram and wave intensity analysis unmask functional coronary microvascular dysfunction in a middle-aged woman with ‘normal’ coronary arteries: a case report",
  "title_text": "Intracoronary electrocardiogram and wave intensity analysis unmask functional coronary microvascular dysfunction in a middle-aged woman with ‘normal’ coronary arteries: a case report",
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