Intracoronary electrocardiogram and wave intensity analysis unmask functional coronary microvascular dysfunction in a middle-aged woman with ‘normal’ coronary arteries: a case report
8 affiliations
- 1Department of Cardiology, Amsterdam UMC, Heart Centre, Amsterdam Cardiovascular Sciences, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
- 2Department 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.
- 3Faculty of Medicine, Istanbul University, Turgut Ozal Millet Cad., 34093 Fatih, Istanbul, Turkey.
- 4Department of Cardiology, Koc University School of Medicine, Davutpasa Cad. No: 4, Topkapi, 34010 Zeytinburnu, Istanbul, Turkey.
- 5Department of Cardiology, Istanbul University Faculty of Medicine, Turgut Ozal Millet Cad., 34093 Fatih, Istanbul, Turkey.
- 6Department of Cardiology, Prof. Dr. Cemil Tascioglu City Hospital, Kaptanpasa Mah., Darulaceze Cad., 34384 Sisli, Istanbul, Turkey.
- 7Department of Nuclear Medicine, Istanbul University, Turgut Ozal Millet Cad., 34093 Fatih, Istanbul, Turkey.
- 8Department of Cardiology, Acibadem International Hospital, Istanbul Cad. No: 82, Yesilkoy, 34149 Bakirkoy, Istanbul, Turkey.
Abstract
Background
Angina 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
A 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
Multimodal 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.
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BibTeX
@article{tas2026intracoronary,
title = {{Intracoronary electrocardiogram and wave intensity analysis unmask functional coronary microvascular dysfunction in a middle-aged woman with ‘normal’ coronary arteries: a case report}},
author = {Ahmet Tas and Yaren Alan and Alp Ozcan and Erdem Cevik and Muhammed Ikbal Bayhan and Duygu Has Simsek and Sabahattin Umman and Murat Sezer},
journal = {European heart journal. Case reports},
year = {2026},
month = oct,
doi = {10.1093/ehjcr/ytag762},
url = {https://europepmc.org/article/PMC/PMC13717201},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Intracoronary electrocardiogram and wave intensity analysis unmask functional coronary microvascular dysfunction in a middle-aged woman with ‘normal’ coronary arteries: a case report
AU - Ahmet Tas
AU - Yaren Alan
AU - Alp Ozcan
AU - Erdem Cevik
AU - Muhammed Ikbal Bayhan
AU - Duygu Has Simsek
AU - Sabahattin Umman
AU - Murat Sezer
PY - 2026
DA - 2026/10/01
JO - European heart journal. Case reports
DO - 10.1093/ehjcr/ytag762
UR - https://europepmc.org/article/PMC/PMC13717201
AB - Background Angina 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 A 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 Multimodal 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.
SN - 2514-2119
ER -