Intracoronary ECG 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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ID: 332583
2026
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Abstract
Abstract Background Angina and/or ischemia 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 ischemia on stress SPECT. Coronary angiography showed no obstructive disease. Doppler-based coronary function testing in the LAD demonstrated reduced CFVR (1.99) with normal HMR (1.31 mmHg·s·cm−1), suggesting functional CMD. Wave-intensity analysis showed high resting accelerating wave energy proportion without hyperemic augmentation, and intracoronary ECG during adenosine hyperemia revealed ischemic ST-segment shifts concordant with perfusion imaging. Discussion Multimodal invasive assessment can phenotype the INOCA endotypes and provide real-time ischemia confirmation. This case highlights the added value of combining intracoronary ECG with wave-intensity analysis for real-time ischemia verification in INOCA, supporting a shift from anatomical exclusion to integrated physiological diagnosis of coronary microvascular dysfunction. Vasoreactivity testing was not performed; therefore, a coexisting vasospastic endotype was not excluded.
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Authors Ahmet Taş, Yaren Alan, Alp Ozcan, Erdem Çevik, Muhammed İkbal Bayhan, Duygu Has Şimşek, Sabahattin Umman, Murat Sezer
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Journal European Heart Journal - Case Reports
Year 2026
DOI
10.1093/ehjcr/ytag762
URL
https://doi.org/10.1093/ehjcr/ytag762
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