New Test Improves Heart Disease Detection, Especially in Women

Cardiovascular disease remains the leading cause of death in the United States for both men and women. However, traditional diagnostic methods like coronary angiography can sometimes miss crucial diagnoses, particularly in cases of ischemic heart disease. Now, UVA Health is leading the way with a new comprehensive test – coronary function testing – designed to provide a more complete picture of heart health and improve detection rates, especially for women.

Why Heart Disease Can Be Harder to Discover in Women

Coronary angiography, traditionally used to identify heart disease, relies on X-ray images and contrast dye to visualize blockages in large heart arteries caused by plaque buildup (atherosclerosis). While effective for many, this approach can be less accurate for women, who are more likely to experience heart issues not stemming from major artery blockages.

The problem often lies within the microvasculature – the network of smaller blood vessels branching off from the main arteries. These smaller vessels constitute the majority of the heart’s blood supply. When they malfunction, it can lead to coronary microvascular disease (CMD).

“We now have a way to say, ‘Well, it might not be the big coronary arteries, the epicardial coronary arteries, but it could be this microvascular network that is dysfunctional,’” explains Patrick Stafford, MD, a heart disease specialist and professor of cardiology at UVA Health.

CMD can cause chest pain and other symptoms even when larger arteries appear normal. Up to half of patients undergoing coronary angiography show no obstructive coronary artery disease, yet can still be at significant risk for major cardiac events. CMD is not a benign condition.

How Coronary Function Testing Works

Coronary function testing assesses how well the heart’s blood vessels relax, tighten, and respond to the body’s needs. Impaired function can limit blood flow and cause symptoms such as:

• Chest pain
• Trouble breathing
• Neck, jaw, or arm pain
• Nausea

The test is performed during a heart catheterization procedure. In addition to a standard angiogram, a thin wire is inserted into the coronary arteries to measure blood pressure, blood flow, and resistance.

“Through taking these measurements, measuring the pressures, we can determine some specific indices that help us determine if someone has coronary microvascular dysfunction,” Stafford says.

During the testing, specific medications are administered to observe how the blood vessels respond, revealing whether they are too constricted, failing to relax properly, or experiencing spasms. This provides detailed information about both large and little blood vessels in the heart.

UVA Health’s Pioneering Approach

UVA Health was the first health system in Virginia to implement this new comprehensive coronary function testing, offering a more accurate and complete assessment of heart health for all patients, with a particular benefit for women who may be underserved by traditional diagnostic methods.

Learn more about UVA Heart and Vascular Center and their commitment to innovative cardiovascular care.