Non-invasive Diagnosis and Management of Microvascular Angina in Patients with Ischemia and Non-obstructive Coronary Artery Disease Using Cardiac PET Imaging

What this Trial Is About

Angina, a common symptom of ischemic heart disease, affects millions globally and often occurs without obstructive coronary artery disease CAD. This study focuses on patients with ischemia but no obstructive CAD INOCA, who experience significant health impacts including repeated procedures, hospitalizations, and reduced quality of life. The research aims to develop and validate a non-invasive algorithm using cardiac PET myocardial perfusion imaging MPI to diagnose and manage microvascular dysfunction in these patients. Participants will undergo Rb-82 rest-stress myocardial perfusion PET imaging with flow quantitation using vasodilator stress and cold pressor tests, plus an exercise treadmill test if able. Those without recent coronary CT angiography will have one performed. A subset with abnormal PET flow parameters will be invited to an invasive angiographic validation sub-study involving detailed coronary physiology testing. Treatment recommendations based on PET results will be provided to clinicians, including medications like aspirin, statins, beta-blockers, and others. Throughout the study, patient symptoms, health status, and resource use e.g., ER visits are monitored with questionnaires and clinical data collection. Outcomes measured at three months include angina and dyspnea scores, quality of life scales, and diagnostic procedure usage. Invasive physiology results and management recommendations will be shared with treating clinicians at study completion. The study is expected to last approximately two years with about 70 participants enrolled.

Imaging Coronary Microvascular Dysfunction (CMD) Study