Inova introduces precise diagnostic technology for microvascular disease and vasospasm

Inova Schar Heart and Vascular is continuing to build upon its legacy of innovation in cardiovascular disease diagnosis and treatment with two new technologies. Inova’s cardiac PET/CT scanning capability supports more precise evaluation of coronary microvascular disease. Additionally, Inova Schar Heart and Vascular is among the first programs in the United States to implement the CoroFlow system. CoroFlow is a new way to assess blood flow during a cardiac catheterization procedure, and it can diagnose coronary microvascular disease and vasospasm. These two technologies are helping to provide answers for a substantial group of patients.

“Many patients undergoing cardiac catheterization have angina but no significant blockages seen when we evaluate the coronary arteries,” said Eric Pauley, MD, Medical Director of Inova Loudoun Hospital’s Cardiac Catheterization Lab and its cardiac rehab program. “That accounts for about 30% of cases. Making the correct diagnosis and tailoring treatment appropriately improves patients’ quality of life.”

A difficult-to-detect problem

For some patients with angina and other forms of chest pain, their symptoms are not caused by coronary artery blockages. The typical cardiac diagnostic studies, including cardiac catheterization or coronary CT angiography, look normal – but this can be deceiving.

The heart’s coronary arteries are made up of a network of tiny arterials and capillaries, which are visible only under a microscope. Disease affecting these small vessels, known as coronary microvascular disease, can impair blood flow to the heart and cause chest pain symptoms that persist.

Coronary microvascular disease is more common in women (although it can also affect men) and is often not detectable on standard imaging. The result can be a delay in diagnosis, a corresponding delay in treatment, and a greater risk of additional damage that can contribute to conditions like heart failure.

“We see a disproportionate burden of ongoing symptoms in women whose angiograms don’t show blockages,” said Kelly Epps, MD, Associate Director of Women’s Cardiovascular. “Being able to identify microvascular disease more precisely helps ensure these patients are evaluated and treated appropriately – and are not reassured prematurely.”

Another possible cause of chest pain in patients who don’t have blockages is vasospasm. In vasospasm, the coronary arteries’ muscular layer clamps down and restricts blood flow. This is also generally undetectable using cardiovascular angiography or standard cardiac catheterization.

This is why the introduction of CoroFlow to Inova Schar Heart and Vascular’s cath labs and the use of cardiac PET/CT at Inova Cardiac Diagnostics are so exciting.

CoroFlow system enables microvasculature assessment during catheterization

The CoroFlow system enables comprehensive assessment of the heart’s circulation during a single cardiac catheterization. Interventional cardiologists at Inova Fairfax, Inova Alexandria and Inova Loudoun hospitals now have access to this technology to evaluate both coronary arteries as well as the previously invisible microvessels. As a result, interventional cardiologists can distinguish blockages from microvascular disease or vasospasm, leading to correct diagnosis and effective treatment.

“The advantage of CoroFlow is workflow and completeness. During a single cardiac catheterization, we can assess the epicardial vessels and the microvasculature, helping differentiate obstructive from nonobstructive drivers of ischemic symptoms and reduce diagnostic uncertainty,” said Behnam Tehrani, MD, System Associate Director for Interventional Cardiology at Inova Schar Heart and Vascular, Executive Director of the Cardiac Catheterization Laboratories and Co-Director of the Complex Coronary Therapeutics Program.

“We are particularly excited to offer this technology at all three Inova hospital locations with cardiac catheterization services,” Dr. Pauley said. “Offering this advanced technology at three locations makes it easily accessible across Northern Virginia.”

Cardiac PET/CT

Inova Schar Heart and Vascular also offers cardiac PET/CT, a type of cardiac imaging that can assess how well blood is moving throughout the heart (both perfusion and blood flow). This technology represents a leap forward compared to prior generations of nuclear cardiology, which only evaluated perfusion. Other kinds of cardiac imaging, such as coronary angiography or cardiac CT, are also unable to assess myocardial blood flow.

“Many patients continue to experience chest pain or shortness of breath even though their coronary arteries appear normal on angiography or CT scans,” said Reza Emaminia, MD, Medical Director of the Cardiac PET Program at Inova Schar Heart and Vascular. “In many of these patients, the problem lies within the heart’s microscopic blood vessels, a condition known as coronary microvascular dysfunction. Cardiac PET/CT is uniquely able to measure blood flow to the heart muscle and detect these abnormalities noninvasively, allowing us to make a diagnosis that often could not be made with traditional imaging alone. This leads to more personalized treatment and, ultimately, better care for our patients.”

The noninvasive cardiac PET/CT consists of two parts. First, the patient is given a tracer, and images of the heart are taken while the patient is at rest. Next, medication is administered to simulate the effects of exercise by increasing blood flow to the heart, followed by a second tracer injection and another set of images. The nuclear cardiologist then compares the rest and stress images to evaluate myocardial perfusion and myocardial blood flow, allowing detection of both obstructive coronary artery disease and coronary microvascular disease

The test is valuable for patients with new chest pain as well as those who have had other diagnostic tests (a cardiac CT or coronary angiography) that appear to be normal, despite ongoing symptoms. It is available at Inova Cardiac Diagnostics – Willow Oaks.

A full range of precision diagnostics

These two capabilities make it easier for patients with lasting symptoms, inconclusive testing or suspected microvascular disease to get answers. It’s just one of the ways Inova Schar Heart and Vascular is demonstrating personalized, precision heart care.

“This is precision medicine in real time,” said Dr. Tehrani. “Our goal is simple: help patients get informed answers faster and feel confident they’re being treated thoughtfully.”

Patients typically are referred for these studies by their cardiologist. Find an Inova cardiologist near you.