Inova Schar Heart and Vascular expands capabilities for evaluation of INOCA, microvascular dysfunction and vasospasm

By InovaNewsroom | July 10, 2026

Inova Schar Heart and Vascular has expanded its diagnostic capabilities for patients with angina, ischemic symptoms and nonobstructive coronary artery disease by implementing advanced coronary physiologic assessment in its catheterization laboratories and opening a dedicated outpatient cardiac PET/CT diagnostic imaging site. Together, these capabilities support more precise evaluation of ischemia with no obstructive coronary arteries (INOCA) including coronary microvascular dysfunction and coronary vasospasm.

Closing the diagnostic gap in patients with persistent ischemic symptoms

Patients with angina or anginal equivalents may have ongoing ischemic symptoms despite the absence of obstructive epicardial coronary artery disease on coronary angiography or coronary CT angiography. In these cases, standard anatomic evaluation may not identify the underlying mechanism of symptoms.

Coronary microvascular dysfunction involves impaired regulation of the small arterioles and capillaries that contribute to myocardial perfusion but are not directly visualized on conventional angiography. When present, microvascular dysfunction can produce exertional or rest angina, dyspnea and persistent symptoms despite “normal” anatomic testing.

Coronary microvascular dysfunction is reported more frequently in women, though it also affects men, and is a key contributor to INOCA. Failure to identify the physiologic substrate can delay appropriate therapy and may contribute to recurrent symptoms, repeated testing and adverse cardiovascular outcomes.

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

Coronary vasospasm is another important nonobstructive cause of ischemic symptoms. Transient vasoconstriction of the epicardial arteries or microvasculature can reduce coronary blood flow and may not be apparent on routine angiography without provocative or physiologic testing.

CoroFlow enables comprehensive invasive coronary physiology assessment

The CoroFlow system enables interventional cardiologists to perform comprehensive physiologic and hemodynamic assessment of the coronary circulation during cardiac catheterization. Now available at Inova Fairfax, Inova Alexandria and Inova Loudoun hospitals, the technology supports evaluation of both epicardial disease and microvascular function, helping clinicians differentiate obstructive from nonobstructive mechanisms of ischemia and tailor treatment accordingly.

“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 not only at Inova Fairfax Hospital but at all three Inova hospital locations with cardiac catheterization services,” said Eric Pauley, MD, Medical Director of Inova Loudoun Hospital’s Cardiac Catheterization Lab and its cardiac rehab program. “Offering this advanced technology at three locations makes it easily accessible across Northern Virginia.”

Cardiac PET/CT provides noninvasive quantification of myocardial blood flow

Inova Schar Heart and Vascular also offers cardiac PET/CT, a noninvasive imaging modality that assesses myocardial perfusion and quantifies myocardial blood flow. This capability advances beyond conventional nuclear cardiology by supporting physiologic evaluation of perfusion reserve, which can help identify coronary microvascular dysfunction when anatomic imaging does not demonstrate obstructive disease.

“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 Cardiac PET/CT study is performed at rest and during pharmacological stress using a dedicated PET radiotracer (rubidium). Physicians evaluate myocardial perfusion and myocardial blood flow to determine whether impaired blood flow is caused by obstructive coronary artery disease, coronary microvascular dysfunction or both.

Cardiac PET/CT is particularly well suited for patients with persistent chest pain or shortness of breath despite normal or inconclusive prior testing, as well as for patients with diabetes, hypertension, obesity, prior coronary stents or coronary bypass surgery, or suspected coronary microvascular dysfunction. The service is available at Inova Cardiac Diagnostics – Willow Oaks.

A mechanism-based approach to persistent angina and INOCA

By combining invasive coronary physiology assessment with advanced noninvasive perfusion imaging, Inova Schar Heart and Vascular offers referring clinicians a broader diagnostic pathway for patients with persistent symptoms, inconclusive testing or suspected INOCA. These capabilities support more targeted, mechanism-based care for coronary microvascular dysfunction and vasospastic disease.

“A significant percentage of patients – 30% or more – have concerning symptoms with a ‘normal’ cath, and some of those patients actually have microvascular disease,” Dr. Pauley said. “Making that diagnosis and then tailoring treatment appropriately makes patients’ quality of life better.”

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

Connect with these physicians on Doximity to learn more:

Kelly Epps-Anderson, MD – Associate Director, Inova’s Women’s Cardiovascular Health Program

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

Reza Emaminia, MD – Medical Director of the Echocardiography Laboratory at Inova Fairfax Hospital, Medical Director of Interventional Echocardiography at Inova Schar Heart and Vascular, and Medical Director of Nuclear Cardiology at Inova

Eric Pauley, MD – Medical Director of Inova Loudoun Hospital’s Cardiac Catheterization Lab