Advances in cardiovascular imaging - Ischaemia without obstruction: a false alarm?

About this episode

This episode discusses a study challenging the benign assumption of myocardial ischaemia in patients with non-obstructive CAD.

With Sarah Birkhoelzer, Oxford University Hospitals, Oxford - UK, and Edgar Argulian, Mount Sinai Morningside, New York - USA. In this episode, we explore a study by Edgar Argulian published in European Heart Journal – Imaging Methods and Practice (2025), which challenges the assumption that myocardial ischaemia on exercise echocardiography (ExE) is benign when coronary angiography shows no obstructive coronary artery disease (CAD). The study retrospectively analysed 84 patients with exercise-induced ischaemia but no obstructive CAD, subdividing them into those with normal coronaries (iNC) and non-obstructive CAD (iNOCAD). Over a median 3.2-year follow-up, patients with ischaemia—especially those with iNC—faced significantly higher rates of acute chest pain and adverse cardiovascular outcomes compared to matched controls. Notably, women were overrepresented in the iNC group and were less likely to be on cardioprotective medications. The findings suggest that what has often been labelled as a "false positive" ExE may in fact reflect underlying microvascular dysfunction, endothelial abnormalities, or vasospasm—particularly in women. This study calls for more tailored evaluation…

People in this episode

Guests: Sarah Birkhoelzer, Edgar Argulian

Topics covered

• cardiovascular imaging
• myocardial ischaemia
• coronary artery disease
• exercise echocardiography
• microvascular dysfunction
• clinical practice

Keywords

• cardiovascular imaging
• myocardial ischaemia
• exercise echocardiography
• non-obstructive CAD
• acute chest pain
• women's health
• clinical implications

Mentioned in this episode

Organizations: Oxford University Hospitals, Mount Sinai Morningside, European Heart Journal – Imaging Methods and Practice

Places: Oxford, New York

More episodes of EACVI Cardio Talk

• Advances in Cardiovascular Imaging: the role of multi-modality imaging for the assessment of left atrium and left atrial appendage. · April 7, 2026 · 28 min
• A Coffee Break with Shantanu Sengupta · March 17, 2026 · 11 min
• Advances in cardiovascular imaging: ESC consensus statement on cardiovascular disease prevention and management in the COVID-19 era · February 17, 2026 · 24 min
• Highlights from the EACVI Congress 2025 · January 22, 2026 · 22 min
• This is the rythm of the night · December 5, 2025
• HIT Journal Club: diagnostic accuracy in cardiovascular imaging · November 20, 2025 · 10 min