Nishtha Sareen

Medical Director of Women Heart Program, Ascension Saint, USA

Abstract Title: Coronary Microvascular testing: What, Why and How

Biography: Dr Nishtha Sareen is the Medical Director of Women’s Cardiovascular Services for Ascension Tennessee (15 hospitals) and Founder for Ascension Michigan (17 hospitals). Board certified in General Cardiology, Interventional Cardiology, Endo vascular, Echocardiography, Coronary CT and Nuclear Cardiology along with Internal Medicine. President-elect for American Heart Association Board for Middle Tennessee. She was awarded Detroit Crains 40 under 40, Dbusiness 30 in their 30s, “Women Who Lead”by WJR radio, Stevie International Awards as the “Women of the Year in Healthcare” Gold 2024 , “Global Recognition Award 2025-Pioneer in Women Heart Health; featured in CEOweekly, Business Insider and Forbes Swiss. Cover Feature InsightsSuccess Magazine “Healthcare Leader to Know in 2025”, CIOLook “Top Influential Women Leaders in Healthcare 2025”and Executive Lens Magazine “Healthcare Leader in 2025” and Global Leadership Winner for UK based Sheinspires Awards.

Research Interest: Angina and/or myocardial ischaemia with non-obstructive coronary arteries (ANOCA/INOCA) affects more than one in three individuals with stable ischaemic heart disease, and women are more often affected. This high prevalence of ANOCA, its impact on health-related quality of life and prognosis, and evidence supporting the role of invasive coronary function tests in persistently symptomatic patients have led to a class I recommendation in international practice guidelines and a call for further research into the diagnosis of this condition. As underlined in these guidelines, ANOCA/INOCA is ‘rarely correctly diagnosed and no tailored therapy is prescribed for these patients.’ . A stratified medical approach guided by invasive evidence of coronary vasomotor dysfunction improves angina and health-related quality of life. Thus, a clinical algorithm to objectively classify patients with ANOCA, applied to both adenosine and acetylcholine responses, during routine care is needed to guide individualized therapy based on the mechanism of ischaemia (endotype).Purpose: 1) To highlight and focus on the indications, contraindications and options during workup for chest pain with open arteries or evaluation of microvascular dysfunction. 2) Discuss Algorithms to approach with focus on patient selection and management options. 3) Discuss our experience across 6 Women Heart Centers in the State of Michigan and 3 in the State of Tennessee 4) Present Case-based discussion of clinical cases, management approaches and consequent outcomes and 5) Present efficiency, procedural and safety data from our patient cohorts across our centers. Presentation Proposal: The first part of the oral presentation will be a focused review of current guidelines, followed by case based discussion of various endotypes and phenotypes of coronary microvascular dysfunction. The mid segment of the presentation will highlight some case based discussion and management strategies. The final segment will discuss our procedural outcomes and proposed algorithm for most reliable and efficient case flow in the cath laboratory. The cases are sequentially saved in an excel sheet with demographic, clinical and angiographic datasets. We will perform statistical analysis to obtain major efficiency and safety outcomes. The data already contain more than 120 cardiac cases and is being constantly updated.