Two new procedures at National Heart Centre Singapore to identify hidden heart diseases

Cardiovascular Ageing and Longevity Programme director Angela Koh and National Heart Centre Singapore cardiology department consultant Keh Yann Shan. PHOTO: LIANHE ZAOBAO

SINGAPORE – After experiencing chest pains in 2022, Frieda Matilda Desker was found to have severely narrowed heart arteries, subsequently undergoing an angioplasty to open her arteries.

However, the 63-year-old part-time administrative officer continued to have chest pain, even though repeated scans showed no abnormalities.

In 2025, she was referred to the National Heart Centre Singapore (NHCS), where she underwent a functional coronary angiography – a more sensitive test that evaluates how the heart’s blood vessels behave.

She was diagnosed with coronary vasospasm, a rare condition where the heart arteries suddenly tighten and restrict blood flow.

Functional coronary angiography is one of two new approaches introduced by NHCS under its Cardiovascular Ageing and Longevity Programme (CRANE) for patients whose conditions cannot be fully explained by standard tests.

The other new approach assesses the heart and muscles simultaneously, providing early insights on heart muscle health.

These approaches aim to tackle what the centre describes as a “long-standing blind spot” – heart diseases that do not show up during routine examinations but progressively erode the quality of life.

In a media statement, NHCS noted that data from the Singapore Cardiac Data Bank showed 22 per cent of patients with chest pain caused by reduced blood flow to the heart, or angina, did not have major blockage in their heart arteries in standard angiograms, which use X-rays to look for blockages.

The condition, known as angina with non-obstructive coronary arteries (ANOCA), is more common among older adults, women and people with diabetes.

Angina affects some 112 million people worldwide, according to the World Heart Federation.

NHCS said that while a standard coronary angiography – which detects narrowing in the major heart arteries – is effective for most patients, the procedure is unable to detect problems in smaller blood vessels or sudden arterial spasms that cause symptoms in some patients.

In contrast, a functional coronary angiography, using specialised pressure wires and medications, can measure blood flow and pressure within the coronary arteries, including microscopic ones invisible in standard imaging.

Clinical guidelines published by the European Society of Cardiology in 2024 recommend the procedure for patients with unexplained chest pain, with numerous studies finding that it can lead to more tailored treatments that improve quality of life for patients.

The functional coronary angiography is offered to patients who – after specialist assessment – have unexplained angina symptoms despite normal results in standard scans, or whose symptoms persist despite treatment.

While parts of the procedure have been available separately in Singapore, NHCS is now rolling it out as a structured, routine service within its dedicated cardiovascular ageing programme.

The centre has performed the procedure more than 100 times since CRANE was launched in 2025.

“Patients with ANOCA often spend years moving between clinics, undergoing repeated tests, and being told nothing is wrong,” said NHCS cardiology department consultant Keh Yann Shan.

“Functional coronary angiography allows us to give patients an actual diagnosis, and from there, a treatment that works,” he said.

The second new approach is the Multiparametric Heart-Muscle Imaging (MOSAIC), which uses advanced echocardiography techniques that utilise ultrasound to assess the heart and muscular system, giving doctors early insights into heart muscle quality at the tissue level.

Clinical assessment identifies suitable patients, such as those with risk factors for age-related heart muscle decline, which allows for earlier, more targeted intervention before significant muscle loss occurs – a key indicator of frailty in seniors.

“The (two) approaches are designed to complement, not replace, standard cardiac care. They give our specialists better tools for patients who need them most,” said CRANE director Angela Koh.

Such approaches are especially important as Singapore’s population ages, with older people more likely to have atypical symptoms or heart conditions that elude standard testing, said Koh, who is also a senior consultant at the NHCS cardiology department.

After undergoing the functional coronary angiography, Desker was placed on calcium channel blockers, which are drugs that lower blood pressure by preventing calcium from entering the cells of the heart and arteries.She said the treatment relieved the tightness in her chest, adding that her family is now at ease.

“If anything were to happen to me, I would not be able to see my kids,” said the mother of three.

Source: The Straits Times © SPH Media Limited. Permission required for reproduction.