Figure 2.

(A) Before performance of treadmill electrocardiography (ECG), a rest 12-lead ECG showed normal sinus rhythm, without ST-segment changes. (B) A 4-stage treadmill ECG showed significant ST-segment changes (-2.80 mV to +2.30 mV). (C) Parasternal long-axis view and (D) apical 4-chamber view of two-dimensional echocardiography showed increased echo-density (arrows) over the interventricular septum. Besides, the interventricular septum was found bulging from the left ventricle (LV) toward right ventricle (RV). By Simpsons method, two-dimensional echocardiography, over apical 4-chamber view, showed normal ejection fraction and wall motion of the LV, with a mean area of (E) 29.83 cm² in diastole and (F) 15.70 cm² in systole, respectively. This extrapolates that permanent myocardial damage could be emerged with times in patients incurring ischemia and no obstructive coronary artery disease (INOCA) due to a hibernated pathology coronary microvascular dysfunction (CMVD), however, ejection fraction and wall motion of the LV could be preserved due to a scattered distribution of myocardial ischemia in CMVD which did not interfere global contraction and metabolism.