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Due to its significant prevalence and clinical implications, angina with non-obstructive coronary arteries (ANOCA) has become a major focus in modern cardiology. In fact, diagnosing ANOCA presents a significant challenge. The final diagnosis is often difficult, delayed, and frequently necessitates an invasive assessment through coronary angiography. However, recent improvements in non-invasive cardiac imaging allow a diagnosis of ANOCA using a combination of clinical evaluation, anatomical coronary imaging, and functional testing. This narrative review aims to critically assess various non-invasive diagnostic methods and propose a multimodal approach to diagnose ANOCA and tailor appropriate treatments.
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http://dx.doi.org/10.1016/j.cpcardiol.2025.103021 | DOI Listing |
Am J Cardiol
September 2025
Tel Aviv Medical Center, 6 Weizmann St, Tel Aviv, 6423906, Israel. Electronic address:
Effective therapy for patients suffering from refractory angina remains a major unmet need. Chronic angina, which is refractory to medical and interventional therapies, affects patients who are not suitable for revascularization, patients following successful revascularization, and patients with coronary microvascular dysfunction. Coronary sinus (CS) narrowing has been studied as a potential therapy for patients with angina.
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September 2025
Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 1, Rome 00168, Italy.
Background: Chest pain is a common reason for emergency department (ED) visits, yet not all cases are attributable to coronary artery disease (CAD). The 2024 European Society of Cardiology (ESC) guidelines emphasize the importance of invasive coronary function testing in patients with angina and non-obstructive coronary arteries. Understanding alternative causes of chest pain is crucial for appropriate diagnosis and management.
View Article and Find Full Text PDFEur Heart J
September 2025
Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy.
EuroIntervention
September 2025
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
Background: Coronary microvascular dysfunction (CMD) is a common cause of chest pain (CP) in patients with angina and non-obstructive coronary arteries (ANOCA). Although both CMD and CP have distinct classifications, the relationship between them remains insufficiently understood.
Aims: This study investigated the relationship between CMD and CP patterns and their prognostic impact in ANOCA patients.
Introduction: Obstructive coronary artery disease (CAD) has long been recognized as the primary mechanism underlying myocardial ischaemia. However, up to 50 % of patients with angina and objective evidence of ischaemia present with non-obstructed coronary arteries (INOCA) in the coronary angiography, falling under the umbrella term INOCA, a heterogeneous group that remains frequently underdiagnosed and undertreated. Performing a coronary function test (CFT) enables us to diagnose and stratify these patients into different endotypes and start a targeted medical therapy.
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