TY - JOUR
T1 - Comprehensive Management of ANOCA, Part 1—Definition, Patient Population, and Diagnosis
T2 - JACC State-of-the-Art Review
AU - Microvascular Network (MVN)
AU - Samuels, Bruce A.
AU - Shah, Samit M.
AU - Widmer, R. Jay
AU - Kobayashi, Yuhei
AU - Miner, Steven E.S.
AU - Taqueti, Viviany R.
AU - Jeremias, Allen
AU - Albadri, Ahmed
AU - Blair, John A.
AU - Kearney, Kathleen E.
AU - Wei, Janet
AU - Park, Ki
AU - Barseghian El-Farra, Ailin
AU - Holoshitz, Noa
AU - Janaszek, Katherine B.
AU - Kesarwani, Manoj
AU - Lerman, Amir
AU - Prasad, Megha
AU - Quesada, Odayme
AU - Reynolds, Harmony R.
AU - Savage, Michael P.
AU - Smilowitz, Nathaniel R.
AU - Sutton, Nadia R.
AU - Sweeny, Joseph M.
AU - Toleva, Olga
AU - Henry, Timothy D.
AU - Moses, Jeffery W.
AU - Fearon, William F.
AU - Tremmel, Jennifer A.
N1 - Publisher Copyright:
© 2023
PY - 2023/9/19
Y1 - 2023/9/19
N2 - Angina with nonobstructive coronary arteries (ANOCA) is increasingly recognized and may affect nearly one-half of patients undergoing invasive coronary angiography for suspected ischemic heart disease. This working diagnosis encompasses coronary microvascular dysfunction, microvascular and epicardial spasm, myocardial bridging, and other occult coronary abnormalities. Patients with ANOCA often face a high burden of symptoms and may experience repeated presentations to multiple medical providers before receiving a diagnosis. Given the challenges of establishing a diagnosis, patients with ANOCA frequently experience invalidation and recidivism, possibly leading to anxiety and depression. Advances in scientific knowledge and diagnostic testing now allow for routine evaluation of ANOCA noninvasively and in the cardiac catheterization laboratory with coronary function testing (CFT). CFT includes diagnostic coronary angiography, assessment of coronary flow reserve and microcirculatory resistance, provocative testing for endothelial dysfunction and coronary vasospasm, and intravascular imaging for identification of myocardial bridging, with hemodynamic assessment as needed.
AB - Angina with nonobstructive coronary arteries (ANOCA) is increasingly recognized and may affect nearly one-half of patients undergoing invasive coronary angiography for suspected ischemic heart disease. This working diagnosis encompasses coronary microvascular dysfunction, microvascular and epicardial spasm, myocardial bridging, and other occult coronary abnormalities. Patients with ANOCA often face a high burden of symptoms and may experience repeated presentations to multiple medical providers before receiving a diagnosis. Given the challenges of establishing a diagnosis, patients with ANOCA frequently experience invalidation and recidivism, possibly leading to anxiety and depression. Advances in scientific knowledge and diagnostic testing now allow for routine evaluation of ANOCA noninvasively and in the cardiac catheterization laboratory with coronary function testing (CFT). CFT includes diagnostic coronary angiography, assessment of coronary flow reserve and microcirculatory resistance, provocative testing for endothelial dysfunction and coronary vasospasm, and intravascular imaging for identification of myocardial bridging, with hemodynamic assessment as needed.
KW - bridging
KW - chest pain
KW - coronary function testing
KW - microvascular
KW - vasospasm
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U2 - 10.1016/j.jacc.2023.06.043
DO - 10.1016/j.jacc.2023.06.043
M3 - Review article
C2 - 37704315
AN - SCOPUS:85170095459
SN - 0735-1097
VL - 82
SP - 1245
EP - 1263
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 12
ER -