Endotypes of angina with non-obstructive coronary arteries: a prospective multicentre study

作者：Steve Miner, Hernán Mejía‐Rentería, Antonio Maria Leone, Ornela Velollari, Robert Sykes, Simone Biscaglia, Giuseppe Esposito, Domenico Galante, Jacopo Oreglia, Daniel Ang, Maren Weferling, Luigi Di Serafino, Colin Berry, Gianluca Campo, Javier Escaned, Filippo Crea, Tommaso Gori · 发表于：European Heart Journal · 年份：2025 · DOI：10.1093/eurheartj/ehaf839 · 被引用次数：30 · 研究领域：Cardiac Imaging and Diagnostics、Heart rate and cardiovascular health、Acute Myocardial Infarction Research

BACKGROUND AND AIMS: Angina with non-obstructive coronary arteries (ANOCA) is a prevalent myocardial ischaemic syndrome, and women are disproportionately affected. Mechanisms of ischaemia are challenging to diagnose and treatment is empirical. METHODS: Consecutive patients with angina (or equivalent symptoms), no angiographically severe stenosis and fractional flow reserve > 0.80 undergoing coronary functional testing were prospectively enrolled in nine centres in Europe and North America. Haemodynamic endotypes were assessed measuring coronary flow reserve and resistance using an intracoronary pressure- and temperature-sensitive sensor and bolus thermodilution. Measurements were obtained during resting conditions and following adenosine and acetylcholine. Chest pain and electrocardiographic ischaemic changes were recorded. The participant characteristics of each haemodynamic endotype were investigated using regression analysis. A three-step Delphi consensus method was applied to identify endotype-specific therapies. RESULTS: Overall, 1001 participants (mean age 62 ± 11years, 56% female) were enrolled and eight distinct endotypes were defined by adenosine testing (n = 3) and acetylcholine testing (n = 5), respectively: high resting coronary blood flow (n = 195, 19%); high resistance (n = 125, 13%); compensated high resistance (n = 112, 11%); epicardial coronary spasm (n = 162, 17%); microvascular spasm (n = 75, 8%); endothelial dysfunction (n = 96, 10%); ischaemia w/o haemody...