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Lookup NU author(s): Professor Vijay KunadianORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2025 The Authors. Angina with non-obstructive coronary arteries (ANOCA) is increasingly recognized as a significant aspect of chronic coronary syndromes. These patients frequently experience recurrent angina, resulting in high healthcare costs and impaired quality of life. Invasive coronary function testing (ICFT) is able to identify ANOCA endotypes, which can guide treatment and improve quality of life. Despite Class II recommendations for invasive microvascular assessments in the previous 2019 European Society of Cardiology (ESC) Guidelines, ICFT has yet to translate into widespread clinical practice. Patients with ANOCA experience poor quality of life and reduced functional capacity, highlighting the need for earlier ICFT implementation. The 2024 ESC Guidelines now strongly recommend ICFT (Class I, level of evidence B) for patients with non-obstructive coronary arteries and persistent angina despite optimal medical therapy, and for confirming or excluding ANOCA in patients with uncertain diagnoses on non-invasive testing (Class I, level of evidence B). Consequently, a standardized approach to optimize the management of ANOCA patients is warranted. Therefore, this review aims to provide interventional cardiologists with a contemporary review of the literature and a practical guideline on implementation of ICFT. It will discuss the following subjects: the definitions of the different endotypes, an example of an ICFT protocol, discontinuation of medication prior to ICFT, use of radial cocktail, target vessel for testing, acetylcholine injection techniques and rechallenge, adenosine injection techniques, the order of testing, the interpretation of ICFT, safety and feasibility, and the pharmacological treatment.
Author(s): Namba HF, Boerhout CKM, Damman P, Kunadian V, Escaned J, Ong P, Perera D, Berry C, van de Hoef TP, Piek JJ
Publication type: Article
Publication status: Published
Journal: International Journal of Cardiology
Year: 2025
Volume: 430
Print publication date: 01/07/2025
Online publication date: 22/03/2025
Acceptance date: 17/03/2025
Date deposited: 09/04/2025
ISSN (print): 0167-5273
ISSN (electronic): 1874-1754
Publisher: Elsevier Ireland Ltd
URL: https://doi.org/10.1016/j.ijcard.2025.133176
DOI: 10.1016/j.ijcard.2025.133176
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