Comprehensive Management of ANOCA, Part 1-Definition, Patient Population, and Diagnosis: JACC State-of-the-Art Review

Bruce A Samuels¹, Samit M Shah², R Jay Widmer³, Yuhei Kobayashi⁴, Steven E S Miner⁵, Viviany R Taqueti⁶, Allen Jeremias⁷, Ahmed Albadri¹, John A Blair⁸, Kathleen E Kearney⁹, Janet Wei¹, Ki Park¹⁰, Ailin Barseghian El-Farra¹¹, Noa Holoshitz¹², Katherine B Janaszek¹³, Manoj Kesarwani¹⁴, Amir Lerman¹⁵, Megha Prasad¹⁶, Odayme Quesada¹⁷, Harmony R Reynolds¹⁸, Michael P Savage¹⁹, Nathaniel R Smilowitz²⁰, Nadia R Sutton²¹, Joseph M Sweeny²², Olga Toleva²³, Timothy D Henry²⁴, Jeffery W Moses²⁵, William F Fearon²⁶, Jennifer A Tremmel²⁷; Microvascular Network (MVN)

Affiliations

¹ Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
² Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA.
³ Baylor Scott and White Health, Temple, Texas, USA.
⁴ New York Presbyterian Brooklyn Methodist Hospital/Weill Cornell Medical College, New York, New York, USA.
⁵ Southlake Regional Medical Centre, Newmarket, Ontario, Canada; School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁶ Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁷ St Francis Hospital and Heart Center, Roslyn, New York, USA.
⁸ Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA.
⁹ Department of Medicine, University of Washington, Seattle, Washington, USA.
¹⁰ Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA.
¹¹ Department of Medicine, Division of Cardiology, University of California, Irvine, California, USA.
¹² Ascension Columbia St Mary's, Milwaukee, Wisconsin, USA.
¹³ Baylor Scott and White Health, Plano, Texas, USA.
¹⁴ Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, California, USA.
¹⁵ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
¹⁶ Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York City, New York, USA.
¹⁷ Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA.
¹⁸ Sarah Ross Soter Center for Women's Cardiovascular Research, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, New York, USA.
¹⁹ Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
²⁰ Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA; Cardiology Section, Department of Medicine, Veterans Affairs New York Harbor Healthcare System, New York, New York, USA.
²¹ Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA.
²² The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
²³ Department of Medicine, Emory University, Atlanta, Georgia, USA.
²⁴ The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA.
²⁵ St Francis Hospital and Heart Center, Roslyn, New York, USA; Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York City, New York, USA.
²⁶ Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.
²⁷ Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA. Electronic address: jtremmel@stanford.edu.

PMID: 37704315
DOI: 10.1016/j.jacc.2023.06.043

Free article

Review

Comprehensive Management of ANOCA, Part 1-Definition, Patient Population, and Diagnosis: JACC State-of-the-Art Review

Bruce A Samuels et al. J Am Coll Cardiol. 2023.

Free article

. 2023 Sep 19;82(12):1245-1263.

doi: 10.1016/j.jacc.2023.06.043.

Authors

Affiliations

¹ Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
² Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA.
³ Baylor Scott and White Health, Temple, Texas, USA.
⁴ New York Presbyterian Brooklyn Methodist Hospital/Weill Cornell Medical College, New York, New York, USA.
⁵ Southlake Regional Medical Centre, Newmarket, Ontario, Canada; School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁶ Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁷ St Francis Hospital and Heart Center, Roslyn, New York, USA.
⁸ Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA.
⁹ Department of Medicine, University of Washington, Seattle, Washington, USA.
¹⁰ Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA.
¹¹ Department of Medicine, Division of Cardiology, University of California, Irvine, California, USA.
¹² Ascension Columbia St Mary's, Milwaukee, Wisconsin, USA.
¹³ Baylor Scott and White Health, Plano, Texas, USA.
¹⁴ Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, California, USA.
¹⁵ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
¹⁶ Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York City, New York, USA.
¹⁷ Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA.
¹⁸ Sarah Ross Soter Center for Women's Cardiovascular Research, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, New York, USA.
¹⁹ Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
²⁰ Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA; Cardiology Section, Department of Medicine, Veterans Affairs New York Harbor Healthcare System, New York, New York, USA.
²¹ Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA.
²² The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
²³ Department of Medicine, Emory University, Atlanta, Georgia, USA.
²⁴ The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA.
²⁵ St Francis Hospital and Heart Center, Roslyn, New York, USA; Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York City, New York, USA.
²⁶ Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.
²⁷ Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA. Electronic address: jtremmel@stanford.edu.

PMID: 37704315
DOI: 10.1016/j.jacc.2023.06.043

Abstract

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.

Keywords: bridging; chest pain; coronary function testing; microvascular; vasospasm.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Samuels has served as a consultant and on a Speakers Bureau for Abbott Vascular and Philips. Dr Shah has received research support from Abbott Vascular and the Food and Drug Administration of the U.S. Department of Health and Human Services. Dr Widmer has served on advisory boards for Abbott Vascular, Philips, and Medtronic; and has received research support from Cardiol Therapeutics. Dr Kobayashi has served as a consultant for Abbott Vascular. Dr Miner has received investigator-initiated research support from Abbott Vascular. Dr Jeremias has served as a consultant for Philips, Abbott Vascular, ACIST, Neovasc, and CathWorks. Dr Blair has received research support from Abbott Vascular and Philips; and is on a Speakers Bureau for Abbott Vascular. Dr Kearney has served as a consultant for Abbott Vascular, Abiomed, Boston Scientific, CSI, Medtronic, Teleflex, and Philips. Dr Wei has served on an advisory board for Abbott Vascular. Dr Park has received honoraria from Abbott Vascular and CSI. Dr Kesarwani has served as a consultant for Abbott Vascular. Dr Lerman has served on an advisory board for Philips/Volcano. Dr Prasad has served on an advisory board and/or as a consultant for Abbott Vascular, Boston Scientific, Cardiol Therapeutics, Conavi, Chiesi, and Neovasc. Dr Quesada has received partial support from the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) (award K23HL151867). Dr Reynolds has received research support from Abbott Vascular, Philips, and Siemens. Dr Smilowitz has served on an advisory board for Abbott Vascular; and has received partial support from the National Heart, Lung, and Blood Institute of the NIH (award K23HL150315). Dr Sutton has received honoraria for speaking or consulting from Abbott, Philips, Zoll, and Shockwave. Dr Sweeny has received honoraria from Abbott Vascular. Dr Henry has received research support and honoraria from Neovasc. Dr Moses has served as a consultant for Covanos; and has held equity in Orchestra BioMed and Covanos. Dr Fearon has received institutional research support from Abbott Vascular, Medtronic, and the NIH (5R33HL139929-05); has served as a consultant for CathWorks and Siemens; and has held stock options with HeartFlow. Dr Tremmel has received honoraria from and served on advisory boards for Abbott Vascular; has received honoraria and research funding from Boston Scientific; and has received honoraria from Shockwave. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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Comprehensive Management of ANOCA, Part 1-Definition, Patient Population, and Diagnosis: JACC State-of-the-Art Review

Affiliations

Comprehensive Management of ANOCA, Part 1-Definition, Patient Population, and Diagnosis: JACC State-of-the-Art Review

Authors

Affiliations

Abstract

Conflict of interest statement

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical