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Review
. 2025 May;50(5):103021.
doi: 10.1016/j.cpcardiol.2025.103021. Epub 2025 Feb 25.

Non-invasive imaging assessment in angina with non-obstructive coronary arteries (ANOCA)

Luca Bergamaschi  1 , Antonio De Vita  2 , Angelo Villano  2 , Saverio Tremamunno  2 , Matteo Armillotta  1 , Francesco Angeli  1 , Marta Belmonte  3 , Pasquale Paolisso  4 , Alberto Foà  5 , Emanuele Gallinoro  4 , Alberto Polimeni  6 , Vincenzo Sucato  7 , Doralisa Morrone  8 , Domenico Tuttolomondo  9 , Anna Giulia Pavon  10 , Marco Guglielmo  11 , Nicola Gaibazzi  9 , Saima Mushtaq  12 , Pasquale Perrone Filardi  3 , Ciro Indolfi  13 , Eugenio Picano  14 , Gianluca Pontone  15 , Gaetano Antonio Lanza  16 , Carmine Pizzi  17 ; Coronary Physiopathology and Microcirculation Working Group of the Italian Society of Cardiology (SIC)
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Free article
Review

Non-invasive imaging assessment in angina with non-obstructive coronary arteries (ANOCA)

Luca Bergamaschi et al. Curr Probl Cardiol. 2025 May.
Free article

Abstract

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.

Keywords: ANOCA; CCTA; Diagnosis; Imaging; PET; SPECT; Stress CMR.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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