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Updated: May 20, 2025

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Invasive coronary function testing in clinical practice: Implementing the 2024 ESC guidelines on chronic coronary

Hanae F Namba1, Coen K M Boerhout1, Peter Damman2

  • 1Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.

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|March 23, 2025
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Summary

Angina with non-obstructive coronary arteries (ANOCA) significantly impacts quality of life. Invasive coronary function testing (ICFT) is now strongly recommended to identify ANOCA endotypes and guide treatment, improving patient outcomes.

Keywords:
Angina with non-obstructive coronary arteriesCoronary microvascular dysfunctionCoronary vasospasmEndothelial dysfunctionInvasive coronary function testing

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Area of Science:

  • Cardiology
  • Vascular Medicine

Background:

  • Angina with non-obstructive coronary arteries (ANOCA) is a prevalent condition associated with recurrent symptoms, reduced quality of life, and significant healthcare utilization.
  • Current clinical practice has not fully adopted invasive coronary function testing (ICFT) despite previous recommendations.

Purpose of the Study:

  • To provide interventional cardiologists with a contemporary review and practical guideline for implementing ICFT in ANOCA patients.
  • To highlight the updated 2024 European Society of Cardiology (ESC) Guidelines strongly recommending ICFT for ANOCA diagnosis and management.

Main Methods:

  • Review of current literature on ANOCA and ICFT.
  • Discussion of ICFT protocols, including medication management, testing procedures (acetylcholine, adenosine), and interpretation.
  • Focus on practical aspects for interventional cardiologists.

Main Results:

  • The 2024 ESC Guidelines now provide a Class I recommendation for ICFT in specific ANOCA patient groups.
  • ICFT is crucial for identifying ANOCA endotypes, guiding targeted therapy, and improving patient quality of life.

Conclusions:

  • Widespread implementation of ICFT is warranted for patients with ANOCA and persistent angina.
  • A standardized approach to ICFT is essential for optimizing the management of ANOCA, leading to better patient outcomes.