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Multiple Endotypes and Angina Burden in Patients With Nonobstructive Coronary Arteries

Christopher C Y Wong1,2,3, Vedant S Pargaonkar1, Luke P Dawson1

  • 1Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, California.

JAMA Cardiology
|May 27, 2026
PubMed

Insights

Coronary function testing (CFT) helps understand chest pain in angina with nonobstructive coronary arteries (ANOCA). More ANOCA endotypes found via CFT correlate with increased angina burden, impacting patient quality of life.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Testing

Background:

  • Angina with nonobstructive coronary arteries (ANOCA) presents a diagnostic challenge.
  • Coronary function testing (CFT) is crucial for identifying underlying mechanisms in ANOCA.
  • The impact of multiple ANOCA endotypes on angina burden requires further investigation.

Purpose of the Study:

  • To investigate the association between the number of ANOCA endotypes and patient-reported angina burden.
  • To determine if coexisting endotypes in ANOCA patients worsen symptoms.

Main Methods:

  • Cross-sectional study of 485 patients with suspected ANOCA undergoing comprehensive CFT.
  • Acetylcholine, adenosine, and intravascular ultrasound with hemodynamic testing were used to identify endotypes.
  • The Seattle Angina Questionnaire (SAQ) assessed angina burden.

Main Results:

  • A significant proportion of ANOCA patients (61%) had two or more endotypes.
  • Angina burden, measured by SAQ scores, worsened significantly with an increasing number of identified endotypes (P=.003).
  • Each additional endotype was independently associated with lower SAQ scores (B=-3.55; P<.001).

Conclusions:

  • Multiple endotypes frequently coexist in ANOCA patients.
  • A higher number of CFT-identified endotypes is associated with a greater angina burden.
  • These findings highlight the clinical significance of comprehensive CFT in managing ANOCA.
Abstract

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