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A proposal of an echocardiography-based pathway for the diagnosis and management of angina with no obstructive

Attila Kardos1,2, Benjamin Bussmann3,4, Maria George5

  • 1Department of Cardiology, Translational Cardiovascular Research Group, Milton Keynes University Hospital NHS Foundation Trust, 8H Standing Way, Eaglestone, Milton Keynes MK6 5LD, UK.

European Heart Journal. Imaging Methods and Practice
|August 8, 2026
PubMed

Insights

Diagnosing angina with non-obstructive coronary artery disease (ANOCA) can be challenging. This review proposes a non-invasive echocardiography pathway to identify ANOCA subtypes for targeted treatment and improved patient outcomes.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Diagnostic Tools

Background:

  • Angina with non-obstructive coronary artery disease (ANOCA) affects a significant patient population (30-60%).
  • Accurate diagnosis of ANOCA is crucial for effective management and prognosis.
  • Current diagnostic tools have limitations in identifying ANOCA endotypes.

Purpose of the Study:

  • To critically appraise existing invasive and non-invasive diagnostic modalities for ANOCA.
  • To propose a novel, fully non-invasive echocardiography-based pathway for ANOCA diagnosis.
  • To facilitate targeted therapy and improve quality of life for ANOCA patients.

Main Methods:

  • Review of current literature on invasive and non-invasive imaging for ANOCA.
  • Focus on multi-parametric stress echocardiography and hyperventilation provocation echocardiography.
  • Proposal of a new diagnostic algorithm utilizing advanced echocardiography techniques.

Main Results:

  • Multi-parametric stress echocardiography with hyperventilation is a safe, cost-effective bedside tool.
  • Echocardiography can potentially triage patients for further invasive testing.
  • The proposed pathway aims to identify ANOCA endotypes for personalized treatment.

Conclusions:

  • A non-invasive echocardiography pathway offers a promising approach to diagnose ANOCA.
  • Targeted therapy based on ANOCA endotypes can improve symptom control and prognosis.
  • This approach may reduce hospital admissions and enhance patient quality of life.

Keywords:
ANOCAINOCAdiagnosticsendotypenon-invasive pathway

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