McChord Johanna, Hubert Astrid, Saccardi Leonie, Seitz Andreas, Sechtem Udo, Bekeredjian Raffi, Ong Peter
Department of Cardiology and Angiology, Robert Bosch Hospital, Stuttgart, Germany.
Catheter Cardiovasc Interv. 2025 Jul 31. doi: 10.1002/ccd.70038.
Angina in the absence of stenosing coronary artery disease (ANOCA) is a common yet challenging condition often linked to endothelial dysfunction (ED), coronary microvascular dysfunction (CMD), and coronary spasm. ED is defined as a coronary blood flow (CBF) increase of < 50% or luminal narrowing of epicardial arteries in response to low-dose acetylcholine (ACh). The prevalence and clinical significance of isolated ED remain uncertain.
This study aimed to determine the prevalence of ED in ANOCA patients and assess its diagnostic value in comprehensive coronary function testing (CFT).
Eighty ANOCA patients underwent invasive coronary angiography with low- and high-dose ACh testing, CBF measurement, and quantitative coronary angiography (QCA)-based coronary diameter assessment. CMD was defined as coronary flow reserve (CFR) < 2.5 and/or hyperemic microvascular resistance (HMR) > 2.5. Coronary spasm was diagnosed using the Coronary Vasomotor Disorders International Study Group (COVADIS) criteria.
ED was present in 67 patients (84%), while coronary spasm and CMD were detected in 80% and 45%, respectively. Spasm provocation and CMD testing provided a 90% diagnostic yield, increasing to 100% with ED assessment. All ANOCA patients without CMD or spasm had ED. Only 10% had isolated ED. Additionally, 27% of ED patients showed spasm at low-dose ACh, highlighting the need for comprehensive spasm testing.
ED is highly prevalent in ANOCA but rarely occurs in isolation. Since ED testing requires significant effort yet adds little to the overall diagnostic yield of CFT or the management of ANOCA patients, CFT should prioritize the assessment of spasm and CMD.
This study was not registered in a public clinical trials registry as it did not meet the criteria for mandatory registration, being a non-interventional, observational study focused on diagnostic evaluation.
无狭窄性冠状动脉疾病的心绞痛（ANOCA）是一种常见但具有挑战性的病症，常与内皮功能障碍（ED）、冠状动脉微血管功能障碍（CMD）和冠状动脉痉挛有关。ED定义为冠状动脉血流（CBF）增加<50%或对低剂量乙酰胆碱（ACh）反应时心外膜动脉管腔狭窄。孤立性ED的患病率和临床意义仍不确定。
本研究旨在确定ANOCA患者中ED的患病率，并评估其在综合冠状动脉功能测试（CFT）中的诊断价值。
80例ANOCA患者接受了有创冠状动脉造影，包括低剂量和高剂量ACh测试、CBF测量以及基于定量冠状动脉造影（QCA）的冠状动脉直径评估。CMD定义为冠状动脉血流储备（CFR）<2.5和/或充血微血管阻力（HMR）>2.5。使用国际冠状动脉血管舒缩障碍研究组（COVADIS）标准诊断冠状动脉痉挛。
67例患者（84%）存在ED，而冠状动脉痉挛和CMD的检出率分别为80%和45%。痉挛激发试验和CMD测试的诊断率为90%，加上ED评估后增至100%。所有无CMD或痉挛的ANOCA患者均有ED。仅10%有孤立性ED。此外，27%的ED患者在低剂量ACh时出现痉挛，突出了全面痉挛测试的必要性。
ED在ANOCA中高度普遍，但很少单独发生。由于ED测试需要大量工作，且对CFT的总体诊断率或ANOCA患者的管理贡献不大，CFT应优先评估痉挛和CMD。
本研究未在公共临床试验注册中心注册，因为它不符合强制注册标准，是一项专注于诊断评估的非干预性观察性研究。
