Novel Insights into the Pathophysiology and Diagnosis of Patients with Angina and Non-obstructive Coronary Arteries

Abstract

Angina with non-obstructive coronary arteries (ANOCA) comprises heterogeneous vasomotor disorders that cause recurrent angina, impaired quality of life, frequent hospitalisations and adverse cardiovascular outcomes. Yet ANOCA often evades conventional coronary assessment, demanding more nuanced diagnostic strategies. This thesis evaluates the diagnostic and prognostic utility of invasive coronary function testing (CFT) across a series of multicentre prospective studies. It quantifies the prevalence of vasomotor endotypes in contemporary cohorts, compares the diagnostic performance of alternative CFT protocols, and examines how these pathways influence patient-reported health status and clinical decision-making. Collectively, the findings provide evidence to refine diagnostic strategies, enhance patient care and inform long-term management in ANOCA. By defining where CFT adds diagnostic yield and clinical value, this work offers practical recommendations for current practice and a foundation for the development of globally standardised protocols to ensure consistent endotype identification across centres.