Comprehensive Management of ANOCA, Part 2-Program Development, Treatment, and Research Initiatives: JACC State-of-the-Art Review

Nathaniel R Smilowitz; Megha Prasad; R Jay Widmer; Olga Toleva; Odayme Quesada; Nadia R Sutton; Amir Lerman; Harmony R Reynolds; Manoj Kesarwani; Michael P Savage; Joseph M Sweeny; Katherine B Janaszek; Ailin Barseghian El-Farra; Noa Holoshitz; Ki Park; Ahmed Albadri; John A Blair; Allen Jeremias; Kathleen E Kearney; Yuhei Kobayashi; Steven E S Miner; Bruce A Samuels; Samit M Shah; Viviany R Taqueti; Janet Wei; William F Fearon; Jeffery W Moses; Timothy D Henry; Jennifer A Tremmel; Microvascular Network (MVN)

doi:10.1016/j.jacc.2023.06.044

Comprehensive Management of ANOCA, Part 2-Program Development, Treatment, and Research Initiatives: JACC State-of-the-Art Review

J Am Coll Cardiol. 2023 Sep 19;82(12):1264-1279. doi: 10.1016/j.jacc.2023.06.044.

Authors

Nathaniel R Smilowitz¹, Megha Prasad², R Jay Widmer³, Olga Toleva⁴, Odayme Quesada⁵, Nadia R Sutton⁶, Amir Lerman⁷, Harmony R Reynolds⁸, Manoj Kesarwani⁹, Michael P Savage¹⁰, Joseph M Sweeny¹¹, Katherine B Janaszek¹², Ailin Barseghian El-Farra¹³, Noa Holoshitz¹⁴, Ki Park¹⁵, Ahmed Albadri¹⁶, John A Blair¹⁷, Allen Jeremias¹⁸, Kathleen E Kearney¹⁹, Yuhei Kobayashi²⁰, Steven E S Miner²¹, Bruce A Samuels¹⁶, Samit M Shah²², Viviany R Taqueti²³, Janet Wei¹⁶, William F Fearon²⁴, Jeffery W Moses²⁵, Timothy D Henry²⁶, Jennifer A Tremmel²⁷; Microvascular Network (MVN)

Affiliations

¹ Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA; Cardiology Section, Department of Medicine, VA New York Harbor Healthcare System, New York, New York, USA.
² Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York, USA.
³ Baylor Scott and White, Temple, Texas, USA.
⁴ Department of Medicine, Emory University, Atlanta, Georgia, USA.
⁵ Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA.
⁶ Department of Internal Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA.
⁷ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
⁸ Sarah Ross Soter Center for Women's Cardiovascular Research, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, New York, USA.
⁹ Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, California, USA.
¹⁰ Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
¹¹ The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹² Baylor Scott and White, Plano, Texas, USA.
¹³ Department of Medicine, Division of Cardiology, University of California, Irvine, California, USA.
¹⁴ Ascension Columbia St Mary's, Milwaukee, Wisconsin, USA.
¹⁵ Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA.
¹⁶ Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
¹⁷ Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA.
¹⁸ St Francis Hospital & Heart Center, Roslyn, New York, USA.
¹⁹ Department of Medicine, University of Washington, Seattle, Washington, USA.
²⁰ New York Presbyterian Brooklyn Methodist Hospital/Weill Cornell Medical College, New York, New York, USA.
²¹ Southlake Regional Medical Centre, Newmarket, Ontario, Canada, School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
²² Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut USA.
²³ Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
²⁴ Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.
²⁵ Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York, USA; St Francis Hospital & Heart Center, Roslyn, New York, USA.
²⁶ Carl and Edyth Lindner Center for Research and Education, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA.
²⁷ Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA. Electronic address: jtremmel@stanford.edu.

PMID: 37704316
DOI: 10.1016/j.jacc.2023.06.044

Abstract

Centers specializing in coronary function testing are critical to ensure a systematic approach to the diagnosis and treatment of angina with nonobstructive coronary arteries (ANOCA). Management leveraging lifestyle, pharmacology, and device-based therapeutic options for ANOCA can improve angina burden and quality of life in affected patients. Multidisciplinary care teams that can tailor and titrate therapies based on individual patient needs are critical to the success of comprehensive programs. As coronary function testing for ANOCA is more widely adopted, collaborative research initiatives will be fundamental to improve ANOCA care. These efforts will require standardized symptom assessments and data collection, which will propel future large-scale clinical trials.

Keywords: chest pain; coronary function testing; microvascular; myocardial bridging; treatment; vasospasm.

Publication types

Review
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Angina Pectoris*
Coronary Vessels
Humans
Life Style
Program Development
Quality of Life*

Abstract

Publication types

MeSH terms

Grants and funding