Diagnosis and pharmacotherapy of coronary vasomotor disorders

This thesis discusses the diagnosis and treatment of coronary vasomotor dysfunction in patients with angina and no significant epicardial coronary obstruction (ANOCA). This thesis addresses several unresolved issues in coronary function testing.
- Chapter II It highlights the lack of consensus on a uniform protocol for coronary function testing, which impedes clinical acceptance and therapeutic management.
- Chapter III studies the prevalence of endotypes of coronary vasomotor dysfunction amongst ANOCA patients undoing coronary function testing.
- Chapters IV and V focus on equivocal test results after acetylcholine provocation testing. The first study investigates using flow recovery time which suggests the occurrence of myocardial ischemia to better define the equivocal test result. The latter explores hemodynamic changes in different endotypes of coronary artery spasm, suggesting potential benefits of medical treatment for equivocal test results.
- Chapter VI establishes a reference range for Doppler flow velocity-derived hyperemic microvascular resistance index in ANOCA patients.
- Chapter VII provides an overview of pharmacotherapeutic strategies for coronary vasomotor disorders.
- Chapter VIII presents findings from a multicenter study on acetylcholine rechallenge, showing nitroglycerin's role in preventing re-inducibility of spasm and chapter IV provides a detailed protocol for this procedure.
- Chapter X investigates hemodynamic changes during acetylcholine provocation and re-challenge after nitroglycerin in different endotypes of spasm, demonstrating varied responses.
- Finally, Chapter XI describes the VERA study evaluating the efficacy of macitentan versus placebo in coronary spasm patients, concluding that macitentan did not reduce anginal burden compared to placebo despite background anti-anginal therapy.