14 Chapter 1 at rest and during maximal vasodilation, typically using the vasodilators adenosine and dipyridamole. However, due to anatomical variation, the LAD might be difficult to visualize and requires an experienced echocardiographer. Therefore, although in-expensive and widely available this technique is scarlessly used. Compared to other imaging techniques, CMR offers several benefits, such as superior temporal and spatial resolution, accurate assessment of myocardial function and viability, and the ability to do so without exposing patients to ionizing radiation in a time-efficient manner.29 Stress perfusion CMR is an established method for myocardial ischemia detection, using first-pass contrast-imaging to detect perfusion defects. However, visual assessment of stress perfusion is dependent on observer’s expertise, and while fully automated quantitative perfusion (QP) shows promising results for detection of CMD, it requires further investigation before clinical implication. Diagnostic therapies in ANOCA Optimal management and pharmacological treatment of ANOCA is challenging, primarily due to the heterogeneity of underlying mechanisms and the lack of comprehensive evaluation of individual treatments through randomized clinical trials. Currently, management and therapies are based on best clinical practice.30 The CorMicA (Coronary Microvascular Angina) trial is one of the few randomized trials performed in ANOCA, and emphasizes the importance of identifying underlying mechanisms in ANOCA-patients. This identification enables tailored treatment strategies, ultimately reducing angina burden and enhancing quality of life.31 However, inconsistent protocols for invasive CFT and varying definitions of the endotypes of ANOCA have limited our understanding, as the practical approach has only recently been standardized. These limitations highlight the considerable gaps in knowledge that remain, underscoring the necessity for a more precise diagnostic algorithm and emphasizing the importance of identifying individual pathophysiology in ANOCA. OUTLINE OF THE THESIS In this thesis entitled “A multimodality approach to unravel the pathophysiology of ANOCA”, the objective was to provide a better understanding into the pathophysiology of ANOCA, with a particular focus on its distribution across sexes. For this purpose, a variety of studies was performed using both invasive as non-invasive imaging modalities, focusing on symptomatic patients with non-obstructive coronary artery disease. Part 1. Endotypes of Chronic Coronary Syndrome Part one of this thesis is focused on understanding the relationship between sex and various endotypes of chronic coronary syndrome (CCS). In Chapter 2, we explore the relationship between sex and various endotypes of this syndrome. Here, invasive coronary assessment distinguishes between obstructive coronary artery disease and coronary
RkJQdWJsaXNoZXIy MTk4NDMw