175 Quantitative Perfusion CMR in ANOCA 13 (26.5%) cases, the LAD demonstrated the lowest MPR, while the RCX presented the most diminished MPR in 30.6% participants. Table 2. Quantitative Perfusion per coronary territories ANOCA patients Healthy controls p-value Rest MBF LAD territory 1.21 ±0.33 1.30 ±0.24 0.304 RCA territory 1.08 ±0.18 1.09 ±0.24 0.787 RCX territory 1.20 ±0.27 1.26 ±0.33 0.514 Stress MBF LAD territory 2.61 ±0.84 3.27 ±0.27 0.005 RCA territory 2.22 ±0.64 2.72 ±0.65 0.009 RCX territory 2.44 ±0.73 2.97 ±0.64 0.010 MPR LAD territory 2.33 ±0.88 2.70 ±0.66 0.097 RCA territory 2.16 ±0.71 2.69 ±0.69 0.005 RCX territory 2.23 ±0.81 2.48 ±0.86 0.312 Data are presented as mean ± SD or median and IQR. Abbreviations: MBF: Myocardial Blood Flow; LAD: Left Anterior Descending; RCA: Right Coronary Artery; RCX: Ramus Circumflex; MPR: Myocardial Perfusion Reserve Supplementary Table 2 shows an overview of the QP CMR results per segment, including both rest and stress MBF, as well as MPR. The comparison between individual coronary segments in ANOCA patients and healthy controls revealed significant findings. Across nearly all coronary segments, stress MBF was reduced in ANOCA patients. Furthermore, in approximately half of the segments, MPR was significantly reduced in the ANOCA patients. MPR in the different ANOCA endotypes Based on CFT results, 2 (8.3%), ANOCA patients were diagnosed with epicardial spasm, 11 (45.8%) ANOCA were diagnosed with MVA, 8 (33.3%) ANOCA patients had an inconclusive CFT result, and 3 (6.1%) ANOCA patients had a negative CFT result. All patients diagnosed with MVA had microvascular spasm, and four (16.7%) patients with MVA met the criteria for both CMD and microvascular spasm. Additionally, a similar distribution of MPR was found over the different ANOCA endotypes (one-way ANOVA, p = 0.766) (Figure 4). 8
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