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January 20, 2026European Cardiology ReviewOpen Access

Non-invasive hyperventilation strongly correlates with invasive acetylcholine testing for coronary vasospasm.

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Why the study?

Invasive coronary functional tests can identify angina mechanisms in patients with ANOCA, but whether non-invasive tests can also reliably assess these mechanisms was unknown.

Do non-invasive coronary functional tests using transthoracic Doppler echocardiography correlate with invasive coronary functional tests in identifying the mechanisms of angina in patients with ANOCA?

Population

18 patients with ANOCA who underwent I-CFTs and 13 healthy controls

Comparison

NI-CFTs vs I-CFTs and healthy controls

Design

Observational comparative study

Key result

Non-invasive hyperventilation testing strongly correlated (Φ coefficient 0.71) with invasive acetylcholine testing for detecting coronary vasospasm in patients with non-obstructed coronary arteries.

Authors

NCNello CambiseAMAngelo Giuseppe MarinoFBFabio De Benedetto

Discussion

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Overview

Non-invasive coronary functional testing using transthoracic Doppler echocardiography shows high diagnostic agreement with invasive testing in patients with ANOCA, offering a potential non-invasive alternative for assessing angina mechanisms.

Study Design

Type

Observational (n=31)

Blinding

Single-blind

Multicenter

No

Structured PICO

Do non-invasive coronary functional tests using transthoracic Doppler echocardiography correlate with invasive coronary functional tests in identifying the mechanisms of angina in patients with ANOCA?

P
Population
18 patients with angina and non-obstructive coronary artery disease (ANOCA) who had undergone invasive coronary functional tests, and 13 healthy controls (total n=31).
I
Intervention
Non-invasive coronary functional tests (NI-CFTs) including hyperventilation, dipyridamole stress test, and cold pressor test, assessed by recording coronary blood flow velocity in the left anterior descending coronary artery via transthoracic Doppler echocardiography.
C
Comparator
Invasive coronary functional tests (I-CFTs) including acetylcholine provocation test and adenosine stress test (for diagnostic agreement), and a healthy control group (for physiological comparison).
O
Outcome
Agreement in coronary abnormalities detected during invasive and non-invasive coronary functional tests.surrogate

Main Result

Effect estimate: Φ coefficient 0.71

p-value: p=0.002

Non-invasive coronary functional testing using transthoracic Doppler echocardiography shows high diagnostic agreement with invasive testing in patients with ANOCA, offering a potential non-invasive alternative for assessing angina mechanisms.

Limitations

  • Small sample size
  • Single-center study
  • Non-invasive tests were performed several weeks after invasive tests, allowing for potential dynamic changes in coronary vasomotor function
  • Hyperventilation is a less effective stimulus compared to intracoronary acetylcholine
  • Lack of invasive assessment of endothelium-dependent coronary microvascular dilator function
  • Echocardiographic technical limitations, including the need for adequate training and window to visualize the LAD-CA

Cite This Study

Cambise et al. (2026) conducted an observational in Angina and non-obstructed coronary arteries (ANOCA) (n=31). Non-invasive coronary functional tests (NI-CFTs) vs. Invasive coronary functional tests (I-CFTs) was evaluated on Correlation between coronary vasoconstriction during hyperventilation test and vasospastic response during invasive acetylcholine test (Φ coefficient 0.71, p=0.002). Non-invasive hyperventilation testing strongly correlated (Φ coefficient 0.71) with invasive acetylcholine testing for detecting coronary vasospasm in patients with non-obstructed coronary arteries.

synapsesocial.com/papers/6a11e4cd5a604c357c21c2abhttps://doi.org/10.15420/ecr.2025.54
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