Emerging Pathway to a Precision Medicine Approach for Angina With Nonobstructive Coronary Arteries in Women

Figures

• 

  Central Illustration. Precision Medicine for ANOCA Diagnosis and Treatment Recommendations ANOCA = angina with nonobstructive coronary arteries.

• 

  Figure 1. Sex-Specific Prevalence of ANOCA Sex-stratified rates of ANOCA diagnosis in men and women from large cohort studies of patients presenting with ischemia. ANOCA = angina with nonobstructive coronary arteries.

• 

  Figure 2. Pathophysiologic Endotypes of ANOCA Causes and pathologic effects of the four endotypes of ANOCA: 1) coronary microvascular dysfunction; 2) endothelial dysfunction; 3) vasospasm; and 4) combined epicardial vasospasm and microvascular dysfunction. ANOCA = angina with nonobstructive coronary arteries; EDH = endothelium-derived hyperpolarization; NO = nitric oxide.

• 

  Figure 3. Physiologic Mechanisms of Coronary Microvascular Dyfunction Reduced flow reserve in coronary microvascular dysfunction is a result of reduced hyperemic blood flow or increased resting perfusion caused by multiple mechanisms. AGE = advanced glycosylation end products; ET1 = endothelin 1; NO = nitric oxide; RAAS = renin-angiotensin aldosterone system; RAGE = receptors of advanced glycosylation end products; ROS = reactive oxygen species.

• 

  Figure 4. Sex-Specific Diagnostic Considerations in ANOCA Utility of various noninvasive and invasive diagnostic techniques in women with ANOCA. ANOCA = angina with nonobstructive coronary arteries; CAD = coronary artery disease; CFR = coronary flow reserve; CFVR = coronary flow velocity reserve; CMD = coronary microvascular dysfunction; FFR = fractional flow reserve; HMR = hyperemic microvascular resistance; IMR = index of microcirculatory resistance; MACE = major adverse cardiovascular events; MCE = myocardial contrast echocardiography; MFR = myocardial flow reserve; MINOCA = myocardial infarction with no obstructive coronary arteries; NICM = nonischemic cardiomyopathy; PCAT = pericoronary adipose tissue attenuation; V/M = coronary lumen volume to myocardial mass; VSA = vasospastic angina.

• 

  Figure 5. Precision Medicine Considerations for ANOCA Diagnosis and Treatment Examples of social determinants. Genomics, transcriptomics, proteomics, radiomics markers that have been associated with angina with nonobstructive coronary arteries (ANOCA).