Cardiac CT in ANOCA, INOCA, and MINOCA: a structured narrative review of evidence, applications, and limitations

Q: What is the clinical evidence from this study?

Study design: Review. Population: Angina, ischemia, or myocardial injury with non-obstructive coronary arteries (ANOCA, INOCA, and MINOCA). Intervention: Cardiac computed tomography (conventional CCTA, pericoronary fat assessment, CT-FFR, CT perfusion, late iodine enhancement, and CT-derived extracellular volume) vs. Invasive coronary angiography, coronary function testing, intracoronary imaging, and multiparametric cardiovascular magnetic resonance (CMR). Primary outcome: Diagnostic validation, vasomotor endotyping, mechanism-specific treatment selection, and clinical utility.

Q: What does this research mean for the field?

Current evidence does not establish that an advanced cardiac CT biomarker strategy improves mechanism-specific treatment selection or patient outcomes in ANOCA, INOCA, or acute MINOCA pathways. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Giovanni Taverna; Manuel Signorini; Emanuele Sammartini; Marco Guglielmo; Maria Teresa Savo; Giulia Mattesi; Valeria Pergola; Emanuele Visco; Giuseppe Ciliberti; Giorgio De Conti; Raffaella Motta; Christoph Gräni; Andrea Igoren Guaricci; Martina Perazzolo Marra

doi:10.3389/fcvm.2026.1958677

November 11, 2026Frontiers in Cardiovascular MedicineOpen Access

Cardiac CT in ANOCA, INOCA, and MINOCA: a structured narrative review of evidence, applications, and limitations

View Full Paper

Ask AI

Bookmark

Share

Key result

Advanced cardiac CT biomarkers across 154 reviewed publications do not establish improved mechanism-specific treatment selection or clinical outcomes in ANOCA, INOCA, or MINOCA pathways.

Why the study?

Cardiac CT depicts coronary anatomy and provides physiological and myocardial measurements in ANOCA, INOCA, and MINOCA, prompting an examination of what these measurements establish regarding anatomy, vasomotor mechanisms, prognosis, and clinical utility.

Does an advanced cardiac CT biomarker strategy improve mechanism-specific treatment selection or patient outcomes in patients with ANOCA, INOCA, or MINOCA?

Key Points

To evaluate the diagnostic capacity, mechanistic insights, prognostic relevance, and clinical utility of cardiac computed tomography in patients with non-obstructive coronary artery syndromes.
Structured narrative review conducting six-domain searches across PubMed, Embase, CENTRAL, and ClinicalTrials.gov updated through 23 September 2026.
Identified a bibliographic inventory of 154 publications using single-assessor historical screening and revision-stage triage rather than duplicate systematic screening.
Coronary CT angiography delineates plaque, bridging, and anomalies, but CT-derived fractional flow reserve assesses only epicardial pressure loss and CT perfusion does not independently distinguish vasomotor mechanisms.
Associations between pericoronary adipose tissue attenuation and vasomotor endotypes were inconsistent across cohorts, including non-significant fat attenuation index differences in the right coronary (P = 0.24) and left anterior descending (P = 0.69) arteries.

Structured PICO

Does an advanced cardiac CT biomarker strategy improve mechanism-specific treatment selection or patient outcomes in patients with ANOCA, INOCA, or MINOCA?

P

Population

Patients with angina, ischemia, or acute myocardial injury with non-obstructive coronary arteries (ANOCA, INOCA, and MINOCA) evaluated across 154 publications in a structured narrative review.

I

Intervention

Cardiac computed tomography (CT), including conventional coronary CT angiography (CCTA), pericoronary adipose tissue assessment, CT-derived fractional flow reserve (CT-FFR), myocardial CT perfusion, late iodine enhancement (LIE), and CT-derived extracellular volume (ECV).

C

Comparator

Invasive coronary angiography, invasive coronary function testing, intracoronary imaging (OCT/IVUS), and multiparametric cardiovascular magnetic resonance (CMR).

O

Outcome

Anatomical characterization, vasomotor mechanism identification (endotyping), diagnostic performance, prognosis, and clinical utility (mechanism-specific treatment selection and patient outcomes).

While conventional CCTA reliably depicts coronary anatomy and plaque in non-obstructive syndromes, advanced CT biomarkers do not independently identify vasomotor mechanisms or replace invasive coronary function testing and multiparametric CMR.

Limitations

Targeted literature selection involving single-assessor historical screening and revision-stage triage rather than a formal systematic review process
No independent validation subset or formal adjudication procedure was used during screening
Syndrome-specific ANOCA, INOCA, vasomotor, and suspected MINOCA cohorts remain small and observational
Definition drift, non-equivalent CT outputs, heterogeneous reference standards, and reuse of related parent cohorts complicate evidence appraisal
Targeted selection involving single-assessor historical screening and revision-stage triage rather than a systematic review process
No independent validation subset or formal adjudication procedure was used
Definition drift between historical infarction-based and contemporary injury-based MINOCA definitions
Heterogeneous reference standards, non-equivalent CT outputs, and reuse/overlap of related parent cohorts

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Advanced CT biomarkers should not yet guide mechanism-specific therapy in ANOCA/INOCA/MINOCA; leaves open need for prospective trials versus invasive physiology or CMR.

Abstract

Cardiac computed tomography (CT) depicts coronary anatomy and provides additional physiological and myocardial measurements in angina or ischemia with non-obstructive coronary arteries (ANOCA/INOCA) and acute non-obstructive presentations. This structured narrative review examines what these measurements establish about anatomy, vasomotor mechanisms, prognosis, and clinical utility. Six-domain searches of PubMed, Embase, and CENTRAL, supplemented by citation-based sources and ClinicalTrials.gov, were updated through 23 September 2026. The bibliographic inventory contains 154 publications; selection was targeted, involving single-assessor historical screening and revision-stage triage rather than a systematic-review process. Contemporary MINOCA denotes myocardial injury with non-obstructive coronary arteries as a working diagnosis; historical study definitions are preserved. Conventional coronary CT angiography depicts plaque, anomalies, myocardial bridging, and selected coronary-wall abnormalities. Plaque and pericoronary-fat associations vary with the population and reference standard. Small syndrome-specific studies and related cohorts provide limited diagnostic evidence; prognostic associations do not validate vasomotor endotyping. CT-derived fractional flow reserve concerns epicardial pressure loss, while CT perfusion does not independently identify a vasomotor mechanism. Late iodine enhancement and CT-derived extracellular volume provide myocardial information, but agreement with individual cardiovascular magnetic resonance (CMR) measurements does not establish equivalence to multiparametric CMR. After non-obstructive invasive angiography, additional CT should answer a defined residual question and justify contrast exposure, radiation, and diagnostic delay. The evidence examined in this review does not establish that an advanced CT biomarker strategy improves mechanism-specific treatment selection or patient outcomes in ANOCA/INOCA or an acute MINOCA pathway.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Taverna et al. (2026) conducted a review in Angina, ischemia, or myocardial injury with non-obstructive coronary arteries (ANOCA, INOCA, and MINOCA). Cardiac computed tomography (conventional CCTA, pericoronary fat assessment, CT-FFR, CT perfusion, late iodine enhancement, and CT-derived extracellular volume) vs. Invasive coronary angiography, coronary function testing, intracoronary imaging, and multiparametric cardiovascular magnetic resonance (CMR) was evaluated on Diagnostic validation, vasomotor endotyping, mechanism-specific treatment selection, and clinical utility. Advanced cardiac CT biomarkers across 154 reviewed publications do not establish improved mechanism-specific treatment selection or clinical outcomes in ANOCA, INOCA, or MINOCA pathways.

synapsesocial.com/papers/6af5cd33a40bbe8669e89c7f https://doi.org/10.3389/fcvm.2026.1958677

View Full Paper

Ask AI

Bookmark

Share

Cardiac CT in ANOCA, INOCA, and MINOCA: a structured narrative review of evidence, applications, and limitations

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Cardiac CT in ANOCA, INOCA, and MINOCA: a structured narrative review of evidence, applications, and limitations

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading