{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T06:10:26Z","timestamp":1790662226643,"version":"4.1.0"},"reference-count":14,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:sec id=\"ab-hbr260013-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Coronary function testing (CFT) can be used to delineate the underlying mechanisms of chest pain in angina with nonobstructive coronary arteries (ANOCA). However, the association between overlapping ANOCA endotypes and angina burden remains poorly defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr260013-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the impact of multiple ANOCA endotypes on angina burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr260013-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This cross-sectional study included patients with suspected ANOCA who underwent acetylcholine provocation testing for endothelium-dependent abnormalities, adenosine-mediated physiology testing for endothelium-independent abnormalities, and intravascular ultrasound with hemodynamic testing for a functionally significant myocardial bridge between August 2007 and February 2025 at Stanford Hospital. Data were analyzed from March 2025 through May 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr260013-7\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>The primary outcome was the association between the number of ANOCA endotypes and angina burden. The Seattle Angina Questionnaire (SAQ) was used to evaluate overall angina burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr260013-8\">\n                    <jats:title>Exposure<\/jats:title>\n                    <jats:p>Patients undergoing comprehensive CFT for ANOCA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr260013-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 485 patients (mean [SD] age, 52 [14] years; 352 female patients [73%]) were included. There were 36 patients (7%) with no abnormalities, 150 patients (31%) with 1 endotype, 215 patients (44%) with 2 endotypes, and 84 patients (17%) with 3 endotypes identified on CFT. Mean (SD) SAQ summary scores were comparable among patients with an endothelium-dependent abnormality (50.5 [18.3]), an endothelium-independent abnormality (49.3 [19.9]), and myocardial bridging (49.8 [19.2]), and worsened with an increasing number of endotypes identified at CFT (normal CFT finding: 55.9 [17.6]; 1 endotype: 53.8 [17.7]; 2 endotypes: 51.2 [18.3]; and 3 endotypes: 45.7 [20.0];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.003). After multivariable adjustment, each additional endotype identified on CFT was associated with a lower SAQ summary score (B\u2009=\u2009\u22123.55; 95% CI, \u22125.56 to \u22121.54;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hbr260013-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this observational cross-sectional study, multiple endotypes frequently coexisted in patients with ANOCA, and a greater number of endotypes identified on CFT was associated with worse angina.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamacardio.2026.1234","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T15:30:25Z","timestamp":1779895825000},"page":"685","source":"Crossref","is-referenced-by-count":1,"title":["Multiple Endotypes and Angina Burden in Patients With Nonobstructive Coronary Arteries"],"prefix":"10.1001","volume":"11","author":[{"given":"Christopher C. Y.","family":"Wong","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, California"},{"name":"Division of Cardiology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China"},{"name":"Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vedant S.","family":"Pargaonkar","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke P.","family":"Dawson","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul R.","family":"Penumaka","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajan","family":"Rehan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia"},{"name":"Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andy S. C.","family":"Yong","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin K. C.","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiro","family":"Honda","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William F.","family":"Fearon","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingela","family":"Schnittger","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A.","family":"Tremmel","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"10","key":"hbr260013r1","doi-asserted-by":"publisher","first-page":"886","DOI":"10.1056\/NEJMoa0907272","article-title":"Low diagnostic yield of elective coronary angiography.","volume":"362","author":"Patel","year":"2010","journal-title":"N Engl J Med"},{"issue":"12","key":"hbr260013r2","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1016\/j.jacc.2023.06.043","article-title":"Comprehensive management of ANOCA, Part 1-definition, patient population, and diagnosis: JACC State-of-the-Art Review.","volume":"82","author":"Samuels","year":"2023","journal-title":"J Am Coll 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