{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T05:50:10Z","timestamp":1792389010071,"version":"4.4.0"},"reference-count":19,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:00:00Z","timestamp":1792281600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:00:00Z","timestamp":1792281600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100011949","name":"Abbott Vascular","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011949","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Angina with non\u2010obstructive coronary arteries (ANOCA) is an underrecognized cause of angina with non\u2010universal diagnostic techniques and patient management strategies. Among ANOCA testing, vasospasm provocation is not always performed mainly due to differences in institutional availability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Using the FlowLab Study, we quantified vasospasm prevalence among patients with ANOCA at US centers and compared physician decision\u2010making, endotype distribution, and management between sites that did and did not include vasospasm testing in their workup.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The FlowLab Study was a prospective, multicenter, US\u2010based study of patients who were referred for coronary angiography and underwent ANOCA testing using the bolus thermodilution method. Presumed diagnosis before cardiac catheterization and final diagnosis after ANOCA testing were compared between participating sites with or without acetylcholine testing availability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 253 procedures at 14 US sites were included in this study. There were 155 procedures among sites performing spasm provocation testing and 98 procedures among sites not performing spasm provocation testing. Prior to cardiac catheterization, sites with spasm provocation testing were less likely to suspect epicardial coronary artery disease as the cause of angina compared to sites without (27% vs. 59.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). A diagnosis of CMD was made more frequently at sites performing spasm testing compared to sites not performing spasm testing (68% vs. 29.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Similarly, among 125 patients who underwent spasm provocation testing, diagnostic yield increased from 34.4% with bolus thermodilution alone to 84.8% after the addition of spasm provocation testing (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). In these patients, intensification involving calcium channel blockers was more frequent with epicardial (67%) and microvascular spasm (41%) than without spasm (24%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In contemporary US practice, adding spasm provocation testing to bolus thermodilution more than doubled diagnostic yield and was followed by medication changes directed toward the diagnosed endotype. Differences between sites with and without spasm testing also reflected variation in procedural practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccd.70947","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T05:37:11Z","timestamp":1792388231000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Additive Value of Acetylcholine Testing in ANOCA: A US\u2010Based Multicenter FlowLab Study"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4904-0049","authenticated-orcid":false,"given":"Edward T.","family":"Ha","sequence":"first","affiliation":[{"name":"Section of Interventional Cardiology Medstar Washington Hospital Center Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3664-4102","authenticated-orcid":false,"given":"Samit M.","family":"Shah","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine Yale School of Medicine New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8607-6935","authenticated-orcid":false,"given":"Olga","family":"Toleva","sequence":"additional","affiliation":[{"name":"Georgia Heart Institute Gainesville Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krystyna","family":"Bronchard","sequence":"additional","affiliation":[{"name":"New York\u2010Presbyterian Brooklyn Methodist Hospital Weill Cornell Medical College New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1360-9216","authenticated-orcid":false,"given":"Kathleen E.","family":"Kearney","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine University of Washington Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4849-6389","authenticated-orcid":false,"given":"Akl C.","family":"Fahed","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farouc","family":"Jaffer","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John E. A.","family":"Blair","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine University of Washington Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allen","family":"Jeremias","sequence":"additional","affiliation":[{"name":"St. Francis Hospital Roslyn New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2413-7865","authenticated-orcid":false,"given":"Joia","family":"Spinelli","sequence":"additional","affiliation":[{"name":"Abbott Vascular Santa Clara California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4360-7606","authenticated-orcid":false,"given":"Brian A.","family":"Bergmark","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women's Hospital Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhei","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"New York\u2010Presbyterian Brooklyn Methodist Hospital Weill Cornell Medical College New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,18]]},"reference":[{"issue":"12","key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1016\/j.jacc.2023.06.043","article-title":"Comprehensive Management of ANOCA, Part 1\u2014Definition, Patient Population, and Diagnosis","volume":"82","author":"Samuels B. 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