{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T21:05:58Z","timestamp":1780434358991,"version":"3.54.1"},"reference-count":24,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"unspecified","delay-in-days":53,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,2,11]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Invasive coronary function testing (CFT) is indicated in patients with refractory angina with non-obstructed coronary arteries (ANOCA). Despite this, questions remain regarding patient selection for testing, safety and integration of CFT within clinical pathways and the impact that endotyping has on long term management of these patients. This study aims to investigate the safety of CFT in patients presenting with anginal chest pain, the prevalence of ANOCA endotypes in the tested population, and the impact of CFT on prescribed medical therapy and secondary care resource utilisation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis of electronic case records of 159 consecutive patients who underwent complete invasive CFT at two UK centres between June 2022 and December 2024 was performed. All patients were tested for endothelium-independent coronary microvascular dysfunction (CMD) and coronary vasospasm (vasospastic angina (VSA)). 44 patients (27.6%) also underwent endothelial function assessment. The median length of follow-up was 9 months (IQR 4\u201316).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>An ANOCA endotype was identified in 101 patients (63.5%) (CFT+ve). Of those, 24 (23.8%) were diagnosed with isolated CMD, 53 (52.4%) with isolated VSA and 24 (23.8%) with a mixed endotype. Five (3.1%) experienced intraprocedural adverse events. In 123 patients (77.3%), CFT led to a change in medical therapy. Re-hospitalisation for recurrent chest pain occurred in 21.7% of CFT+ve\u2009and 13.7% of CFT\u2212ve patients, with the majority re-presenting within 6 months of CFT. VSA was linked to higher re-hospitalisation odds (OR 2.64 (1.10\u20136.33), p=0.03), and patients with VSA tended to re-present earlier than others (p=0.017). Higher antianginal therapy prescription and prior emergency presentations were also predictive of risk of re-presentation (OR 1.61, p=0.02\u2009and OR 4.18, p=0.001, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CFT testing had low intraprocedural risk and influenced onward management. Hospitalisation for chest pain post CFT testing was common. Further refinement of clinical pathways, including early follow-up for medical optimisation, is suggested.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003910","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T13:30:19Z","timestamp":1771853419000},"page":"e003910","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of invasive coronary function testing on management of ANOCA patients and secondary care resource utilisation: insights from a multicentre retrospective study in the UK"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4253-8533","authenticated-orcid":false,"given":"Joanna","family":"Abramik","sequence":"first","affiliation":[{"name":"Cardiology, Royal United Hospital Bath NHS Trust, Bath, UK"},{"name":"Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"},{"name":"Department of Health, University of Bath, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Withers","sequence":"additional","affiliation":[{"name":"Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0670-2567","authenticated-orcid":false,"given":"David","family":"Murphy","sequence":"additional","affiliation":[{"name":"Cardiology, Royal United Hospital Bath NHS Trust, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan CL","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Department of Health, University of Bath, Bath, UK"},{"name":"Radiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Khavandi","sequence":"additional","affiliation":[{"name":"Cardiology, Royal United Hospital Bath NHS Trust, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dylan","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Health, University of Bath, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Felekos","sequence":"additional","affiliation":[{"name":"Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Carson","sequence":"additional","affiliation":[{"name":"Cardiology, Royal United Hospital Bath NHS Trust, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Mariathas","sequence":"additional","affiliation":[{"name":"Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,23]]},"reference":[{"key":"2026022305300862000_13.1.e003910.1","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.ijcard.2020.04.074","article-title":"Myocardial ischemia: From disease to syndrome","volume":"314","author":"Marzilli","year":"2020","journal-title":"Int J Cardiol"},{"key":"2026022305300862000_13.1.e003910.2","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.119.014954","article-title":"Association of Isolated Coronary Microvascular Dysfunction With Mortality and Major Adverse Cardiac Events: A Systematic Review and Meta-Analysis of Aggregate Data","volume":"9","author":"Gdowski","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"2026022305300862000_13.1.e003910.3","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehr331"},{"key":"2026022305300862000_13.1.e003910.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.09.006"},{"key":"2026022305300862000_13.1.e003910.5","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae177"},{"key":"2026022305300862000_13.1.e003910.6","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1136\/heartjnl-2021-320718","article-title":"Invasive coronary physiology in patients with angina and non-obstructive coronary artery disease: a consensus document from the coronary microvascular dysfunction workstream of the British Heart Foundation\/National Institute for Health Research Partnership","volume":"109","author":"Perera","year":"2022","journal-title":"Heart"},{"key":"2026022305300862000_13.1.e003910.7","first-page":"539","article-title":"Coronary Endothelial Function","volume":"18","author":"Ibrahim","year":"2025","journal-title":"JACC: Cardiovascular Interventions"},{"key":"2026022305300862000_13.1.e003910.8","doi-asserted-by":"crossref","unstructured":"Beltrame JF , Crea F , Kaski JC , et al . International standardization of diagnostic criteria for vasospastic angina. Eur Heart J 2015;ehv351. doi:10.1093\/eurheartj\/ehv351","DOI":"10.1093\/eurheartj\/ehv351"},{"key":"2026022305300862000_13.1.e003910.9","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.121.023207","article-title":"Prevalence of Coronary Microvascular Disease and Coronary Vasospasm in Patients With Nonobstructive Coronary Artery Disease: Systematic Review and Meta-Analysis","volume":"11","author":"Mileva","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"2026022305300862000_13.1.e003910.10","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.4244\/EIJ-D-21-00402","article-title":"Principles and pitfalls in coronary vasomotor function testing","volume":"17","author":"Feenstra","year":"2022","journal-title":"EuroIntervention"},{"key":"2026022305300862000_13.1.e003910.11","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.jjcc.2016.09.012","article-title":"Overview of the pharmacological spasm provocation test: Comparisons between acetylcholine and ergonovine","volume":"69","author":"Sueda","year":"2017","journal-title":"J Cardiol"},{"key":"2026022305300862000_13.1.e003910.12","doi-asserted-by":"crossref","DOI":"10.3390\/jcm14041128","article-title":"Coronary Microvascular Dysfunction and Vasospastic Angina-Pathophysiology, Diagnosis and Management Strategies","volume":"14","author":"Abramik","year":"2025","journal-title":"J Clin Med"},{"key":"2026022305300862000_13.1.e003910.13","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0093170","article-title":"Burden of hospital admission and repeat angiography in angina pectoris patients with and without coronary artery disease: a registry-based cohort study","volume":"9","author":"Jespersen","year":"2014","journal-title":"PLoS One"},{"key":"2026022305300862000_13.1.e003910.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2022.09.047"},{"key":"2026022305300862000_13.1.e003910.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2023.10.034"},{"key":"2026022305300862000_13.1.e003910.16","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad191"},{"key":"2026022305300862000_13.1.e003910.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.11.031"},{"key":"2026022305300862000_13.1.e003910.18","doi-asserted-by":"crossref","first-page":"133176","DOI":"10.1016\/j.ijcard.2025.133176","article-title":"Invasive coronary function testing in clinical practice: Implementing the 2024 ESC guidelines on chronic coronary syndromes","volume":"430","author":"Namba","year":"2025","journal-title":"Int J Cardiol"},{"key":"2026022305300862000_13.1.e003910.19","doi-asserted-by":"crossref","DOI":"10.3390\/jcm10184270","article-title":"Current Evidence on Long-Term Prognostic Factors in Vasospastic Angina","volume":"10","author":"Kim","year":"2021","journal-title":"J Clin Med"},{"key":"2026022305300862000_13.1.e003910.20","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy185"},{"key":"2026022305300862000_13.1.e003910.21","doi-asserted-by":"crossref","unstructured":"Crooijmans C , Jansen TPJ , Meeder JG , et al . Safety and feasibility of nationwide invasive coronary function testing in patients with angina and no obstructive coronary artery disease (NL-CFT). Eur Heart J 2024;45. doi:10.1093\/eurheartj\/ehae666.2362","DOI":"10.1093\/eurheartj\/ehae666.2362"},{"key":"2026022305300862000_13.1.e003910.22","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.004096"},{"key":"2026022305300862000_13.1.e003910.23","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1161\/CIRCULATIONAHA.123.066571","article-title":"Prevalence of Abnormal Coronary Function in Patients With Angina and No Obstructive Coronary Artery Disease on Coronary Computed Tomography Angiography: Insights From the CorCTA Trial","volume":"149","author":"Taqueti","year":"2024","journal-title":"Circulation"},{"key":"2026022305300862000_13.1.e003910.24","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.124.037913","article-title":"Angina Severity and Symptom Improvement Are Associated With Diagnostic Acetylcholine Provocation Dose in Vasospastic Angina","volume":"14","author":"Crooijmans","year":"2025","journal-title":"J Am Heart Assoc"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2025-003910","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T13:30:22Z","timestamp":1771853422000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2025-003910"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":24,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,2,23]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/openhrt-2025-003910"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2025-003910","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}