{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T22:02:41Z","timestamp":1791237761206,"version":"4.1.0"},"reference-count":38,"publisher":"Radcliffe Medical Media Ltd","license":[{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/legalcode"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur Cardiol"],"abstract":"<jats:p>Background: Invasive coronary functional tests (I-CFTs) can identify the mechanism(s) of angina in patients with non-obstructed coronary arteries (ANOCA). In this study, we assessed whether non-invasive coronary functional tests (NI-CFTs) can also produce reliable results when assessing these mechanisms. Methods: We performed NI-CFTs by recording coronary blood flow velocity (CBFV) in the left anterior descending coronary artery by transthoracic Doppler echocardiography in 18 patients with ANOCA who had undergone I-CFTs (an acetylcholine provocation test and an adenosine stress test) and 13 healthy controls. The NI-CFTs included hyperventilation, a dipyridamole stress test and a cold pressor test. Results: Acetylcholine induced epicardial or coronary microvascular spasm in 11 patients (61.1%), whereas adenosine coronary flow reserve (CFR) was reduced (&lt;2.5) in seven (39%). Hyperventilation-induced coronary vasoconstriction produced a reduction in CBFV &gt;10% compared to baseline in eight patients (44.4%) and none in the control group (p=0.005). Dipyridamole-CFR was lower in the patient group than in the control group (2.25 \u00b1 0.49 versus 2.76\u00b10.49; p=0.01) and correlated with adenosine-CFR (r=0.75; p&lt;0.001). Full agreement in coronary abnormalities detected during I-CFTs and NI-CFTs (hyperventilation\/dipyridamole stress test) was found in 14 patients (77.8%). Furthermore, cold pressor test-CFR was lower in patients than in the control group (1.33 \u00b1 0.18 versus 1.52 \u00b1 0.22; p=0.019); cold pressor test-CFR &lt;1.35 identified three patients who showed both normal I-CFTs and a normal response to hyperventilation and dipyridamole at NI-CFTs. Conclusion: In ANOCA patients, the results of NI-CFTs performed with transthoracic Doppler echocardiography of the left anterior descending coronary artery showed a high correlation with coronary function abnormalities detected using I-CFTs. Our data suggest that NI-CFTs deserve investigation in larger multicentre studies to assess their usefulness in guiding clinical management of ANOCA patients.<\/jats:p>","DOI":"10.15420\/ecr.2025.54","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T11:56:40Z","timestamp":1768910200000},"source":"Crossref","is-referenced-by-count":3,"title":["Non-invasive Coronary Functional Tests in Patients with Angina and Non-obstructive Coronary Artery Disease"],"prefix":"10.15420","author":[{"given":"Nello","family":"Cambise","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00rg70c39","id-type":"ROR","asserted-by":"publisher"}],"name":"Agostino Gemelli University Polyclinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6588-6035","authenticated-orcid":false,"given":"Angelo Giuseppe","family":"Marino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"De Benedetto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauro","family":"Cortigiani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludovica","family":"Lenci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8725-7447","authenticated-orcid":false,"given":"Antonio","family":"De Vita","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00rg70c39","id-type":"ROR","asserted-by":"publisher"}],"name":"Agostino Gemelli University Polyclinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6837-6464","authenticated-orcid":false,"given":"Saverio","family":"Tremamunno","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00rg70c39","id-type":"ROR","asserted-by":"publisher"}],"name":"Agostino Gemelli University Polyclinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Lombardo","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00rg70c39","id-type":"ROR","asserted-by":"publisher"}],"name":"Agostino Gemelli University Polyclinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4775-8380","authenticated-orcid":false,"given":"Quirino","family":"Ciampi","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01x9zv505","id-type":"ROR","asserted-by":"publisher"}],"name":"Fatebenefratelli Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1276-9883","authenticated-orcid":false,"given":"Antonio Maria","family":"Leone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6439-1018","authenticated-orcid":false,"given":"Rocco Antonio","family":"Montone","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00rg70c39","id-type":"ROR","asserted-by":"publisher"}],"name":"Agostino Gemelli University Polyclinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9777-013X","authenticated-orcid":false,"given":"Carlo","family":"Trani","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00rg70c39","id-type":"ROR","asserted-by":"publisher"}],"name":"Agostino Gemelli University Polyclinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6569-9401","authenticated-orcid":false,"given":"Francesco","family":"Burzotta","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00rg70c39","id-type":"ROR","asserted-by":"publisher"}],"name":"Agostino Gemelli University Polyclinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenio","family":"Picano","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02122at02","id-type":"ROR","asserted-by":"publisher"}],"name":"Univerzitetski Klini\u010dki Centar Srbije"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2187-6653","authenticated-orcid":false,"given":"Gaetano Antonio","family":"Lanza","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00rg70c39","id-type":"ROR","asserted-by":"publisher"}],"name":"Agostino Gemelli University Polyclinic"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6096","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Patel MR, Peterson ED, Dai D, et al. 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