{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T22:54:23Z","timestamp":1783464863230,"version":"3.55.0"},"reference-count":37,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:00:00Z","timestamp":1761609600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Pharmacologic therapy guided by invasive coronary function tests (CFTs) may improve symptomatic outcomes in patients with angina and non-obstructive coronary artery disease (ANOCA). In this study, we specifically aimed to investigate whether the induction of coronary microvascular spasm (CMVS) by the acetylcholine (Ach) test predicts a better therapeutic effect of calcium-channel blocker therapy compared to beta-blocker therapy. Methods: We enrolled 31 ANOCA patients, who were divided into two groups according to the result of Ach testing: 16 patients with CMVS (CMVS group) and 15 patients with a negative test (NEG group). Patients with Ach-induced epicardial spasm were excluded. In an open-label crossover trial, patients were randomly assigned to each receive, for a period of 4 weeks, either metoprolol (50 mg twice daily) or diltiazem (120 mg twice daily). At the end of each 4-week period, patients underwent an ECG\u2013exercise stress test (EST) and were invited to fill out the Seattle Angina Questionnaire (SAQ). Results: No significant differences were found between metoprolol and diltiazem in terms of SAQ scores, and ECG-EST results were also largely comparable with the two drug treatments, both in the CMVS group and the NEG group. In particular, the SAQ summary score was 63.1 \u00b1 24 and 66.0 \u00b1 25 (p = 0.59) for metoprolol and diltiazem, respectively, in the CMVS group, and 70.9 \u00b1 17 and 74.3 \u00b1 16 (p = 0.37) with the two drugs, respectively, in the NEG group. Conclusions: Our small open-label study shows that patients with ANOCA with negative Ach test or Ach-induced CMVS show largely comparable short-term symptomatic outcomes and ECG-EST results when treated with either metoprolol or diltiazem.<\/jats:p>","DOI":"10.3390\/jcm14217635","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T09:16:24Z","timestamp":1761729384000},"page":"7635","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Metoprolol vs. Diltiazem in Patients with Angina and Non-Obstructive Coronary Artery Disease with or Without Evidence of Coronary Microvascular Spasm on Acetylcholine Testing"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6588-6035","authenticated-orcid":false,"given":"Angelo Giuseppe","family":"Marino","sequence":"first","affiliation":[{"name":"Dipartimento di Scienze Cardiovascolari e del Torace, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1538-0483","authenticated-orcid":false,"given":"Nello","family":"Cambise","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"De Benedetto","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Cardiovascolari e del Torace, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludovica","family":"Lenci","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Cardiovascolari e del Torace, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5855-5525","authenticated-orcid":false,"given":"Sara","family":"Pontecorvo","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Cardiovascolari e del Torace, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0956-3451","authenticated-orcid":false,"given":"Federico","family":"Di Perna","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Cardiovascolari e del Torace, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0551-7797","authenticated-orcid":false,"given":"Giacomo","family":"Buonamassa","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Cardiovascolari e del Torace, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3684-3355","authenticated-orcid":false,"given":"Antonietta","family":"Belmusto","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Cardiovascolari e del Torace, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6837-6464","authenticated-orcid":false,"given":"Saverio","family":"Tremamunno","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8725-7447","authenticated-orcid":false,"given":"Antonio","family":"De Vita","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6987-5750","authenticated-orcid":false,"given":"Rosangela","family":"Capasso","sequence":"additional","affiliation":[{"name":"Dipartimento di Medicina Clinica e Molecolare, Divisione di Cardiologia, Sapienza Universit\u00e0 di Roma, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6439-1018","authenticated-orcid":false,"given":"Rocco Antonio","family":"Montone","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2187-6653","authenticated-orcid":false,"given":"Gaetano Antonio","family":"Lanza","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Cardiovascolari e del Torace, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","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. 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