Endotype-driven Classification, Diagnosis, and Targeted Treatment of Functional Coronary Vascular Disease
By
Omar El Khatib
Ashraf Al Azzoni
Ronney Shantouf
Bassam Atallah
July 20, 2026
Clinical Scorecard: Endotype-driven Classification, Diagnosis, and Targeted Treatment of Functional Coronary Vascular Disease
At a Glance
Category Detail
Condition Angina with Non-Obstructive Coronary Arteries (ANOCA) Key Mechanisms Endothelial dysfunction, impaired vasodilation, inappropriate vasoconstriction Target Population Patients with angina and exertional dyspnea without obstructive coronary lesions Care Setting Cardiology clinics and diagnostic imaging centers
Key Highlights
Up to 70% of patients with anginal symptoms may have ANOCA. ANOCA can progress to INOCA, MINOCA, and ischemic cardiomyopathy. Diagnosis involves a stepwise assessment including ECG and non-invasive testing. Management should be endotype-specific, integrating pharmacologic and non-pharmacologic therapies. Early recognition and targeted therapies are crucial for improving prognosis. Guideline-Based Recommendations
Diagnosis
Initial evaluation includes 12-lead ECG and targeted laboratory studies. Use standardized tools like RF-CL model and coronary artery calcium scoring. Management
Integrate endotype-specific pharmacologic therapies such as calcium channel blockers and nitrates. Include lifestyle modifications and cardiovascular risk reduction strategies. Monitoring & Follow-up
Implement structured follow-up pathways for patients with ANOCA and INOCA. Risks
Patients with INOCA and non-obstructive coronary atheroma are at increased risk of major adverse cardiac events. Patient & Prescribing Data
Patients experiencing angina with non-obstructive coronary arteries.
Personalized, endotype-guided strategies are essential for optimizing symptom control.
Clinical Best Practices
Conduct a systematic, multimodal assessment before invasive testing. Utilize advanced diagnostic modalities for higher-risk classifications. Related Resources & Content
