A proposal of an echocardiography-based pathway for the diagnosis and management of angina with no obstructive coronary arteries: a state-of-the-art review: Advancing Targeted Therapy and Prognosis Through Endotype Identification.

In this paper we are discussing the currently available tools in the diagnosis of angina with non-occlusive coronary artery disease (ANOCA) a potentially disabling condition that affects approximately 30-60% of patients with angina. With the advancement in ultrasound technology, multi-parametric stress echocardiography in combination with hyperventilation provocation echocardiography lends itself as a bedside, scalable, safe and cost-effective test to triage patients who may require downstream invasive functional coronary angiography. The review is providing with the critical appraisal of the current invasive and non-invasive imaging modalities before the proposal of a fully non-invasive echocardiography-based pathway to identify ANOCA endotypes to allow delivery of targeted therapy for symptom control to avoid recurrent hospital admissions and to monitor treatment effect to improve quality of life and prognosis in ANOCA patients.