{
  "abstract": "Background Patients with angina and no obstructive coronary artery disease (ANOCA) frequently receive empirical antianginal therapy that fails to target underlying pathophysiological mechanisms. Whether stress perfusion cardiac magnetic resonance (CMR)-guided endotyping and stratified medical therapy improves treatment satisfaction and appropriate medication prescribing in this population is uncertain.Methods In the Coronary Microvascular Angina CMR Imaging Trial, 250 patients with suspected ANOCA, who had undergone invasive coronary angiography demonstrating no obstructive disease, were enrolled and underwent stress perfusion CMR with quantification of myocardial blood flow. Participants were randomised 1:1 to CMR-guided management (intervention) or angiography-guided management (control). Treatment satisfaction was assessed using the validated Treatment Satisfaction Questionnaire for Medication (TSQM-9) at baseline, 6 months and 12 months. Medication prescriptions were documented at these time points.Results Stress CMR imaging led to diagnostic reclassification in 53.0% of patients, with microvascular angina diagnosed in 51.0%. At 12 months, global treatment satisfaction was significantly higher in the intervention group compared with controls (adjusted difference, 19.30 units (95% CI 13.89 to 24.71); p<0.001), with consistent improvements across the effectiveness and convenience domains. CMR-guided management was associated with more appropriate prescribing, including higher use of preventive therapies (85.5% vs 67.5%; p=0.001), and more targeted antianginal prescribing, including calcium channel blockers (43.5% vs 27.0%; p=0.008) and long-acting nitrates (56.5% vs 32.5%; p<0.001).Conclusions In patients with ANOCA, non-invasive CMR-guided endotyping substantially improves treatment satisfaction and enables more appropriate, mechanism-targeted pharmacotherapy compared with angiography-guided care.Trial registration number ClinicalTrials.gov ID NCT04805814.",
  "authors": [
    {
      "affiliations": [
        "University of Glasgow BHF Glasgow Cardiovascular Research Centre, Glasgow, Scotland, UK"
      ],
      "name": "Conor P Bradley"
    },
    {
      "affiliations": [
        "Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK"
      ],
      "name": "Gemma McKinley"
    },
    {
      "affiliations": [
        "Golden Jubilee National Hospital, Clydebank, Scotland, UK"
      ],
      "name": "Vanessa Orchard"
    },
    {
      "affiliations": [
        "Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria"
      ],
      "name": "Christina Tiller"
    },
    {
      "affiliations": [
        "University of Glasgow, Glasgow, UK"
      ],
      "name": "B Stanley"
    },
    {
      "affiliations": [
        "University of Glasgow BHF Glasgow Cardiovascular Research Centre, Glasgow, Scotland, UK",
        "Cardiology, Golden Jubilee National Hospital, Glasgow, UK"
      ],
      "name": "Daniel Ang"
    },
    {
      "affiliations": [
        "School of Cardiovascular and Metabolic Health, University of Glasgow BHF Glasgow Cardiovascular Research Centre, Glasgow, Scotland, UK"
      ],
      "name": "Andrew J Morrow"
    },
    {
      "affiliations": [
        "School of Cardiovascular and Metabolic Health, University of Glasgow College of Medical, Veterinary and Life Sciences, Glasgow, UK",
        "Cardiology, Golden Jubilee National Hospital, West of Scotland Regional Heart and Lung Centre, Glasgow, UK"
      ],
      "name": "Robert Sykes"
    },
    {
      "affiliations": [
        "Golden Jubilee National Hospital, Clydebank, Scotland, UK"
      ],
      "name": "Pamela Gildea"
    },
    {
      "affiliations": [
        "Golden Jubilee National Hospital, Clydebank, Scotland, UK"
      ],
      "name": "Maria Petty"
    },
    {
      "affiliations": [
        "Golden Jubilee National Hospital, Clydebank, Scotland, UK"
      ],
      "name": "Richard Brogan"
    },
    {
      "affiliations": [
        "University Hospital Hairmyres, East Kilbride, South Lanarkshire, UK"
      ],
      "name": "David Carrick"
    },
    {
      "affiliations": [
        "Golden Jubilee National Hospital, Clydebank, Scotland, UK"
      ],
      "name": "Damien Collison"
    },
    {
      "affiliations": [
        "Institute of Cardiovascular and Medical Sciences, University of Glasgow BHF Glasgow Cardiovascular Research Centre, Glasgow, Scotland, UK"
      ],
      "name": "Hany Eteiba"
    },
    {
      "affiliations": [
        "Golden Jubilee National Hospital, Clydebank, Scotland, UK"
      ],
      "name": "Angie Ghattas"
    },
    {
      "affiliations": [
        "University of Glasgow College of Medical, Veterinary and Life Sciences, Glasgow, UK",
        "Golden Jubilee National Hospital, West of Scotland Regional Heart and Lung Centre, Glasgow, UK"
      ],
      "name": "Richard Good"
    },
    {
      "affiliations": [
        "Golden Jubilee National Hospital, Clydebank, Scotland, UK"
      ],
      "name": "Francis Joshi"
    },
    {
      "affiliations": [
        "Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK"
      ],
      "name": "Mitchell Lindsay"
    },
    {
      "affiliations": [
        "University of Glasgow BHF Glasgow Cardiovascular Research Centre, Glasgow, Scotland, UK"
      ],
      "name": "Peter McCartney"
    },
    {
      "affiliations": [
        "Department of Cardiology, University Hospital Ayr, Ayr, UK"
      ],
      "name": "James McGowan"
    },
    {
      "affiliations": [
        "University Hospital Hairmyres, East Kilbride, South Lanarkshire, UK"
      ],
      "name": "Ross McGeoch"
    },
    {
      "affiliations": [
        "Golden Jubilee National Hospital, Clydebank, Scotland, UK"
      ],
      "name": "Keith E Robertson"
    },
    {
      "affiliations": [
        "Golden Jubilee National Hospital, Clydebank, Scotland, UK"
      ],
      "name": "J Paul Rocchiccioli"
    },
    {
      "affiliations": [
        "Golden Jubilee National Hospital, Clydebank, Scotland, UK"
      ],
      "name": "Aadil Shaukat"
    },
    {
      "affiliations": [
        "Golden Jubilee National Hospital, Clydebank, Scotland, UK"
      ],
      "name": "Stuart Watkins"
    },
    {
      "affiliations": [
        "Laboratory of Cardiac Energetics, National Heart, Lung and Blood Institute, Bethesda, Maryland, USA"
      ],
      "name": "Peter Kellman"
    },
    {
      "affiliations": [
        "Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK"
      ],
      "name": "Alex McConnachie"
    },
    {
      "affiliations": [
        "University of Glasgow BHF Glasgow Cardiovascular Research Centre, Glasgow, Scotland, UK",
        "Golden Jubilee National Hospital, Clydebank, Scotland, UK"
      ],
      "name": "Colin Berry"
    }
  ],
  "title": "Non-invasive endotyping improves treatment satisfaction and prescribing appropriateness in patients with angina and no obstructive coronary artery disease",
  "uid": "2d8e7856-73cb-5adc-a368-41b9a7b099a3"
}