{"id":"46076","type":"article","url":"https://hartvaat.nl/2026/04/17/niet-invasieve-endotypering-met-stress-mri-verbetert-de-behandeling-van-angina-z/","title":"Niet-invasieve endotypering met stress-MRI verbetert de behandeling van angina zonder vernauwingen (ANOCA)","title_en":"","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e004135?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e004135?rss=1","authors":["Bradley","C. P.","McKinley","G.","Orchard","V.","Tiller","C.","Stanley","B.","Ang","D.","Morrow","A. J.","Sykes","R.","Gildea","P.","Petty","M.","Brogan","R.","Carrick","D.","Collison","D.","Eteiba","H.","Ghattas","A.","Good","R.","Joshi","F.","Lindsay","M.","McCartney","P.","McGowan","J.","McGeoch","R.","Robertson","K. E.","Rocchiccioli","J. P.","Shaukat","A.","Watkins","S.","Kellman","P.","McConnachie","A.","Berry","C."],"significance":7,"published":"2026-07-21","source_date":"2026-04-17","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stabiele-angina-pectoris/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"Patients with angina and no obstructive coronary artery disease (ANOCA) often receive empirical antianginal therapy that misses the underlying mechanism. In this randomised trial (Coronary Microvascular Angina CMR Imaging Trial; 250 patients with ANOCA after non-obstructive coronary angiography), stress perfusion CMR with myocardial blood-flow quantification (intervention) was compared with angiography-guided care (control). Stress CMR led to a new diagnosis in 53%, with microvascular angina in 51%. At 12 months, treatment satisfaction (TSQM-9) was substantially higher in the intervention group (difference 19.3 points), with more appropriate prescribing: more preventive therapy (86% vs 68%) and more targeted antianginals (more calcium channel blockers and long-acting nitrates). Non-invasive CMR-guided endotyping thus improves satisfaction and leads to more mechanism-targeted medication in ANOCA.","created":"2026-07-03T20:27:15Z","updated":"2026-07-04T19:09:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Patiënten met angina pectoris zonder obstructief coronairlijden (ANOCA) krijgen vaak empirische antiangineuze therapie die het onderliggende mechanisme niet raakt. In deze gerandomiseerde trial (Coronary Microvascular Angina CMR Imaging Trial; 250 patiënten met ANOCA na een coronairangiografie zonder obstructie) werd stress-perfusie-MRI met kwantificatie van de myocardiale doorbloeding (interventie) vergeleken met angiografie-geleide zorg (controle). De stress-MRI leidde bij 53% tot een nieuwe diagnose, met microvasculaire angina bij 51%. Na 12 maanden was de behandeltevredenheid (TSQM-9) fors hoger in de interventiegroep (verschil 19,3 punten) en werd er passender voorgeschreven: meer preventieve therapie (86% vs. 68%) en gerichter antiangineus (meer calciumantagonisten en langwerkende nitraten). Niet-invasieve, MRI-gestuurde endotypering verbetert dus de tevredenheid én leidt tot meer mechanisme-gerichte medicatie bij ANOCA.","abstract_original":"<sec><st>Background</st>\n<p>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.</p>\n</sec>\n<sec><st>Methods</st>\n<p>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.</p>\n</sec>\n<sec><st>Results</st>\n<p>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&lt;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&lt;0.001).</p>\n</sec>\n<sec><st>Conclusions</st>\n<p>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.</p>\n</sec>\n<sec><st>Trial registration number</st>\n<p>ClinicalTrials.gov ID <A HREF=\"NCT04805814\">NCT04805814</A>.</p>\n</sec>"}