The assessment of ANOCA: coming of age?

Can one think of a single physiological function that does not deteriorate with age? It would have been surprising to see that the function of the coronary microcirculation behaved any differently, and this impression is supported by recent work1.

Accordingly, the results published in this issue of EuroIntervention by Jansen et al2 come as no surprise. However, to tackle the question of how microvascular function changes in older patients, the authors used, for the first time, continuous thermodilution-derived absolute flow and resistance measurements. Microvascular function was evaluated in a cohort of 305 patients with angina with no obstructive coronary artery disease (ANOCA). The mean age of the cohort was 59±9 years, and the vast majority of patients were female (83%). Of note, significant epicardial disease was totally excluded, both in terms of significant focal disease (any diameter stenosis >30%) and haemodynamically significant disease (fractional flow reserve [FFR] ≤0.80). In order to evaluate the impact of age on measures of microvascular function, linear regression was used with age as a continuous variable, whilst the cohort was also analysed in 3...