A multimodality approach to unravel the pathophysiology of ANOCA

Chronic coronary syndrome (CCS) comprises various underlying pathophysiological mechanisms, from obstructive coronary artery disease (CAD) to endotypes of Angina with Non-Obstructive Coronary Arteries (ANOCA). These endotypes include enhanced vasoconstriction (i.e. coronary vasospasm) and impaired vasodilation (i.e. coronary microvascular dysfunction (CMD)). However, a deeper understanding of CCS and it’s relation to ANOCA is essential. Therefore, the research described in this thesis aimed to achieve the following objectives: 1. To understand the relationship between sex and various endotypes of CCS. 2. To identify the role of sex differences in ANOCA. 3. To investigate reduction of myocardial blood volume as a potential pathophysiological mechanism in ANOCA. 4. To evaluate the possibilities to non-invasively diagnose ANOCA using Cardiac Magnetic Resonance (CMR) imaging.