Hoshino, MasahiroHoek, RoelJukema, RuurtDahdal, JorgeVan Diemen, PepijnRaijmakers, PieterDriessen, RoelTwisk, JosDanad, IbrahimKakuta, TsunekazuKnuuti, JuhaniKnaapen, Paul2026-09-232026-09-232025Hoshino, M., Hoek, R., Jukema, R. A., Dahdal, J., van Diemen, P., Raijmakers, P., Driessen, R., Twisk, J., Danad, I., Kakuta, T., Knuuti, J., & Knaapen, P. (2025). Homogeneity of the coronary microcirculation in angina with non-obstructive coronary artery disease. European heart journal. Cardiovascular Imaging, 26(7), 1120–1127. https://doi.org/10.1093/ehjci/jeaf101https://hdl.handle.net/11447/11172Aims: The homogeneity of coronary microvascular dysfunction (CMD) across different myocardial territories in angina with non-obstructive coronary artery disease (ANOCA) patients is scarcely explored. This study investigates the variability in microvascular resistance reserve (MRR) across the 3 main perfusion territories of the coronary circulation to investigate the homogeneity or dishomogeneity of microcirculatory function. Methods and results: This post hoc analysis of the PACIFIC trials included symptomatic ANOCA patients with [15O]H2O positron emission tomography (PET) and three-vessel invasive fractional flow reserve (FFR). MRR was computed in the three main coronary branches by integrating PET-derived coronary flow reserve and invasive FFR. A total of 155 patients (50% male, age 59 ± 10 years) and 465 vessels (MRR: 3.92 ± 1.21) were included. There were no significant differences in MRR among the three coronary branches. Correlations in MRR among the three coronary branches were good (r = 0.76 to 0.86). The mean difference between MRR measurements in different arteries was small (2.4 to 7.5%), without any consistent directional bias. The overall intra-class correlation coefficient for absolute agreement was 0.80 (95% CI: 0.74-0.85), indicating good single-measure reliability. Approximately 80% (123/155) of patients showed diagnostic concordance of CMD (MRR ≤3.0) across the three vessels. Conclusion: In most ANOCA patients, microvascular function is homogeneously distributed across the three major coronary territories. Single-artery testing may suffice in many cases, aligning with guidelines. However, some patients exhibit notable inter-territorial variation, suggesting that multi-vessel evaluation may be prudent in borderline scenarios.en[15O]H2O PETCoronary flow reserveFractional flow reserveMicrovascular resistance reservenon-obstructive coronary artery diseaseArticlehttps://doi.org/10.1093/ehjci/jeaf101