TY - JOUR

T1 - Coronary Microvascular Function and Cardiovascular Risk Factors in Women With Angina Pectoris and No Obstructive Coronary Artery Disease

T2 - The iPOWER Study

AU - Mygind, Naja Dam

AU - Michelsen, Marie Mide

AU - Peña, Adam

AU - Frestad, Daria

AU - Dose, Nynne

AU - Aziz, Ahmed

AU - Faber, Rebekka

AU - Høst, Nis

AU - Gustafsson, Ida

AU - Hansen, Peter Riis

AU - Hansen, Henrik Steen

AU - Bairey Merz, C Noel

AU - Kastrup, Jens

AU - Prescott, Eva

N1 - © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

PY - 2016/3

Y1 - 2016/3

N2 - BACKGROUND: The majority of women with angina-like chest pain have no obstructive coronary artery disease when evaluated with coronary angiography. Coronary microvascular dysfunction is a possible explanation and associated with a poor prognosis. This study evaluated the prevalence of coronary microvascular dysfunction and the association with symptoms, cardiovascular risk factors, psychosocial factors, and results from diagnostic stress testing.METHODS AND RESULTS: After screening 3568 women, 963 women with angina-like chest pain and a diagnostic coronary angiogram without significant coronary artery stenosis (<50%) were consecutively included. Mean age (SD) was 62.1 (9.7). Assessment included demographic and clinical data, blood samples, questionnaires, and transthoracic echocardiography during rest and high-dose dipyridamole (0.84 mg/kg) with measurement of coronary flow velocity reserve (CFVR) by Doppler examination of the left anterior descending coronary artery. CFVR was successfully measured in 919 (95%) women. Median (IQR) CFVR was 2.33 (1.98-2.76), and 241 (26%) had markedly impaired CFVR (<2). In multivariable regression analysis, predictors of impaired CFVR were age (P<0.01), hypertension (P=0.02), current smoking (P<0.01), elevated heart rate (P<0.01), and low high-density lipoprotein cholesterol (P=0.02), but these variables explained only a little of the CFVR variation (r(2)=0.09). CFVR was not associated with chest pain characteristics or results from diagnostic stress testing.CONCLUSION: Impaired CFVR was detected in a substantial proportion, which suggests that coronary microvascular dysfunction plays a role in the development of angina pectoris. CFVR was associated with few cardiovascular risk factors, suggesting that CFVR is an independent parameter in the risk evaluation of these women. Symptom characteristics and results from stress testing did not identify individuals with impaired CFVR.

AB - BACKGROUND: The majority of women with angina-like chest pain have no obstructive coronary artery disease when evaluated with coronary angiography. Coronary microvascular dysfunction is a possible explanation and associated with a poor prognosis. This study evaluated the prevalence of coronary microvascular dysfunction and the association with symptoms, cardiovascular risk factors, psychosocial factors, and results from diagnostic stress testing.METHODS AND RESULTS: After screening 3568 women, 963 women with angina-like chest pain and a diagnostic coronary angiogram without significant coronary artery stenosis (<50%) were consecutively included. Mean age (SD) was 62.1 (9.7). Assessment included demographic and clinical data, blood samples, questionnaires, and transthoracic echocardiography during rest and high-dose dipyridamole (0.84 mg/kg) with measurement of coronary flow velocity reserve (CFVR) by Doppler examination of the left anterior descending coronary artery. CFVR was successfully measured in 919 (95%) women. Median (IQR) CFVR was 2.33 (1.98-2.76), and 241 (26%) had markedly impaired CFVR (<2). In multivariable regression analysis, predictors of impaired CFVR were age (P<0.01), hypertension (P=0.02), current smoking (P<0.01), elevated heart rate (P<0.01), and low high-density lipoprotein cholesterol (P=0.02), but these variables explained only a little of the CFVR variation (r(2)=0.09). CFVR was not associated with chest pain characteristics or results from diagnostic stress testing.CONCLUSION: Impaired CFVR was detected in a substantial proportion, which suggests that coronary microvascular dysfunction plays a role in the development of angina pectoris. CFVR was associated with few cardiovascular risk factors, suggesting that CFVR is an independent parameter in the risk evaluation of these women. Symptom characteristics and results from stress testing did not identify individuals with impaired CFVR.

KW - Age Factors

KW - Aged

KW - Chi-Square Distribution

KW - Coronary Angiography

KW - Coronary Circulation

KW - Coronary Vessels

KW - Denmark

KW - Dipyridamole

KW - Echocardiography, Doppler

KW - Echocardiography, Stress

KW - Female

KW - Humans

KW - Linear Models

KW - Logistic Models

KW - Microcirculation

KW - Microvascular Angina

KW - Microvessels

KW - Middle Aged

KW - Multivariate Analysis

KW - Predictive Value of Tests

KW - Prevalence

KW - Risk Assessment

KW - Risk Factors

KW - Sex Factors

KW - Vasodilator Agents

KW - Women's Health

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1161/JAHA.115.003064

DO - 10.1161/JAHA.115.003064

M3 - Journal article

C2 - 27068634

VL - 5

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 3

M1 - e003064

ER -