Coronary Microvascular Function and Cardiovascular Risk Factors in Women With Angina Pectoris and No Obstructive Coronary Artery Disease: The iPOWER Study

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

C. Noel Bairey Merz¹  Eva Prescott²  Nynne Dose²  Naja Dam Mygind²  Rebekka Faber²  Marie Mide Michelsen²  Adam Pena³  Peter Riis Hansen³  Daria Frestad⁴  Ida Gustafsson⁴  Ahmed Aziz⁵  Henrik Steen Hansen⁵  Nis Høst⁶  Jens Kastrup⁶ 

[1] Barbra Streisand Women's Heart Center, Cedars‐Sinai Heart Institute, Los Angeles, CA;Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark;Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark;Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Denmark;Department of Cardiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark;Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark;

关键词: angina pectoris;    coronary artery disease;    echocardiography;    microvascular dysfunction;    women;   

DOI  :  10.1161/JAHA.115.003064

来源: DOAJ

【 摘 要 】

BackgroundThe 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 ResultsAfter 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 (r2=0.09). CFVR was not associated with chest pain characteristics or results from diagnostic stress testing. ConclusionImpaired 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.

【 授权许可】

Unknown