scholarly journals Angina relates to coronary flow in women with ischemia and no obstructive coronary artery disease

2021 ◽  
Author(s):  
Nissi Suppogu ◽  
Janet Wei ◽  
Odayme Quesada ◽  
Chrisandra Shufelt ◽  
Galen Cook-Wiens ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Flow ◽  
Obstructive Coronary Artery Disease ◽  
Artery Disease

scholarly journals Left ventricular concentric remodelling and functional impairment in women with ischaemia with no obstructive coronary artery disease and intermediate coronary flow reserve: a report from the WISE-CVD study

2019 ◽  
Vol 20 (8) ◽  
pp. 875-882 ◽  
Author(s):  
Seong-Mi Park ◽  
Janet Wei ◽  
Galen Cook-Wiens ◽  
Michael D Nelson ◽  
Louise Thomson ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Obstructive Coronary Artery Disease ◽  
Left Ventricular ◽  
Flow Reserve ◽  
Group 2 ◽  
Artery Disease ◽  
Group 1

Abstract Aims Women with evidence of ischaemia but no obstructive coronary artery disease (INOCA) often have coronary microvascular dysfunction (CMD). Although invasively measured coronary flow reserve (CFR) is useful for the diagnosis of CMD, intermediate CFR values are often found of uncertain significance. We investigated myocardial flow reserve and left ventricular (LV) structural and functional remodelling in women with suspected INOCA and intermediate CFR. Methods and results Women’s Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study participants who had invasively measured intermediate CFR of 2.0≤ CFR ≤3.0 (n = 125) were included for this analysis. LV strain, peak filling rate (PFR) and myocardial perfusion reserve index (MPRI) were obtained by cardiac magnetic resonance imaging. Participants were divided: (i) Group 1 (n = 66) high MPRI ≥ 1.8, and (ii) Group 2 (n = 59) low MPRI < 1.8. The mean age was 54 ± 12 years and CFR was 2.46 ± 0.27. MPRI was significantly different but CFR did not differ between groups. LV relative wall thickness (RWT) trended higher in Group 2 and circumferential peak systolic strain and early diastolic strain rate were lower (P = 0.039 and P = 0.035, respectively), despite a similar LV ejection fraction and LV mass. PFR was higher in Group 1 and LV RWT was negatively related to PFR (r = −0.296, P = 0.001). Conclusions In women with suspected INOCA and intermediate CFR, those with lower MPRI had a trend towards more adverse remodelling and impaired diastolic LV function compared with those with higher MPRI. CFR was similar between the two groups. These findings provide evidence that both coronary microvessel vasomotion and structural and functional myocardial remodelling contribute to CMD.

scholarly journals Coronary flow velocity reserve predicts adverse prognosis in women with angina and no obstructive coronary artery disease: results from the iPOWER study

2020 ◽  
Author(s):  
Jakob Schroder ◽  
Marie M Michelsen ◽  
Naja D Mygind ◽  
Hannah E Suhrs ◽  
Kira B Bove ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Flow ◽  
Adverse Outcome ◽  
Obstructive Coronary Artery Disease ◽  
Composite Outcome ◽  
Coronary Flow Velocity Reserve ◽  
Coronary Flow Velocity ◽  
Artery Disease

Abstract Aims  Many patients with angina, especially women, do not have obstructive coronary artery disease (CAD) yet have impaired prognosis. We investigated whether routine assessment of coronary microvascular dysfunction (CMD) is feasible and predicts adverse outcome in women with angina and no obstructive CAD. Methods and results  After screening 7253, we included 1853 women with angina and no obstructive CAD on angiogram who were free of previous CAD, heart failure, or valvular heart disease in the prospective iPOWER (Improving Diagnosis and Treatment of Women with Angina Pectoris and Microvascular Disease) study. CMD was assessed by Doppler echocardiography in the left anterior descending artery as coronary flow velocity reserve (CFVR). Patients were followed for a composite outcome of cardiovascular death, myocardial infarction (MI), heart failure, stroke, and coronary revascularization. CFVR was obtained in 1681 patients (91%) and the median CFVR was 2.33 (quartiles 1–3: 2.00–2.74). During a median follow-up of 4.5 years, 96 events occurred. In univariate Cox regression, CFVR was associated with the composite outcome {hazard ratio (HR) 1.07 [95% confidence interval (CI) 1.03–1.11] per 0.1 unit decrease in CFVR; P &lt; 0.001}, primarily driven by an increased risk of MI and heart failure. Results remained significant in multivariate analysis [HR 1.05 (95% CI 1.01–1.09) per 0.1 unit decrease in CFVR; P = 0.01]. In exploratory analyses, CFVR was also associated with the risk of repeated hospital admission for angina and all-cause mortality. Conclusion  Assessment of CFVR by echocardiography is feasible and predictive of adverse outcome in women with angina and no obstructive CAD. Results support a more aggressive preventive management of these patients and underline the need for trials targeting CMD.

Abstract 4234: Prognostic Implication of the Continuous Prognostic Spectrum of Coronary Flow Reserve in Patients with and without Angiographically Obstructive Coronary Artery Disease

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Lauro Cortigiani ◽  
Fausto Rigo ◽  
Sonia Gherardi ◽  
Rosa Sicari ◽  
Maria Luisa Gianfaldoni ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Prognostic Value ◽  
Wall Motion ◽  
Obstructive Coronary Artery Disease ◽  
Flow Reserve ◽  
Stress Echo ◽  
Artery Disease

Dual imaging of wall motion and coronary flow reserve (CFR) on left anterior descending (LAD) artery is now the state-of-the art technique for vasodilator stress echo. The additive prognostic value of CFR over regional wall motion has been established, but there is more than a binary (normal-abnormal ) response in CFR, which can be continuously titrated. Objectives. To assess the prognostic value of Doppler echocardiographic derived CFR in patients with and without angiographically obstructive coronary artery disease (CAD). 1244 patients (785 men, age 64±11 yy) with known or suspected CAD underwent dipyridamole (up to 0.84 mg/kg over 6′) stress echo with CFR evaluation of left anterior descending artery by Doppler and coronary angiography. Patients were followed-up for a median of 17 months. Mean CFR in the entire population was 2.25±0.64. During follow-up, there were 227 events (26 deaths, 55 STEMI, and 146 NSTEMI). Patients (n=384) undergoing revascularization were censored. Using the Kaplan-Meier method, the lowest quartile of CFR (<1.80) was associated with a significantly (p<0.0001) worst event rate than other quartiles (Figure ), both considering the group with (83 vs 53%, p<0.0001) and without (53 vs 12%, p<0.0001) obstructive CAD at angiography. CFR is a strong and independent prognostic predictor in patients with known or suspected CAD, but the spectrum of prognostic stratification is expanded if the response is titrated according to a continuous scale rather than artificially dichotomized.

scholarly journals Transthoracic Assessment of Coronary Flow Velocity Reserve: A Practical Approach to Diagnostic Testing in Patients with Angina and No Obstructive Coronary Artery Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Daria Frestad Bechsgaard ◽  
Eva Prescott
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Flow Velocity ◽  
Coronary Flow ◽  
Obstructive Coronary Artery Disease ◽  
Coronary Microvascular Dysfunction ◽  
Coronary Flow Velocity Reserve ◽  
Transthoracic Doppler Echocardiography ◽  
Coronary Flow Velocity ◽  
Artery Disease

More than half of the patients with symptoms suggestive of myocardial ischemia presenting at invasive angiography have no obstructive coronary artery disease (CAD). A large proportion of these patients have ischemia caused by coronary microvascular dysfunction, a condition associated with adverse cardiovascular prognosis. Measurement of coronary flow velocity reserve by transthoracic Doppler echocardiography is a feasible and reproducible method for the evaluation of coronary microvascular function. This review provides a practical overview of the method in a clinical setting of angina and noobstructive CAD, including technical details and prognostic significance.

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