Ventricular repolarization alterations in women with angina pectoris and suspected coronary microvascular dysfunction

2018 ◽  
Vol 51 (1) ◽  
pp. 15-20
Author(s):  
Nynne Dose ◽  
Marie Mide Michelsen ◽  
Naja Dam Mygind ◽  
Adam Pena ◽  
Christina Ellervik ◽  
...  
Keyword(s):  
Angina Pectoris ◽  
Microvascular Dysfunction ◽  
Ventricular Repolarization ◽  
Coronary Microvascular Dysfunction

scholarly journals Pro-inflammatory biomarkers in women with non-obstructive angina pectoris and coronary microvascular dysfunction

2019 ◽  
Vol 24 ◽  
pp. 100370
Author(s):  
Jakob Schroder ◽  
Naja Dam Mygind ◽  
Daria Frestad ◽  
Marie Michelsen ◽  
Hannah Elena Suhrs ◽  
...  
Keyword(s):  
Angina Pectoris ◽  
Microvascular Dysfunction ◽  
Inflammatory Biomarkers ◽  
Coronary Microvascular Dysfunction

Biomarkers of Myocardial Fibrosis are Associated with Diabetes but not with Coronary Microvascular Dysfunction in Women with Angina and No Obstructive Coronary Artery Disease

2020 ◽  
Author(s):  
Kira Bang Bove ◽  
Naja Dam Mygind ◽  
Signe Holm Nielsen ◽  
Marie Mide Michelsen ◽  
Daria Frestad Bechsgaard ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Angina Pectoris ◽  
Myocardial Fibrosis ◽  
Obstructive Coronary Artery Disease ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Transthoracic Doppler Echocardiography ◽  
Type Iv ◽  
Artery Disease

Abstract Background Coronary microvascular dysfunction (CMD) is highly prevalent in women with no obstructive coronary artery disease and possibly related to myocardial fibrosis caused by excessive extracellular matrix (ECM) remodeling. ECM turnover can be measured in blood indicating fibrotic activity. We hypothesized that women with DM, angina and no obstructive coronary artery disease have increased ECM turnover and that this is associated with CMD.Methods We included 344 women with angina pectoris and no obstructive coronary artery disease (187 with DM, predominantly type II) and 76 asymptomatic women without DM as controls. Biomarkers reflecting formation of type IV and VI collagen (PRO-C4 and PRO-C6) and degradation of type IV, V and VI collagen (C4M, C5M, C6M), mimecan (MIM) and titin (TIM) were measured in all participants. CMD was defined as coronary flow velocity reserve (CFVR) <2.0 assessed by transthoracic Doppler echocardiography.Results Median age was 64.2 (IQR 57.0-70.0), slightly higher in symptomatic women with DM. Median CFVR was 2.21 (1.89-2.55) in symptomatic women with DM, 2.35 (1.96-2.77) in symptomatic women without DM and 2.63 (2.19-2.95) in controls (age-adjusted p for trend<0.001). With exception of CM5, women with DM had significantly higher levels of all ECM biomarkers than women without DM (age-adjusted p<0.01), whereas biomarkers did not differ between symptomatic women without DM and controls. High ECM biomarker levels were associated with HbA1c, high BMI, low HDL and high triglycerides (p=0.003-0.0001). There was no correlation between ECM biomarkers and CFVR.Conclusion Women with angina pectoris and DM had increased levels of myocardial fibrosis biomarkers compared with women without DM. There was no association between CMD and biomarkers of myocardial fibrosis.

Optimale Diagnostik und Therapie der mikrovaskulären Angina pectoris

2017 ◽  
Vol 142 (21) ◽  
pp. 1586-1593 ◽  
Author(s):  
Peter Ong ◽  
Udo Sechtem
Keyword(s):  
Angina Pectoris ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Beta Blockers ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Channel Blockers ◽  
Microvascular Angina ◽  
Flow Reserve ◽  
Diagnostik Und Therapie

AbstractPatients with microvascular angina are characterized by angina pectoris with proof of myocardial ischemia in the absence of any relevant epicardial stenosis and without myocardial disease (type 1 coronary microvascular dysfunction according to Crea and Camici). Structural and functional alterations of the coronary microvessels (diameter < 500 µm) are the reason for this phenomenon. Frequently such alterations are associated with cardiovascular risk factors. Patients with angina pectoris without epicardial stenoses represent for 10 – 50 % of all patients undergoing coronary angiography depending on the clinical presentation. Diagnostic approaches include non-invasive (e. g. combination of coronary CT-angiography and positron emission tomography/echo Doppler-based coronary flow reserve measurements) as well as invasive procedures (coronary flow reserve measurements in response to adenosine, intracoronary acetylcholine testing). Pharmacological treatment of these patients is often challenging and should be based on the characterization of the underlying mechanisms. Moreover, strict risk factor control and individually titrated combinations of antianginal substances (e. g. beta blockers, calcium channel blockers, nitrates, ranolazine, ivabradine etc.) are recommended.

Coronary microvascular dysfunction is not associated with a history of reproductive risk factors in women with angina pectoris—An iPOWER substudy

Maturitas ◽  
2018 ◽  
Vol 107 ◽  
pp. 110-115 ◽  
Author(s):  
Hannah Elena Suhrs ◽  
Anna Meta Kristensen ◽  
Anna Bay Rask ◽  
Marie Mide Michelsen ◽  
Daria Frestad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Angina Pectoris ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Reproductive Risk ◽  
History Of ◽  
Reproductive Risk Factors

Abstract 15094: Prevalence of Coronary Microvascular Dysfunction in Women With Angina and No Obstructive Coronary Artery Disease: Preliminary Results From the iPower Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Naja D Mygind ◽  
Marie M Michelsen ◽  
Adam A Pena ◽  
Rebekka Faber ◽  
Jens Kastrup ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Angina Pectoris ◽  
Obstructive Coronary Artery Disease ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
High Dose ◽  
Transthoracic Doppler Echocardiography ◽  
Flow Reserve ◽  
Artery Disease

Background: Women are more often than men found to have no obstructive coronary artery disease (CAD) when evaluated with a coronary angiogram (CAG) due to angina pectoris and suspected ischemic heart disease. Coronary microvessel dysfunction (CMD) is a possible explanation, and can be assessed by transthoracic Doppler echocardiography (TTDE) with measurement of coronary flow reserve (CFR). Reduced CFR carries an adverse prognosis despite absence of obstructive CAD. The aim of the ongoing iPower study is to evaluate CFR in women with angina pectoris and no obstructive CAD. Methods: Women with angina pectoris and a CAG without obstructive coronary artery disease (>50%) are systematically invited to participate. Assessment includes demographic and clinical data, blood samples and TTE during rest and high-dose dipyridamole stress (0.84mg/kg) with measurement of CFR by Doppler of the left anterior descending artery. Results: To date (May 21st 2014) 3500 women have been screened (flowchart), 793 women have been included (response rate 23%). Mean age was 62.4 (+/-9.6) and the burden of risk factors was relatively high (Table 1). CFR was successfully measured in 763 patients (96%). Median (IQR) CFR was 2.4 (2.0-2.8). Cut-off point for CMD of both 2 and 2.5 has been used previously. In this population, 214 (28%) had a CFR≤2 and 468 (61%) a CFR≤2.5. Conclusions: To our knowledge, iPower is the largest and most comprehensive study systematically assessing CMD in women with angina pectoris and no obstructive CAD. Non-invasive CFR assessment is feasible, and microvascular function impaired in a large proportion. Future follow-up will determine the prognostic value of CFR as a measure of CMD.

scholarly journals Evaluation of Non-invasive Imaging Parameters in Coronary Microvascular Disease: A Systematic Review

2020 ◽  
Author(s):  
Floor Groepenhoff ◽  
R.G.M. Klaassen ◽  
G.B. Valstar ◽  
S.H. Bots ◽  
N.C. Onland-Moret ◽  
...  
Keyword(s):  
Systematic Review ◽  
Angina Pectoris ◽  
Imaging Technique ◽  
Imaging Techniques ◽  
Microvascular Disease ◽  
Microvascular Dysfunction ◽  
Current Evidence ◽  
Coronary Microvascular Dysfunction ◽  
Non Invasive ◽  
Positron Emission

Abstract Background: Coronary microvascular dysfunction (CMD) is an important underlying cause of angina pectoris. Currently, no diagnostic tool is available to directly visualize the coronary microvasculature. Invasive microvascular reactivity testing is the diagnostic standard for CMD, but several non-invasive imaging techniques are being evaluated. However, evidence on reported non-invasive parameters and cut-off values is limited. Thus, we aimed to provide an overview of reported non-invasive parameters and corresponding cut-off values for CMD.Methods: Pubmed and EMBASE databases were systematically searched for studies enrolling patients with angina pectoris without obstructed coronary arteries, investigating at least one non-invasive imaging technique to quantify CMD. Methodological quality assessment of included studies was performed using QUADAS-2.Results: Thirty-six studies were included. Nine cardiac magnetic resonance (CMR) studies reported MPRI (n = 9) and nine positron emission tomography (PET) and transthoracic echocardiography (TTE) studies reported CFR. Mean MPRI ranged from 1.47 ± 0.36 to 1.83 ± 0.50 in patients and from 1.50 ± 0.47 to 2.23 ± 0.37 in healthy controls. Reported mean CFR in PET and TTE ranged from 1.39 ± 0.31 to 2.85 ± 1.35 and 1.69 ± 0.40 to 2.40 ± 0.40 for patients, and 2.68 ± 0.83 to 4.32 ± 1.78 and 2.65 ± 0.65 to 3.31 ± 1.10 for controls, respectively.Conclusions: This systematic review summarized current evidence on reported parameters and cut-off values to diagnose CMD for various non-invasive imaging modalities. Nonetheless, standardization of methodology and reporting of outcome measures is required to provide clinically applicable reference values.

scholarly journals Evaluation of non-invasive imaging parameters in coronary microvascular disease: a systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
F. Groepenhoff ◽  
R. G. M. Klaassen ◽  
G. B. Valstar ◽  
S. H. Bots ◽  
N. C. Onland-Moret ◽  
...  
Keyword(s):  
Systematic Review ◽  
Angina Pectoris ◽  
Imaging Technique ◽  
Imaging Techniques ◽  
Microvascular Disease ◽  
Microvascular Dysfunction ◽  
Current Evidence ◽  
Coronary Microvascular Dysfunction ◽  
Non Invasive ◽  
Positron Emission

Abstract Background Coronary microvascular dysfunction (CMD) is an important underlying cause of angina pectoris. Currently, no diagnostic tool is available to directly visualize the coronary microvasculature. Invasive microvascular reactivity testing is the diagnostic standard for CMD, but several non-invasive imaging techniques are being evaluated. However, evidence on reported non-invasive parameters and cut-off values is limited. Thus, we aimed to provide an overview of reported non-invasive parameters and corresponding cut-off values for CMD. Methods Pubmed and EMBASE databases were systematically searched for studies enrolling patients with angina pectoris without obstructed coronary arteries, investigating at least one non-invasive imaging technique to quantify CMD. Methodological quality assessment of included studies was performed using QUADAS-2. Results Thirty-seven studies were included. Ten cardiac magnetic resonance studies reported MPRI and nine positron emission tomography (PET) and transthoracic echocardiography (TTE) studies reported CFR. Mean MPRI ranged from 1.47 ± 0.36 to 2.01 ± 0.41 in patients and from 1.50 ± 0.47 to 2.68 ± 0.49 in controls without CMD. Reported mean CFR in PET and TTE ranged from 1.39 ± 0.31 to 2.85 ± 1.35 and 1.69 ± 0.40 to 2.40 ± 0.40 for patients, and 2.68 ± 0.83 to 4.32 ± 1.78 and 2.65 ± 0.65 to 3.31 ± 1.10 for controls, respectively. Conclusions This systematic review summarized current evidence on reported parameters and cut-off values to diagnose CMD for various non-invasive imaging modalities. In current clinical practice, CMD is generally diagnosed with a CFR less than 2.0. However, due to heterogeneity in methodology and reporting of outcome measures, outcomes could not be compared and no definite reference values could be provided.

Coronary microvascular dysfunction

2020 ◽  
Vol 68 (2) ◽  
Author(s):  
Vincenzo Sucato ◽  
Giuseppina Novo ◽  
Antonino Saladino ◽  
Salvatore Evola ◽  
Alfredo R. Galassi
Keyword(s):  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction
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