Adverse Pregnancy Outcomes Are Associated with Reduced Coronary Flow Reserve in Women With Signs and Symptoms of Ischemia Without Obstructive Coronary Artery Disease: A Report from the Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction Study

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.

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Prevalence of Coronary Endothelial and Microvascular Dysfunction in Women with Symptoms of Ischemia and No Obstructive Coronary Artery Disease Is Confirmed by a New Cohort: The NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation–Coronary Vascular Dysfunction (WISE-CVD)

Journal of Interventional Cardiology ◽

10.1155/2019/7169275 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

R. David Anderson ◽

John W. Petersen ◽

Puja K. Mehta ◽

Janet Wei ◽

B. Delia Johnson ◽

...

Keyword(s):

Coronary Artery ◽

Vascular Dysfunction ◽

Hormone Replacement ◽

Obstructive Coronary Artery Disease ◽

Signs And Symptoms ◽

Microvascular Dysfunction ◽

Coronary Microvascular Dysfunction ◽

Cardiac Events ◽

Flow Reserve ◽

Artery Disease

Objective. In a separate, contemporary cohort, we sought to confirm findings of the original Women’s Ischemia Syndrome Evaluation (WISE). Background. The original WISE observed a high prevalence of both invasively determined coronary endothelial and coronary microvascular dysfunction (CMD) that predicted adverse events in follow-up. Methods. We comparatively studied the WISE-Coronary Vascular Dysfunction (CVD) cohort (2009-2011), with signs and symptoms of ischemia but without significant CAD, to the original WISE (1997-2001) cohort. CMD was defined as coronary flow reserve (CFR) ≤2.5, or endothelial dysfunction as epicardial coronary artery constriction to acetylcholine (ACH), or <20% epicardial coronary dilation to nitroglycerin (NTG). Results. In WISE (n=181) and WISE-CVD (n=235) women, mean age in both was 54 years, and 83% were white (WISE) vs 74% (WISE-CVD, p=0.04). Use of hormone replacement therapy was less frequent in WISE-CVD vs WISE (46% vs 57%, p=0.026) as was presence of hypertension (40% vs 52%, p=0.013), hyperlipidemia (20% vs 46%, p<0.0001), and smoking (46% vs 56%, p=0.036). Similar rates were observed in WISE-CVD and WISE cohorts for CMD (mean CFR 2.7±0.6 vs 2.6±0.8, p=0.35), mean change in diameter with intracoronary ACH (0.2±10.0 vs 1.6±12.8 mm, p=0.34), and mean change in diameter with intracoronary NTG (9.7±13.0 vs 9.8±13.5 mm, p=0.94), respectively. Conclusions. This study confirms prevalence of CMD in the contemporary WISE-CVD cohort similar to that of the original WISE cohort, despite a lower risk factor burden in WISE-CVD. Because these coronary functional abnormalities predict major adverse cardiac events, clinical trials of therapies targeting these abnormalities are indicated.

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DIAGNOSTIC ACCURACY OF QUANTITATIVE H215O PET MEASUREMENTS OF HYPEREMIC MYOCARDIAL BLOOD FLOW VERSUS CORONARY FLOW RESERVE FOR THE DETECTION OF OBSTRUCTIVE CORONARY ARTERY DISEASE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(12)61313-8 ◽

2012 ◽

Vol 59 (13) ◽

pp. E1312 ◽

Cited By ~ 2

Author(s):

Ibrahim Danad ◽

Pieter G. Raijmakers ◽

Yolande Appelman ◽

Hendrik Harms ◽

Mark Lubberink ◽

...

Keyword(s):

Coronary Artery Disease ◽

Blood Flow ◽

Coronary Artery ◽

Diagnostic Accuracy ◽

Myocardial Blood Flow ◽

Coronary Flow ◽

Obstructive Coronary Artery Disease ◽

Flow Reserve ◽

Artery Disease ◽

H215o Pet

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

Circulation ◽

10.1161/circ.118.suppl_18.s_850 ◽

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.

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