scholarly journals Sex Differences in Coronary Function Test Results in Patient With Angina and Nonobstructive Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Tijn P. J. Jansen ◽  
Suzette E. Elias-Smale ◽  
Stijn van den Oord ◽  
Helmut Gehlmann ◽  
Aukelien Dimitiriu-Leen ◽  
...  
Keyword(s):  
Vascular Dysfunction ◽  
Obstructive Coronary Artery Disease ◽  
Coronary Intervention ◽  
Flow Reserve ◽  
Index Of Microvascular Resistance ◽  
Microvascular Spasm ◽  
Traditional Risk Factors ◽  
Artery Disease ◽  
A Prospective Study ◽  
Vasomotor Dysfunction

Introduction: Invasive coronary function testing (CFT) has become the recommended diagnostic tool to assess the various endotypes of coronary vasomotor dysfunction in patients with angina and no obstructive coronary artery disease (ANOCA), which has implications for therapy and prognosis. Although the expanding performance of CFT is leading to increased knowledge of coronary vasomotor dysfunction, little is known about sex-related differences in the results of comprehensive CFT.Methods: We conducted a prospective study of all consecutive patients with ANOCA that underwent clinically indicated CFT in a tertiary interventional from February 2019 to February 2021. CFT consisted of acetylcholine testing to diagnose epicardial or microvascular spasm, and adenosine testing to diagnose CMD. CMD was defined as an index of microvascular resistance (IMR) ≥ 25 and/or coronary flow reserve (CFR) < 2.0.Results: In total, 228 women and 38 men underwent CFT. No differences in traditional risk factors were seen, but women had a higher prevalence of migraine (45 vs. 14%, p = 0.001). Men more often had a history of percutaneous coronary intervention (12 vs. 49%, p = 0.001). We found no difference in clinical presentation. Coronary vasomotor dysfunction was present in 95% of men and 88% of women (p = 0.25), but males show more often epicardial spasm and less microvascular spasm than women (63 vs. 42% and 29 vs. 40% respectively, p = 0.039). Impaired CFR was more prevalent among females (6 vs 20%, p = 0.033). IMR [median of 23 (15–32) vs. 19 (13–25), p = 0.08] did not differ between the sexes.Conclusion: Men undergoing CFT show a comparable prevalence of coronary vascular dysfunction as women. However, men have a higher prevalence of epicardial spasm and a lower prevalence of microvascular spasm compared with women. An impaired CFR was more often present in women, with an equally impairment of IMR.

scholarly journals Relation Between Coronary Tortuosity and Vasomotor Dysfunction in Patients Without Obstructed Coronaries?

2022 ◽  
Vol 8 ◽  
Author(s):  
Tijn P. J. Jansen ◽  
Kyra van Keeken ◽  
Regina E. Konst ◽  
Aukelien Dimitriu-Leen ◽  
Angela H. E. M. Maas ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Flow ◽  
Obstructive Coronary Artery Disease ◽  
Coronary Artery Spasm ◽  
Microvascular Dysfunction ◽  
Flow Reserve ◽  
Index Of Microvascular Resistance ◽  
Artery Disease ◽  
Coronary Tortuosity ◽  
Vasomotor Dysfunction

Background: A large proportion of patients with angina and no obstructive coronary artery disease (ANOCA) has underlying coronary vasomotor dysfunction (CVDys), which can be diagnosed by a coronary function test (CFT). Coronary tortuosity is a common angiographic finding during the CFT. Yet, no data exist on the association between vasomotor dysfunction and coronary tortuosity.Aim: To investigate the association between CVDys and coronary tortuosity in patients with ANOCAMethods: All consecutive ANOCA patients who underwent clinically indicated CFT between February 2019 and November 2020 were included. CFT included acetylcholine spasm testing to diagnose epicardial or microvascular spasm, and adenosine testing to diagnose microvascular dysfunction (MVD). MVD was defined as an index of microvascular resistance (IMR) ≥ 25 and/or coronary flow reserve (CFR) <2.0. Coronary tortuosity, was scored (no, mild, moderate or severe) based on the angles of the curvatures in the left anterior descending (LAD) artery on angiography.Results: In total, 228 patients were included (86% female, mean age 56 ± 9 years). We found coronary artery spasm in 81% of patients and MVD in 45% of patients (15%: abnormal CFR, 30%: abnormal IMR). There were 73 patients with no tortuosity, 114 with mild tortuosity, 41 with moderate tortuosity, and no patients with severe tortuosity. No differences were found in cardiovascular risk factors or medical history, and the prevalence of CVDys did not differ between the no tortuosity, mild tortuosity and moderate tortuosity group (82, 82, and 85%, respectively).Conclusion: In this study, CVDys was not associated with coronary tortuosity. Future experimental and clinical studies on the complex interplay between coronary tortuosity, wall shear stress, endothelial dysfunction and coronary flow are warranted.

scholarly journals 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)

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
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.

scholarly journals Case ReportsClinical effect of ivabradine in patient with congestive heart failure with cardiogenic shock condition: A case reportAcute mesenteric ischemia on extensive anterior STEMI with paroxysmal atrial fibrilation: A rare complicationAcute fulminant myocarditis mimicking ST-elevation myocardial infarctionFractional flow reserve: Nurturing a functional perspective in angioplasty (Case Report)The role of invasive fractional flow reserve (FFR) in multivessel diseaseFibrinolytic followed by early angiography in cardiac arrest survivor patients with ST elevation ACS: A pharmaco-invasive in non-primary PCI capable hospitalEarly accelerated idioventricular rhythm followed by premature ventricular complexes as a marker for successful reperfusion in ST-elevation myocardial infarct patientInferior ST-elevation myocardial infarction complicated by unstable total atrioventricular block and diabetic ketoacidosis in end stage renal failure patientOutlflow tract ventricular arrythmia 3D ablation in LV summit Area: A case reportIntravascular hemolysis complication after transcatheter PDA closure with ADO device: A case reportA very rare case: A patient with extreme levocardia without remarkable symptomTransradial primary percutaneous coronary intervention on a patient with ST-Elevation myocardial infarction with comorbid peripheral artery disease and severe partial obstruction in the abdominal aortaAcute coronary syndrome with ventricular stormCardio-cerebral infaction: A rare case of concomitant acute right ventricular infarction and ischemic strokeTypical ECG pattern of acute pulmonary embolism in a 45 years old dyspneic and chest pain male patient: A case reportPersistent high degree AV block after early invasive strategy in acute decompensated heart failure caused by NSTEMI: A case reportAdult patent ductus arteriosus complicated by pulmonary artery endarteritis and pneumoniaRoutine thrombus aspiration in primary percutaneous coronary intervention: Is it still necessary? (Case Report)Curable severe tachycardiomyopathy due to typical atrial flutter by radiofrequency catheter ablationSinus node dysfunction in right heart failure: A rare caseLipomatous hypertrophy of the interatrial expanding into left atrial appendage mimicking thrombus: A very rare case reportConservative approach for patient in acute heart failure with cor triatriatum dexter and atrial fibrillation: A rare case reportAcute rheumatic fever in juvenile complicated by complete heart block: A case reportA nineteen years old young woman with idiopathic hypertrophic subaortic stenosis: A case reportRecurrent acute coronary syndrome – a manifestation of clopidogrel resistance: A case reportSubarterial doubly committed ventricularseptal defectcomplicated with right-sided fungalinfective endocarditisCase report: The hemodynamic effect of non invasive ventilation in atrial septal defect with severe pulmonary hypertension and respiratory failureEchocardiography-guided percutaneus transvenous mitral commissurotomy in a pregnant woman with severe mitral stenosisThe correlation between endothelial function parameter flow mediated vasodilatation with the complexity of coronary artery disease based on Syntax ScoreRuptured sinuses of valsalva aneurysms: Report of five casesParacetamol as alternative for patent ductus arteriosus (PDA) management

2016 ◽  
Vol 18 (suppl B) ◽  
pp. B51-B57 ◽  
Author(s):  
A. Widya ◽  
A. Jalaludinsyah ◽  
D.G. Widyawati ◽  
E. Hindoro ◽  
E. Supriadi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Rare Case ◽  
Ductus Arteriosus ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Flow Reserve ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Artery Disease ◽  
Patent Ductus

scholarly journals Proteomic biomarker profiles and vascular dysfunction in angina with no obstructive coronary artery disease

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Ejupi ◽  
A Aziz ◽  
P Ong ◽  
B H Shafi ◽  
T Lange ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Prediction Model ◽  
Prediction Models ◽  
Vascular Dysfunction ◽  
Obstructive Coronary Artery Disease ◽  
Protein Biomarkers ◽  
Age And Gender ◽  
Artery Disease ◽  
And Gender

Abstract Background Coronary vascular dysfunction is a common cause of symptoms in patients with angina and no obstructed coronary arteries (ANOCA). Several endotypes have been defined but there are big gaps in our understanding of the underlying pathophysiology. Proteomic analyses may improve the understanding of the pathophysiology. Purpose Exploratory approach to 1) compare the proteomic biomarker profile across different types of vascular dysfunction in ANOCA and 2) assess the value of prediction models with protein biomarkers for vascular dysfunction in ANOCA. Methods We included 107 angina patients without previous coronary artery disease, left ventricular ejection fraction &gt;45% and no obstructive coronary artery disease (CAD) (&lt;50% stenosis of epicardial vessels) on coronary angiography. Three types of vascular dysfunction were assessed: 1) Vasomotor dysfunction (VMD) defined as epicardial or microvascular vasospasm on acetylcholine provocation, 2) Coronary microvascular dysfunction (CMD) defined as coronary flow velocity reserve (CFVR) ≤2.5 on echocardiography of the LAD on adenosine stimulation and 3) Reactive Hyperaemia Index (RHI) ≤1.67 as a measure of peripheral endothelial dysfunction. Blood samples were analysed for 184 protein biomarkers related to cardiovascular disease. Correlations between biomarkers and results of vascular function assessments were analysed with Pearson's correlation coefficient and visualized with volcano plots. Significantly correlated biomarkers (p&lt;0.05) were tested in prediction models for their incremental value over age and gender with C-statistics. Results CFVR was correlated to 24 biomarkers before (figure 1a) and 2 biomarkers after adjustment for age and gender. The basic prediction model had AUC of 0.68 and was not significantly improved by adding biomarkers (figure 2a). RHI was correlated to 27 biomarkers before (figure 1b) and 10 biomarkers after adjustment for age and gender. The clinical prediction model was significantly improved (p=0.037) by adding TRAIL R2 and IL-18, in addition to age and gender, with an AUC of 84.4 (figure 2b). VMD was correlated to 14 biomarkers before (figure 1c) and 6 biomarkers after adjustment for age and gender. The prediction model was significantly improved (p=0.011) by adding HSP-27, RARRES-2 and SERPINA-12 in addition to age and gender in prediction of VMD with an AUC of 85.4 (figure 2c). Conclusion Several biomarkers were associated with vascular dysfunction in ANOCA patients with little overlap between different endotypes. We identified biomarkers that may contribute to the understanding of the underlying pathophysiology and have applications for screening. Results need to be confirmed in larger studies. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark.Department of Cardiology and Angiology, Robert Bosch Krankenhaus, Stuttgart, Germany

Abstract 14277: Serum Nt-prob-type Natriuretic Peptide is Associated With Coronary Microvascular Dysfunction in Patients With Angina and Non-obstructive Coronary Artery Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ali Ahmad ◽  
Jaskanwal D Sara ◽  
Michel T Corban ◽  
Takumi Toya ◽  
Ilke Ozcan ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Natriuretic Peptide ◽  
Obstructive Coronary Artery Disease ◽  
Inverse Correlation ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Flow Reserve ◽  
Artery Disease ◽  
And Gender

Title: Serum NT-proB-type Natriuretic Peptide is associated with Coronary Microvascular Dysfunction in Patients with Angina and Non-obstructive Coronary Artery Disease Authors: Ali Ahmad, MD, Jaskanwal D. Sara, MBChB, Michel T. Corban, MD, Takumi Toya, MD, Ilke Özcan, MD, Lilach O. Lerman, MD PhD, Amir Lerman, MD Introduction: Coronary microvascular dysfunction (CMD) is prevalent in patients with heart failure with preserved ejection fraction. Subclinical ischemia and myocardial fibrosis in CMD might raise filling pressure, a hallmark of HFpEF, which induces secretion of NT-proB-type natriuretic peptide (NTpro-BNP). We sought to explore the relationship between CMD and NT-proBNP. Methods: We studied 698 patients with signs and/or symptoms of ischemia and with non-obstructive CAD (<40% angiographic stenosis) who underwent invasive CMD evaluation and had NT-proBNP checked within 6 weeks. CMD was defined as coronary flow reserve (CFR) (hyperemic flow/baseline flow as measured by the doppler wire) of ≤2.5 in response to intracoronary adenosine injection. Results: Overall mean age was 52.8±12.2 years, and women represented 69% of the patients. Log NT-proBNP showed a modest inverse correlation with CFR (Pearson’s R = -0.22, P<0.0001; Figure 1 ), which remained significant after adjusting for age and gender (Standardized ß coefficient = -0.14; P = 0.001). Patients with CMD had higher levels of NT-proBNP than those without (82 [44-190] vs. 62 (33-130], P <0.0001; Figure 2) . Conclusion: Declining coronary microvascular function is correlated with higher NT-proBNP levels. Patients with CMD had higher levels of NT-proBNP, a marker of elevated LV pressure, contributing to the possible role of CMD in early HFpEF pathophysiology. Keywords: Coronary microvascular dysfunction, NT-proBNP

Abstract 2870: In Women without Obstructive Coronary Artery Disease, Endothelial-Dependent and Non-Endothelial Dependent Coronary Reactivity Dysfunction are Associated with Different Types of Adverse Outcomes. The NHLBI Women’s Ischemia Syndrome Evaluation (WISE).

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Scott Midwall ◽  
R. David Anderson ◽  
Delia Johnson ◽  
Eileen Handberg ◽  
Rhonda Cooper-Dehoff ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Adverse Events ◽  
Obstructive Coronary Artery Disease ◽  
Treatment Strategies ◽  
Adverse Outcomes ◽  
Flow Reserve ◽  
Different Types ◽  
Artery Disease ◽  
Major Adverse Events

Backround: Altered coronary reactivity frequently occurs in women with chest discomfort both with and without obstructive coronary artery disease (CAD). Among those with obstructive CAD, the endothelial-dependent and non-endothelial dependent components of this altered reactivity have been associated with adverse outcomes. The clinical events among those with altered coronary reactivity but without obstructive CAD are not well defined. Methods: We evaluated 169 women with suspected myocardial ischemia who had no obstructive CAD at coronary angiography. Coronary reactivity was assessed by measuring flow reserve (CFR) with adenosine (endothelial-dependent) and change in vessel diameter (DIAM) following acetylcholine (non-endothelial dependent). Women were then followed for major adverse events (death, myocardial infarction, stroke, or hospitalization for heart failure) as well as hospitalization for recurrent angina by annual telephone contact over a median of 6.0 years. Results: Mean age was 54 ± 10 years, 15% were non-white, 37% had abnormal CFR (<2.32), and 47% had abnormal DIAM (no change or constriction). Of the women receiving both coronary reactivity tests, results were concordant in only 52%. Major events occurred in 16% (28/169) of which 5% (8/169) died. An additional 24% (41/169) were hospitalized for worsening angina. Major adverse events were predicted by abnormal CFR (27% vs 10%, p = 0.006) but not abnormal DIAM, while abnormal DIAM, but not CFR, predicted hospitalization for angina. Conclusion: Endothelial-dependent and non-dependent coronary dysfunction coexist in approximately one-half of women tested without angiographic evidence of CAD and appear to predict different types of adverse outcomes during follow-up. These results should foster developement of new diagnostic and treatment strategies targeting both endothelial and non-endothelial (e.g. vascular smooth muscle) dependent coronary dysfunction in women.

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