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

Naja Dam Mygind, Marie Mide Michelsen, Adam Pena, Daria Frestad, Nynne Dose, A. Aziz, Rebekka Faber, Nis Høst, Ida Gustafsson, Peter Riis Hansen, H. S. Hansen, C. N. B. Merz, Jens Kastrup, Eva Prescott

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Abstrakt

Background-The 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 Results-After 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 (r 2=0.09). CFVR was not associated with chest pain characteristics or results from diagnostic stress testing. Conclusion-Impaired 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.

OriginalsprogEngelsk
Artikelnummere003064
TidsskriftJournal of the American Heart Association
Vol/bind5
Udgave nummer3
ISSN2047-9980
DOI
StatusUdgivet - 15. mar. 2016

Bibliografisk note

ISI Document Delivery No.: DY7MA Times Cited: 2 Cited Reference Count: 34 Mygind, Naja Dam Michelsen, Marie Mide Pena, Adam Frestad, Daria Dose, Nynne Aziz, Ahmed Faber, Rebekka Host, Nis Gustafsson, Ida Hansen, Peter Riis Hansen, Henrik Steen Merz, C. Noel Bairey Kastrup, Jens Prescott, Eva Danish Heart Foundation [11-10-R87-B-A3628-22678]; University of Copenhagen This work was supported by the Danish Heart Foundation (grant 11-10-R87-B-A3628-22678) and by the University of Copenhagen. 2 Wiley-blackwell Hoboken

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  • Citationsformater

    Mygind, N. D., Michelsen, M. M., Pena, A., Frestad, D., Dose, N., Aziz, A., Faber, R., Høst, N., Gustafsson, I., Hansen, P. R., Hansen, H. S., Merz, C. N. B., Kastrup, J., & Prescott, E. (2016). 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, 5(3), [e003064]. https://doi.org/10.1161/jaha.115.003064