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. 2016 Mar 15;5(3):e003064.
doi: 10.1161/JAHA.115.003064.

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

Naja Dam Mygind  1 , Marie Mide Michelsen  2 , Adam Pena  3 , Daria Frestad  4 , Nynne Dose  2 , Ahmed Aziz  5 , Rebekka Faber  2 , Nis Høst  6 , Ida Gustafsson  4 , Peter Riis Hansen  3 , Henrik Steen Hansen  5 , C Noel Bairey Merz  7 , Jens Kastrup  6 , Eva Prescott  2
Affiliations

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

Naja Dam Mygind et al. J Am Heart Assoc. .

Abstract

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.

Keywords: angina pectoris; coronary artery disease; echocardiography; microvascular dysfunction; women.

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Figures

Figure 1
Figure 1
Inclusion and exclusion criteria in the iPOWER study.
Figure 2
Figure 2
Measurement of coronary flow velocity. DPV indicates diastolic peak velocity.
Figure 3
Figure 3
Participant flow chart. CAD indicates coronary artery disease; CAG, coronary angiography; CFVR, coronary flow reserve.
Figure 4
Figure 4
Seattle Angina Questionnaire. Higher scores represent higher/better function of each variable in Seattle Angina Questionnaire. *P value from trend‐test (age‐corrected multivariate regression). ‡ P value from regression analysis with natural logarithmically transformed CFVR as outcome. CFVR indicates coronary flow velocity reserve.
See this image and copyright information in PMC

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