Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov 1;98(5):827-835.
doi: 10.1002/ccd.29237. Epub 2020 Sep 9.

Functional coronary angiography in symptomatic patients with no obstructive coronary artery disease

Sonali Kumar  1   2 , Puja K Mehta  1   3 , Parham Eshtehardi  2 , Olivia Y Hung  2 , Jin-Sin Koh  2 , Arnav Kumar  3   2 , Ahmed Al-Badri  3 , Rani Rabah  2 , Melroy D'Souza  4 , Sonu Gupta  2 , Michael McDaniel  2 , Viola Vaccarino  5 , John Douglas  2 , Kreton Mavromatis  2 , Joo Myung Lee  2   6 , Arshed Quyyumi  3 , Habib Samady  3   2
Affiliations

Functional coronary angiography in symptomatic patients with no obstructive coronary artery disease

Sonali Kumar et al. Catheter Cardiovasc Interv. .

Abstract

Background: Patients without obstructive coronary artery disease (CAD) may have epicardial or microvascular dysfunction. The purpose of this study was to characterize patterns of epicardial and microvascular dysfunction in men and women with stable and unstable angina undergoing functional coronary angiography to inform medical therapy.

Methods: 163 symptomatic patients with ≤50% diameter stenosis and fractional flow reserve (FFR) > 0.8 underwent endothelium-dependent epicardial and microvascular function after intracoronary acetylcholine (10-4 M, 81 mcg over 3 minutes). Endothelium-independent function was assessed using coronary flow reserve (CFR) and hyperemic microvascular resistance (HMR) after intravenous adenosine (140 ug/kg/min). Coronary microvascular dysfunction (CMD) was defined as CFR < 2.5, HMR ≥2, or ≤50% change in coronary blood flow with acetylcholine (CBFACH ).

Results: Seventy-two percent had endothelial-dependent epicardial dysfunction (response to ACH: % ∆ in coronary artery diameter and ∆%CBFACH ) and 92% had CMD. Among CMD patients, 65% had CFR < 2.5, 35% had HMR ≥2, and 60% had CBFACH change ≤50%. CFR modestly correlated with HMR (r = -0.38, p < .0001). Among patients with normal CFR, 26% had abnormal epicardial and 20% had abnormal microvascular endothelial dysfunction. Women had a lower CFR (p = .02), higher FFR (p = .03) compared to men. There were no differences in epicardial and microvascular function between patients with stable and unstable angina.

Conclusion: In patients with no obstructive CAD: CMD is prevalent, abnormal CFR does not correlate with epicardial or microvascular endothelial dysfunction, women have lower CFR, higher FFR but similar endothelial function compared to men.

Keywords: coronary blood flow; coronary flow reserve.

PubMed Disclaimer

Comment in

References

REFERENCES

    1. Bugiardini R, Bairey Merz CN. Angina with "normal" coronary arteries: a changing philosophy. JAMA. 2005;293(4):477-484.
    1. Bairey Merz CN, Pepine CJ, Walsh MN, Fleg JL. Ischemia and no obstructive coronary artery disease (INOCA): developing evidence-based therapies and research agenda for the next decade. Circulation. 2017;135(11):1075-1092.
    1. Lee BK, Lim HS, Fearon WF, et al. Invasive evaluation of patients with angina in the absence of obstructive coronary artery disease. Circulation. 2015;131(12):1054-1060.
    1. Crea F, Camici PG, Bairey Merz CN. Coronary microvascular dysfunction: an update. Eur Heart J. 2014;35(17):1101-1111.
    1. Gulati M, Cooper-DeHoff RM, McClure C, et al. Adverse cardiovascular outcomes in women with nonobstructive coronary artery disease: a report from the Women's ischemia syndrome evaluation study and the St James women take heart project. Arch Intern Med. 2009;169(9):843-850.

Publication types

LinkOut - more resources