Angina relates to coronary flow in women with ischemia and no obstructive coronary artery disease.
Angina
Coronary flow reserve
Microvascular
Journal
International journal of cardiology
ISSN: 1874-1754
Titre abrégé: Int J Cardiol
Pays: Netherlands
ID NLM: 8200291
Informations de publication
Date de publication:
15 06 2021
15 06 2021
Historique:
received:
23
11
2020
revised:
19
02
2021
accepted:
22
02
2021
pubmed:
5
3
2021
medline:
29
5
2021
entrez:
4
3
2021
Statut:
ppublish
Résumé
Women with suspected ischemia and no obstructive coronary artery disease (INOCA) often have coronary microvascular dysfunction (CMD) as measured by impaired coronary flow reserve (CFR), which is associated with angina and adverse cardiovascular events. CFR is a ratio of hyperemic to baseline average peak velocity (bAPV), and the relation of baseline flow to angina is not understood. We evaluated 259 women enrolled in the WISE-Coronary Vascular Dysfunction (WISE-CVD) project with suspected CMD who underwent invasive coronary functional testing. We analyzed variables stratified by high (e.g. ≥22 cm/s) vs low (<22 cm/s) bAPV, using t-test or Wilcoxon rank; linear and multivariable regression was used with bAPV as a continuous variable. Women with high bAPV had worse Seattle Angina Questionnaire (SAQ) angina frequency (58 ± 26 vs 67 ± 25, p = 0.005) and SAQ-7 scores (57 ± 22 vs 62 ± 21, p = 0.03), with higher nitrate (p = 0.02) and ranolazine use (p = 0.03). The high bAPV subgroup also had lower CFR (p < 0.001)). Linear regression related higher bAPV with lower SAQ-7 (p = 0.01) and lower angina frequency scores (p = 0.001). These results remained significant in multivariable modelling adjusting for baseline differences (p < 0.04). SAQ-7 was significantly predicted by bAPV. Among women with suspected INOCA, angina relates to high bAPV, a result supported by the concomitant greater use of anti-anginal drugs. These results suggest that high bAPV contributes to impaired CFR and may represent a specific pathophysiologic contributor to CMD and may be a treatment target in INOCA subjects.
Sections du résumé
BACKGROUND
Women with suspected ischemia and no obstructive coronary artery disease (INOCA) often have coronary microvascular dysfunction (CMD) as measured by impaired coronary flow reserve (CFR), which is associated with angina and adverse cardiovascular events. CFR is a ratio of hyperemic to baseline average peak velocity (bAPV), and the relation of baseline flow to angina is not understood.
METHODS
We evaluated 259 women enrolled in the WISE-Coronary Vascular Dysfunction (WISE-CVD) project with suspected CMD who underwent invasive coronary functional testing. We analyzed variables stratified by high (e.g. ≥22 cm/s) vs low (<22 cm/s) bAPV, using t-test or Wilcoxon rank; linear and multivariable regression was used with bAPV as a continuous variable.
RESULTS
Women with high bAPV had worse Seattle Angina Questionnaire (SAQ) angina frequency (58 ± 26 vs 67 ± 25, p = 0.005) and SAQ-7 scores (57 ± 22 vs 62 ± 21, p = 0.03), with higher nitrate (p = 0.02) and ranolazine use (p = 0.03). The high bAPV subgroup also had lower CFR (p < 0.001)). Linear regression related higher bAPV with lower SAQ-7 (p = 0.01) and lower angina frequency scores (p = 0.001). These results remained significant in multivariable modelling adjusting for baseline differences (p < 0.04). SAQ-7 was significantly predicted by bAPV.
CONCLUSIONS
Among women with suspected INOCA, angina relates to high bAPV, a result supported by the concomitant greater use of anti-anginal drugs. These results suggest that high bAPV contributes to impaired CFR and may represent a specific pathophysiologic contributor to CMD and may be a treatment target in INOCA subjects.
Identifiants
pubmed: 33662486
pii: S0167-5273(21)00373-9
doi: 10.1016/j.ijcard.2021.02.064
pmc: PMC8107128
mid: NIHMS1691160
pii:
doi:
Substances chimiques
Ranolazine
A6IEZ5M406
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
35-39Subventions
Organisme : NIA NIH HHS
ID : U54 AG065141
Pays : United States
Organisme : NHLBI NIH HHS
ID : K23 HL125941
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000124
Pays : United States
Organisme : NHLBI NIH HHS
ID : K23 HL151867
Pays : United States
Organisme : NHLBI NIH HHS
ID : K23 HL127262
Pays : United States
Organisme : NCRR NIH HHS
ID : M01 RR000425
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL090957
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.
Références
J Am Coll Cardiol. 2010 Jun 22;55(25):2825-32
pubmed: 20579539
Circulation. 2008 Mar 25;117(12):1526-36
pubmed: 18347213
J Am Coll Cardiol. 2016 Mar 15;67(10):1158-1169
pubmed: 26965536
Eur Heart J. 2004 Apr;25(8):663-70
pubmed: 15084371
Circ Cardiovasc Imaging. 2014 May;7(3):510-6
pubmed: 24633782
Am J Physiol Heart Circ Physiol. 2011 Dec;301(6):H2279-84
pubmed: 21984541
Clin Cardiol. 2012 Mar;35(3):141-8
pubmed: 22389117
Circulation. 2015 Jan 6;131(1):19-27
pubmed: 25400060
Clin Cardiol. 2017 Oct;40(10):886-891
pubmed: 28605043
Eur Heart J. 2016 May 14;37(19):1504-13
pubmed: 26614823
Circulation. 2006 Aug 29;114(9):894-904
pubmed: 16923752
Circ Cardiovasc Qual Outcomes. 2014 Sep;7(5):640-7
pubmed: 25185249
Int J Cardiol. 2020 Jun 15;309:19-22
pubmed: 32037132
Circulation. 2017 Mar 14;135(11):1075-1092
pubmed: 28289007
Am J Cardiol. 1989 Sep 15;64(10):651-4
pubmed: 2782256
Eur Heart J. 1995 Aug;16 Suppl I:2-6
pubmed: 8829952
Circulation. 1990 Apr;81(4):1319-30
pubmed: 2317912
JACC Cardiovasc Interv. 2012 Jun;5(6):646-53
pubmed: 22721660
Compr Physiol. 2016 Mar 15;6(2):975-1003
pubmed: 27065172
JACC Cardiovasc Interv. 2020 Jan 13;13(1):20-29
pubmed: 31918939
Am Heart J. 2001 May;141(5):735-41
pubmed: 11320360
Am Heart J. 2013 Jul;166(1):134-41
pubmed: 23816032
Cardiovasc Res. 2001 Apr;50(1):151-61
pubmed: 11282088
J Am Coll Cardiol. 1995 Feb;25(2):333-41
pubmed: 7829785
JACC Cardiovasc Interv. 2018 Oct 22;11(20):2044-2054
pubmed: 30268877
Circulation. 2017 Dec 12;136(24):2325-2336
pubmed: 28864442
Physiol Rev. 2006 Oct;86(4):1263-308
pubmed: 17015490
J Am Coll Cardiol. 1996 Nov 1;28(5):1154-60
pubmed: 8890809
Circ Cardiovasc Imaging. 2015 Apr;8(4):
pubmed: 25801710
J Am Coll Cardiol. 2019 Feb 19;73(6):684-693
pubmed: 30765035