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Published on: August 17, 2022
Coronary Microvascular Function and Cardiovascular Risk Factors in Women With Angina Pectoris and No Obstructive
Naja Dam Mygind1, Marie Mide Michelsen2, Adam Pena3
1Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark naja.dam.mygind@regionh.dk ndmygind@dadlnet.dk.
Insights
Coronary microvascular dysfunction is common in women with chest pain and no artery blockages. This condition, indicated by impaired coronary flow velocity reserve (CFVR), is linked to age and traditional risk factors but not stress test results.
Area of Science:
- Cardiology
- Vascular Biology
- Diagnostic Imaging
Background:
- Many women experience angina-like chest pain without obstructive coronary artery disease.
- Coronary microvascular dysfunction (CMD) is a potential cause, linked to poorer health outcomes.
- This study investigates the prevalence and predictors of CMD in women with chest pain.
Purpose of the Study:
- To determine the prevalence of coronary microvascular dysfunction in women with angina-like chest pain.
- To explore associations between CMD and cardiovascular risk factors, symptoms, and stress test results.
- To evaluate the role of coronary flow velocity reserve (CFVR) in risk assessment.
Main Methods:
- Included 963 women with chest pain and no significant coronary artery stenosis.
- Measured coronary flow velocity reserve (CFVR) using Doppler echocardiography during dipyridamole stress.
- Collected demographic, clinical, and psychosocial data, including questionnaires and blood samples.
Main Results:
- 26% of women had markedly impaired CFVR (<2).
- Impaired CFVR was associated with older age, hypertension, current smoking, higher heart rate, and lower HDL cholesterol.
- CFVR was not associated with chest pain characteristics or diagnostic stress test findings.
Conclusions:
- Impaired CFVR is prevalent, suggesting CMD contributes to angina pectoris in women.
- CFVR appears to be an independent parameter for risk evaluation, associated with few traditional risk factors.
- Symptom characteristics and stress test results do not identify women with impaired CFVR.
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.
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