Determinants of coronary flow reserve in non-diabetic patients with chest pain without myocardial perfusion defects
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Published on: June 28, 2019
Helena U Westergren1,2, Erik Michaëlsson2, Juuso I Blomster1,2
1Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
Insights
Low coronary flow reserve (CFR) predicts future cardiovascular events in patients with chest pain and normal perfusion scans. Insulin resistance is linked to reduced CFR in men, while systolic blood pressure is key for women.
Area of Science:
- Cardiology
- Vascular Biology
- Diagnostic Imaging
Background:
- Microvascular dysfunction is a potential cause of chest pain in patients lacking myocardial perfusion defects.
- Coronary flow reserve (CFR) assessed by ultrasound can evaluate microvascular function.
- This study examines CFR in patients with chest pain and normal myocardial perfusion scintigraphy.
Purpose of the Study:
- To evaluate microvascular function using CFR in patients with chest pain and normal myocardial perfusion.
- To investigate the relationship between cardiovascular parameters and decreased CFR in a sex-specific manner.
Main Methods:
- 202 non-diabetic patients with chest pain and suspected ischemia underwent CFR examination and blood sampling.
- A supervised principal component analysis of 66 variables was employed.
- Patients were followed for cardiovascular events over a median of 5.4 years.
Main Results:
- A CFR below 2.0 independently predicted event-free survival (HR: 2.5, p = 0.033).
- High insulin resistance was the strongest biochemical marker associated with decreased CFR.
- Insulin resistance correlated with CFR in men, while systolic blood pressure predicted CFR in women.
Conclusions:
- Low CFR is a prognostic indicator for cardiovascular events in non-diabetic patients with chest pain and normal perfusion.
- Insulin resistance is a marker for reduced CFR in men.
- Systolic blood pressure is an important predictor in women within this patient group.
Background:
Microvascular dysfunction could be responsible for chest pain in patients without myocardial perfusion defects. We evaluated microvascular function using ultrasound-assessed coronary flow reserve (CFR) in patients with chest pain and normal myocardial perfusion scintigram. Secondly, we investigated association between cardiovascular parameters and decreased CFR in a sex specific manner.
Methods:
A total of 202 (128 women) non-diabetic patients with chest pain and suspected myocardial ischemia, but without myocardial perfusion defects on myocardial perfusion scintigram, were enrolled and underwent CFR examination and blood sampling. All patients were followed-up for cardiovascular events. We used a supervised principal component analysis including 66 variables such as clinical parameters, ongoing medication, coronary artery disease history, lipids, metabolic parameters, inflammatory and other cardiovascular parameters.
Results:
During a median follow-up time of 5.4 years, 25 cardiovascular events occurred; (men;18, women;7). Average CFR of the study cohort was 2.7±1.2 and 14% showed impaired CFR<2.0. In an adjusted Cox regression analysis, CFR<2.0 independently predicted event-free survival (HR:2.5, p = 0.033). In the supervised principal component analysis high insulin resistance assessed by Homeostatic model assessment for insulin resistance was the strongest biochemical marker associated with decreased CFR. Interestingly, upon sex specific multivariable linear regression analysis, the association was only significant in men (β = -0.132, p = 0.041) while systolic blood pressure remained an independent predictor in women (β = -0.009, p = 0.011).
Conclusions:
In non-diabetic patients with chest pain without myocardial perfusion defects, low CFR has prognostic value for future cardiovascular events. Insulin resistance appears to be a marker for decreased CFR in men. Indeed, in the context of contribution of traditional risk factors in this patient population, the value of systolic blood pressure seems to be important in the women.
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