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Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
Published on: August 17, 2022
Women with coronary microvascular dysfunction and no obstructive coronary artery disease have reduced exercise
Daria Frestad Bechsgaard1, Jens Dahlgaard Hove2, Hannah Elena Suhrs3
1Department of Cardiology, Hvidovre University Hospital, University of Copenhagen, Kettegaard Allé 30, 2650 Hvidovre, Copenhagen, Denmark.
Insights
Women with angina and coronary microvascular dysfunction (CMD) have significantly reduced exercise capacity. This CMD is linked to impaired heart rate response and recovery, impacting cardiovascular prognosis.
Area of Science:
- Cardiology
- Exercise Physiology
Background:
- Coronary microvascular dysfunction (CMD) and reduced exercise capacity are linked to poor cardiovascular outcomes.
- The relationship between CMD and exercise capacity in patients with angina but no obstructive coronary artery disease (CAD) requires further investigation.
Purpose of the Study:
- To determine if women with angina and CMD, but without obstructive CAD, exhibit reduced exercise capacity compared to controls.
- To assess the association between CMD and various cardiopulmonary exercise testing (CPET)-derived variables.
Main Methods:
- Transthoracic Doppler echocardiography with dipyridamole vasodilation was used to assess CMD.
- Cardiopulmonary exercise testing (CPET) with an incremental ergometer protocol was performed on all participants.
Main Results:
- Women with angina and CMD showed significantly reduced peak oxygen consumption (VO2) compared to controls with normal microvascular function (17.3 vs. 27.3 ml/kg/min).
- CMD presence in symptomatic women was independently associated with reduced peak VO2.
- CMD was also linked to diminished heart rate reserve and blunted heart rate recovery.
Conclusions:
- Women experiencing angina with CMD and no obstructive CAD demonstrate substantially lower exercise capacity than their healthy counterparts.
- The combination of angina and CMD is associated with impaired heart rate dynamics during and after exercise.
Background:
Both coronary microvascular dysfunction (CMD) and reduced exercise capacity are associated with adverse cardiovascular prognosis. The association between CMD and cardiopulmonary exercise testing (CPET) derived exercise capacity in symptomatic individuals without obstructive coronary artery disease (CAD) is not clear. We investigated whether exercise capacity was reduced in women with angina, CMD and no obstructive CAD compared with sex-matched controls. Furthermore, we assessed the association between CMD and other CPET-derived variables.
Methods:
All participants underwent transthoracic Doppler echocardiography of the left anterior descending artery with dipyridamole-induced vasodilation and CPET using ergometer cycle with an incremental test protocol.
Results:
We included 99 women with angina and no obstructive CAD (patients) and 27 asymptomatic women (controls), age (mean ± standard deviation) 61 ± 10 and 58 ± 10 years, respectively. Patients had a higher burden of risk factors compared with controls, while the weekly physical activity level was comparable between the groups (p = 0.72). CMD was present in 27 (27%) patients and 5 (19%) controls. Peak VO2 was significantly reduced in patients with CMD compared with controls with normal coronary microvascular function ((median (IQR) 17.3 (15.5-21.3) vs. 27.3 (21.6-30.8) ml/kg/min; age-adjusted p = 0.001), independent of cardiovascular risk factors (p = 0.041). Presence of CMD in symptomatic women was also associated with diminished heart rate reserve (p < 0.001) and blunted heart rate recovery.
Conclusions:
Women with angina, CMD and no obstructive CAD have markedly reduced exercise capacity compared with sex-matched controls. Moreover, combination of angina and CMD is associated with impaired heart rate response and heart rate recovery.
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