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Impaired coronary flow velocity reserve is associated with cardiovascular risk factors but not with angina symptoms

Kira Bang Bove1, Marie M Michelsen2, Jakob Schroder2

  • 1Department of Cardiology, Bispebjerg Hospital, Kobenhavn, Denmark kirabove@gmail.com.

Open Heart
|January 19, 2021
PubMed

Insights

Coronary microvascular dysfunction (CMD) is more common in women with angina, but this difference disappears when accounting for cardiovascular risk factors. Standard tests do not identify CMD in these patients, questioning current definitions of microvascular angina.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Diagnostic Imaging

Background:

  • Coronary microvascular dysfunction (CMD) is hypothesized to cause angina in women without obstructive coronary artery disease (CAD).
  • Evidence linking angina pectoris to CMD is limited, necessitating further investigation.
  • Understanding CMD is crucial for diagnosing and managing chest pain in women.

Purpose of the Study:

  • To compare CMD prevalence in women with angina versus asymptomatic women.
  • To evaluate the relationship between CMD, angina characteristics, cardiovascular risk factors, and stress test results.
  • To investigate the diagnostic utility of current methods for identifying CMD in women with angina and non-obstructive CAD.

Main Methods:

  • A cross-sectional study involving 1684 women with angina and <50% coronary artery stenosis, compared to 102 asymptomatic controls.
  • Coronary microvascular function assessed using coronary flow velocity reserve (CFVR) via transthoracic Doppler stress echocardiography; CFVR < 2 defined as CMD.
  • Standardized angina questionnaires and health records for stress testing results were utilized.

Main Results:

  • Median CFVR was lower in symptomatic women (2.33) than asymptomatic women (2.60), with CMD found in 25% vs 19% respectively.
  • After adjusting for cardiovascular risk factors (hypertension, diabetes, smoking, heart rate), the difference in CFVR between groups was no longer significant (p=0.213).
  • No significant associations were found between CFVR and angina characteristics, symptom burden, or stress test outcomes.

Conclusions:

  • Impaired CFVR is more prevalent in symptomatic women but is associated with cardiovascular risk factors, not solely angina.
  • Standard stress tests and symptom characteristics do not reliably identify women with impaired CFVR among those with angina and non-obstructive CAD.
  • Current definitions of microvascular angina may need re-evaluation given these findings.
Abstract

Keywords:
angina pectorisechocardiographymicrovascular anginarisk factors

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