Functional and Economic Impact of INOCA and Influence of Coronary Microvascular Dysfunction
Christopher L Schumann1, Roshin C Mathew1, John-Henry L Dean1
1Division of Cardiovascular Medicine and the Cardiac Imaging Center, University of Virginia Health System, Charlottesville, Virginia, USA.
Insights
Patients with ischemia and no obstructive coronary artery disease (INOCA) experience significant quality of life impacts and economic burden. Coronary microvascular dysfunction (CMD) is common in INOCA but does not worsen symptoms.
Area of Science:
- Cardiology
- Cardiac Imaging
- Vascular Medicine
Background:
- Ischemia and no obstructive coronary artery disease (INOCA) presents a high symptom burden and increased risk of major adverse cardiac events.
- Coronary microvascular dysfunction (CMD) is a frequent cause of INOCA, yet its associated morbidity remains undercharacterized.
- Understanding the quality of life and economic consequences for INOCA patients is crucial for comprehensive care.
Purpose of the Study:
- To characterize the quality of life and economic impact in patients with INOCA.
- To identify the influence of coronary microvascular dysfunction (CMD) on these impacts.
- To explore predictors of CMD within the INOCA population.
Main Methods:
- Sixty-six INOCA patients underwent stress cardiac magnetic resonance imaging (CMR) to assess myocardial perfusion reserve (MPR).
- Reduced MPR (≤2.4) indicated possible or definite CMD.
- Quality of life and economic impact were evaluated using questionnaires and compared between INOCA patients with and without CMD.
Main Results:
- The prevalence of definite CMD was 24%, with 59% having definite or borderline CMD (MPR ≤2.4).
- INOCA patients reported significant physical limitations, angina frequency, reduced quality of life, and substantial work limitations.
- No significant difference in reported symptoms was found between INOCA patients with and without CMD.
Conclusions:
- INOCA is linked to high morbidity comparable to other high-risk cardiac conditions, with notable economic implications due to work limitations.
- CMD, while a common cause of INOCA, does not appear to exacerbate patient morbidity.
- The INOCA population experiences a significant symptom burden irrespective of the underlying cause.
Objectives:
This study sought to better characterize the quality of life and economic impact in patients with symptoms of ischemia and no obstructive coronary disease (INOCA) and to identify the influence of coronary microvascular dysfunction (CMD).
Background:
Patients with INOCA have a high symptom burden and an increased incidence of major adverse cardiac events. CMD is a frequent cause of INOCA. The morbidity associated with INOCA and CMD has not been well-characterized.
Methods:
Sixty-six patients with INOCA underwent stress cardiac magnetic resonance with calculation of myocardial perfusion reserve (MPR); MPR 2.0 to 2.4 was considered borderline-reduced (possible CMD) and MPR <2.0 was defined as reduced (definite CMD). Subjects completed quality of life questionnaires to assess the morbidity and economic impact of INOCA. Questionnaire results were compared between INOCA patients with and without CMD. In addition, logistic regression was used to determine the predictors of CMD within the INOCA population.
Results:
The prevalence of definite CMD was 24%. Definite or borderline CMD was present in 59% (MPR ≤2.4). Patients with INOCA reported greater physical limitation, angina frequency, and reduced quality of life compared to referent stable coronary artery disease and acute myocardial infarction populations. In addition, Patients with INOCA reported frequent time missed from work and work limitations, suggesting a substantial economic impact. No difference was observed in reported symptoms between INOCA patients with and without CMD. Glomerular filtration rate and body-mass index were significant predictors of CMD in multivariable regression analysis.
Conclusions:
INOCA is associated with high morbidity similar to other high-risk cardiac populations, and work limitations reported by Patients with INOCA suggest a substantial economic impact. CMD is a common cause of INOCA but is not associated with increased morbidity. These results suggest that there is significant symptom burden in the INOCA population regardless of etiology.
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