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The association between heart rate reserve and impaired coronary flow velocity reserve: a study based on adenosine
Tingting Liu1,2, Mingyan Ding2, Dandan Sun2
1Faculty of Medical Imaging and Nuclear Medicine, Graduate School of Dalian Medical University, Dalian, 116044, China.
Insights
Reduced heart rate reserve (HRR) is linked to impaired coronary flow velocity reserve (CFVR) in angina patients without obstructive coronary artery disease. This association is particularly strong in women, where a blunted HRR may help stratify risk.
Area of Science:
- Cardiology
- Non-invasive cardiovascular imaging
- Coronary artery disease research
Background:
- Angina with no obstructive coronary artery disease (ANOCA) presents a diagnostic challenge.
- Coronary flow velocity reserve (CFVR) assessed by adenosine stress echocardiography (SE) is a key indicator of microvascular function.
- Heart rate reserve (HRR) is another physiological parameter that may reflect cardiac stress response.
Purpose of the Study:
- To investigate the correlation between heart rate reserve (HRR) and coronary flow velocity reserve (CFVR) in patients with ANOCA.
- To explore sex-specific differences in the relationship between HRR and impaired CFVR.
Main Methods:
- Adenosine stress echocardiography (SE) was performed on 111 ANOCA patients.
- Patients were categorized into groups with impaired CFVR (CFVR < 2) and control groups (CFVR ≥ 2).
- The relationship between HRR and CFVR was analyzed, including subgroup analysis by sex.
Main Results:
- ANOCA patients with impaired CFVR exhibited a significantly reduced HRR during adenosine infusion (25.73 ± 8.39 vs. 34.30 ± 19.93, P < 0.001).
- The blunted HRR response to adenosine was more pronounced in female patients compared to males.
- A strong association between CFVR and blunted HRR was found in women (r = 0.46, P < 0.001), but not in men (r = 0.18, P = 0.199).
- In females, HRR was identified as the strongest negative predictor of impaired CFVR (HR = 0.854, P = 0.006).
- An HRR < 35% demonstrated high sensitivity (70%) and specificity (87%) for detecting impaired CFVR in women (AUC = 0.838).
Conclusions:
- A blunted HRR is observed in ANOCA patients with impaired CFVR, with a more significant effect in women.
- A blunted HRR (< 35%) is a strong indicator of impaired CFVR in women with ANOCA, independent of traditional risk factors.
- HRR measurement could enhance risk stratification for impaired CFVR in female ANOCA patients.
Abstract:
This study was to explore the correlation between heart rate reserve (HRR) to coronary flow velocity reserve (CFVR), using adenosine stress echocardiography (SE), in patients with angina and no obstructive coronary artery disease (ANOCA). 111 ANOCA patients underwent adenosine SE were enrolled, which were divided into two groups, impaired CFVR group (CFVR < 2) and control groups (CFVR ≥ 2). The relationships between HRR and impaired CFVR were explored in total and subgroup to sex. A reduced HRR during adenosine infusion was seen in ANOCA patients with impaired CFVR (25.73 ± 8.39 vs. 34.30 ± 19.93, P < 0.001). Compared to respective controls, the blunted HRR to adenosine was more pronounced in female patients (women: 27.21 ± 8.01 vs. 39.48 ± 10.57, P < 0.001; men: 24.05 ± 8.70 vs. 29.12 ± 8.69, P = 0.041). A strong association between CFVR and a blunted HRR was observed in women (r = 0.46, P < 0.001), while no association in men (r = 0.18, P = 0.199). In female, a multivariate logistic regression identified HRR as the strongest negative predictor of impaired CFVR [HR (95% CI) = 0.854 (0.764-0.956), P = 0.006]. Based on the ROC curve, HRR < 35% was a strong indicator of impaired CFVR, with AUC of 0.838, sensitivity of 70%, and specificity of 87% in females. A blunted HRR was seen in patients with impaired CFVR, with a most pronounced effect being seen in female patients. The blunted HRR < 35% is intricately linked to impaired CFVR in women with ANOCA beyond the value of traditional risk factors, which could ultimately contribute to risk stratification of impaired CFVR in such patients.
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