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- Title
Prevalence of Coronary Endothelial and Microvascular Dysfunction in Women with Symptoms of Ischemia and No Obstructive Coronary Artery Disease Is Confirmed by a New Cohort: The NHLBI-Sponsored Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD).
- Authors
Anderson, R. David; Petersen, John W.; Mehta, Puja K.; Wei, Janet; Johnson, B. Delia; Handberg, Eileen M.; Kar, Saibal; Samuels, Bruce; Azarbal, Babak; Kothawade, Kamlesh; Kelsey, Sheryl F.; Sharaf, Barry; Shaw, Leslee J.; Sopko, George; Bairey Merz, C. Noel; Pepine, Carl J.
- Abstract
<bold>Objective: </bold>In a separate, contemporary cohort, we sought to confirm findings of the original Women's Ischemia Syndrome Evaluation (WISE).<bold>Background: </bold>The original WISE observed a high prevalence of both invasively determined coronary endothelial and coronary microvascular dysfunction (CMD) that predicted adverse events in follow-up.<bold>Methods: </bold>We comparatively studied the WISE-Coronary Vascular Dysfunction (CVD) cohort (2009-2011), with signs and symptoms of ischemia but without significant CAD, to the original WISE (1997-2001) cohort. CMD was defined as coronary flow reserve (CFR) ≤2.5, or endothelial dysfunction as epicardial coronary artery constriction to acetylcholine (ACH), or <20% epicardial coronary dilation to nitroglycerin (NTG).<bold>Results: </bold>In WISE (n=181) and WISE-CVD (n=235) women, mean age in both was 54 years, and 83% were white (WISE) vs 74% (WISE-CVD, p=0.04). Use of hormone replacement therapy was less frequent in WISE-CVD vs WISE (46% vs 57%, p=0.026) as was presence of hypertension (40% vs 52%, p=0.013), hyperlipidemia (20% vs 46%, p<0.0001), and smoking (46% vs 56%, p=0.036). Similar rates were observed in WISE-CVD and WISE cohorts for CMD (mean CFR 2.7±0.6 vs 2.6±0.8, p=0.35), mean change in diameter with intracoronary ACH (0.2±10.0 vs 1.6±12.8 mm, p=0.34), and mean change in diameter with intracoronary NTG (9.7±13.0 vs 9.8±13.5 mm, p=0.94), respectively.<bold>Conclusions: </bold>This study confirms prevalence of CMD in the contemporary WISE-CVD cohort similar to that of the original WISE cohort, despite a lower risk factor burden in WISE-CVD. Because these coronary functional abnormalities predict major adverse cardiac events, clinical trials of therapies targeting these abnormalities are indicated.
- Subjects
ENDOTHELIUM diseases; CORONARY disease; ISCHEMIA; SYMPTOMS; SYNDROMES; TAKOTSUBO cardiomyopathy; CORONARY vasospasm
- Publication
Journal of Interventional Cardiology, 2019, p1
- ISSN
0896-4327
- Publication type
journal article
- DOI
10.1155/2019/7169275