Coronary flow velocity response to adenosine characterizes coronary microvascular function in women with chest pain and no obstructive coronary disease - Results from the pilot phase of the Women's Ischemia Syndrome Evaluation (WISE) study
Se. Reis et al., Coronary flow velocity response to adenosine characterizes coronary microvascular function in women with chest pain and no obstructive coronary disease - Results from the pilot phase of the Women's Ischemia Syndrome Evaluation (WISE) study, J AM COL C, 33(6), 1999, pp. 1469-1475
Citations number
27
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
OBJECTIVES
We sought to develop and validate a definition of coronary microvascular dy
sfunction in women with chest pain and no significant epicardial obstructio
n based on adenosine-induced changes in coronary flow velocity (i.e., coron
ary velocity reserve).
BACKGROUND
Chest pain is frequently not caused by fixed obstructive coronary artery di
sease (CAD) of of large vessels in women. Coronary microvascular dysfunctio
n is an alternative mechanism or chest pain that is more prevalent in women
and is associated with attenuated coronary volumetric flow augmentation in
response to hyperemic stimuli (i.e., abnormal coronary flow reserve). Howe
ver, traditional assessment of coronary volumetric flow reserve is time con
suming and not uniformly available.
METHODS
As part of the Women's Ischemia Syndrome Evaluation (WISE) study, 48 women
with chest pam and normal coronary arteries or minimal coronary luminal irr
egularities (mean stenosis = 7%) underwent assessment of coronary blood flo
w reserve and coronary flow velocity reserve. Blood flow responses to intra
coronary adenosine were measured using intracoronary Doppler ultrasonograph
y and quantitative angiography
RESULTS
Coronary volumetric flow reserve correlated with coronary velocity reserve
(Pearson correlation = 0.87, p < 0.001). In 29 (60%) women with abnormal co
ronary microcirculation (mem coronary flow reserve = 1.84), adenosine incre
ased coronary velocity by 89% (p < 0.001) but did not change coronary cross
-sectional area. In 19 (40%) women with normal microcirculation (mean flow
reserve = 3.24), adenosine increased coronary velocity and area by 179% (p
< 0.001) and 17% (p < 0.001), respectively. A coronary velocity reserve thr
eshold of 2.24 provided the best balance between sensitivity and specificit
y (90% and 89%, respectively) for the diagnosis of microvascular dysfunctio
n. In addition, failure of the epicardial coronary to dilate at least 9% wa
s found to be a sensitive (79%) and specific (79%) surrogate marker of micr
ovascular dysfunction
CONCLUSIONS
Coronary flow velocity response to intracoronary adenosine characterizes co
ronary microvascular function in women with chest pain in the absence of ob
structive CAD. Attenuated epicardial coronary dilation response to adenosin
e may be a surrogate marker of microvascular dysfunction in women with ches
t pain and no obstructive CAD. (C) 1999 by the American College of Cardiolo
gy.