title: Heterogeneity of microvascular dysfunction in women with chest pain not attributable to coronary artery disease: implications for clinical practice.
abstract: BACKGROUND
  Women with chest pain in the absence of obstructive coronary artery disease (CAD) frequently have coronary microvascular dysfunction and inducible myocardial ischemia. Microvascular dysfunction is commonly diagnosed by demonstrating abnormal flow reserve in a single coronary artery during angiography. Therefore, diagnostic accuracy is dependent on homogeneity of microvascular dysfunction in the myocardium.
  
  
  METHODS
  In the Women's Ischemia Syndrome Evaluation (WISE), 34 women with chest pain and no significant CAD and 9 female control subjects underwent 13N-NH3 positron emission tomography to measure adenosine-induced changes in myocardial perfusion (ie, coronary flow reserve [CFR]). Flow reserve was correlated among the left anterior descending (LAD), circumflex (LCx), and right (RCA) coronary artery distributions.
  
  
  RESULTS
  The mean CFR in the LAD, LCx, and RCA was 2.85 +/- 1.35, 2.58 +/- 0.94, and 3.24 +/- 1.42, respectively. Concordance in the classification of microvascular function as normal (CFR > or =2.5) versus abnormal was present in the LAD and RCA, LAD and LCx, and RCA and LCx distributions in only 71.8%, 66.7%, and 61.6% of patients, respectively. There was a modest degree of correlation of CFR between the LAD and RCA (r = 0.79, P <.001), LAD and LCx (r = 0.61, P <.001), and LCx and RCA (r = 0.57, P <.001). Comparison of CFR in the 3 coronary arteries simultaneously in all patients demonstrated that the LCx had values that were significantly lower than the RCA and LAD distributions.
  
  
  CONCLUSIONS
  Substantial discordance of classification of microvascular function among coronary artery distributions in women with chest pain and no CAD suggests that microvascular dysfunction is distributed heterogeneously in the myocardium. Assessment of CFR in a single coronary artery during cardiac catheterization may not provide an accurate assessment of the coronary microcirculation in women with chest pain not attributable to CAD.
authors.affiliation: Cardiovascular Institute, University of Pittsburgh, Pittsburgh, Pa, USA.
authors.forename: Oscar C
authors.initials: OC
authors.lastname: Marroquin
authors.forename: Richard
authors.initials: R
authors.lastname: Holubkov
authors.forename: Daniel
authors.initials: D
authors.lastname: Edmundowicz
authors.forename: Cheryl
authors.initials: C
authors.lastname: Rickens
authors.forename: Gerald
authors.initials: G
authors.lastname: Pohost
authors.forename: Steven
authors.initials: S
authors.lastname: Buchthal
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
authors.forename: George
authors.initials: G
authors.lastname: Sopko
authors.forename: Robert C
authors.initials: RC
authors.lastname: Sembrat
authors.forename: Carolyn Cidis
authors.initials: CC
authors.lastname: Meltzer
authors.forename: Steven E
authors.initials: SE
authors.lastname: Reis
mesh_terms: D000241:Adenosine; D016022:Case-Control Studies; D002637:Chest Pain / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003326:Coronary Circulation / Q000502:physiology*; D003327:Coronary Disease; D005260:Female; D006801:Humans; D008833:Microcirculation / Q000502:physiology; D014055:Tomography, Emission-Computed
chemical_list: D000241:Adenosine