title: Coronary microvascular reactivity is only partially predicted by atherosclerosis risk factors or coronary artery disease in women evaluated for suspected ischemia: results from the NHLBI Women's Ischemia Syndrome Evaluation (WISE).
abstract: BACKGROUND
  Altered coronary reactivity is frequent in women with findings of myocardial ischemia without significant obstructive disease. This suggests a defect in coronary microvascular function. The adenosine-related component of this altered reactivity has been described in male and mixed gender populations, while the factors influencing this component of coronary reactivity in symptomatic women have received limited attention. Accordingly, the relationship between adenosine-related microvascular coronary reactivity and risk factors in symptomatic women evaluated for suspected ischemia remains uncertain.
  
  
  OBJECTIVE
  Abnormal coronary microvascular reactivity to adenosine is predicted by atherosclerosis risk factors in women.
  
  
  METHODS
  As part of the NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE), we investigated the relationship between risk factors and coronary microvascular reactivity as flow velocity reserve to intracoronary adenosine (CFVR(Ado)) in 210 women referred for angiography to evaluate suspected ischemia.
  
  
  RESULTS
  Univariate analyses identified associations between CFVR(Ado) and multiple risk conditions; however, after adjusting for age, none remained significant. The best multivariable model using combinations of risk conditions to predict CFVR(Ado) yielded an R2 of only 0.18.
  
  
  CONCLUSIONS
  Among women with suspected ischemia, risk factors account for <20% of observed variability in CFVR(Ado). Therefore, other as yet unidentified factors must primarily account for coronary microvascular reactivity to adenosine.
authors.affiliation: University of Florida, Division of Cardiovascular Medicine, Gainesville, FL 32610-0277, USA.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Wessel
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Arant
authors.forename: Susan P
authors.initials: SP
authors.lastname: McGorray
authors.forename: Barry L
authors.initials: BL
authors.lastname: Sharaf
authors.forename: Steven E
authors.initials: SE
authors.lastname: Reis
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kerensky
authors.forename: Gregory O
authors.initials: GO
authors.lastname: von Mering
authors.forename: Karen M
authors.initials: KM
authors.lastname: Smith
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Pauly
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Handberg
authors.forename: Sunil
authors.initials: S
authors.lastname: Mankad
authors.forename: Marian B
authors.initials: MB
authors.lastname: Olson
authors.forename: B Delia
authors.initials: BD
authors.lastname: Johnson
authors.forename: C Noel Bairey
authors.initials: CN
authors.lastname: Merz
authors.forename: George
authors.initials: G
authors.lastname: Sopko
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
mesh_terms: D000241:Adenosine; D050197:Atherosclerosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003331:Coronary Vessels / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007249:Inflammation; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011237:Predictive Value of Tests; D012307:Risk Factors; D014665:Vasodilator Agents
chemical_list: D015415:Biomarkers; D014665:Vasodilator Agents; D000241:Adenosine