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).
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.
Wessel
Timothy R
TR
University of Florida, Division of Cardiovascular Medicine, Gainesville, FL 32610-0277, USA.
Arant
Christopher B
CB
McGorray
Susan P
SP
Sharaf
Barry L
BL
Reis
Steven E
SE
Kerensky
Richard A
RA
von Mering
Gregory O
GO
Smith
Karen M
KM
Pauly
Daniel F
DF
Handberg
Eileen M
EM
Mankad
Sunil
S
Olson
Marian B
MB
Johnson
B Delia
BD
Merz
C Noel Bairey
CN
Sopko
George
G
Pepine
Carl J
CJ
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
D015415:Biomarkers; D014665:Vasodilator Agents; D000241:Adenosine