title: Increased wave reflection and ejection duration in women with chest pain and nonobstructive coronary artery disease: ancillary study from the Women's Ischemia Syndrome Evaluation.
abstract: OBJECTIVE
  Wave reflections augment central aortic SBP and increase systolic pressure time integral (SPTI) thereby increasing left ventricular (LV) afterload and myocardial oxygen (MVO2) demand. When increased, such changes may contribute to myocardial ischemia and angina pectoris, especially when aortic diastolic time is decreased and myocardial perfusion pressure jeopardized. Accordingly, we examined pulse wave reflection characteristics and diastolic timing in a subgroup of women with chest pain (Women's Ischemia Syndrome Evaluation, WISE) and no obstructive coronary artery disease (CAD).
  
  
  METHODS
  Radial artery BP waveforms were recorded by applanation tonometry, and aortic BP waveforms derived. Data from WISE participants were compared with data from asymptomatic women (reference group) without chest pain matched for age, height, BMI, mean arterial BP, and heart rate.
  
  
  RESULTS
  Compared with the reference group, WISE participants had higher aortic SBP and pulse BP and ejection duration. These differences were associated with increased augmentation index and reflected pressure wave systolic duration. These modifications in wave reflection characteristics were associated with increased SPTI and wasted LV energy (Ew) and a decrease in pulse pressure amplification, myocardial viability ratio, and diastolic pressure time fraction.
  
  
  CONCLUSIONS
  WISE participants with no obstructive CAD have changes in systolic wave reflections and diastolic timing that increase LV afterload, MVO2 demand, and Ew with the potential to reduce coronary artery perfusion. These alterations in cardiovascular function contribute to an undesirable mismatch in the MVO2 supply/demand that promotes ischemia and chest pain and may contribute to, or increase the severity of, future adverse cardiovascular events.
authors.affiliation: Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida 32601, USA.
authors.forename: Wilmer W
authors.initials: WW
authors.lastname: Nichols
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Denardo
authors.forename: B Delia
authors.initials: BD
authors.lastname: Johnson
authors.forename: Barry L
authors.initials: BL
authors.lastname: Sharaf
authors.forename: C Noel
authors.initials: CN
authors.lastname: Bairey Merz
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
mesh_terms: D000328:Adult; D002637:Chest Pain / Q000503:physiopathology*; D003324:Coronary Artery Disease / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D013318:Stroke Volume