title: Improving diagnosis and treatment of women with angina pectoris and microvascular disease: the iPOWER study design and rationale.
abstract: BACKGROUND
  The iPOWER study aims at determining whether routine assessment of coronary microvascular dysfunction (CMD) in women with angina and no obstructive coronary artery disease is feasible and identifies women at risk.
  
  
  METHODS
  All women with angina referred to invasive angiographic assessment in Eastern Denmark are invited to join the study according to in- and exclusion criteria. Assessment includes demographic, clinical and psychosocial data, symptoms, electrocardiogram, blood- and urine samples and transthoracic echocardiography during rest and dipyridamol stress with measurement of coronary flow reserve (CFR) by Doppler of the left anterior descending artery. In substudies CMD will be assessed by positron emission tomography, peripheral endothelial function, magnetic resonance imaging-and computed tomography derived myocardial perfusion scans, angiographic corrected TIMI frame counts, advanced echocardiographic modalities at rest and during stress, and invasive measures of CFR and coronary vascular reactivity. The study will include 2000 women who will be followed for 5 years for cardiovascular outcomes.
  
  
  RESULTS
  By May 2013, 1685 women have been screened, 759 eligible patients identified, 530 contacted, and 299 (56%) agreed to participate. Among the first 50 patients, Doppler CFR was successfully measured in 49 (98%).
  
  
  CONCLUSIONS
  Among women with suspected ischemic heart disease and no obstructive coronary artery disease, non-invasive Doppler CFR is feasible as a routine assessment. The study will provide information on methods to diagnose CMD and determine the prognostic value of routine non-invasive assessment of microvascular function. Future study will provide women identified with CMD participation in interventional substudies designed to test treatment strategies.
authors.affiliation: Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark. Electronic address: Eva.irene.bossano.prescott@regionh.dk.
authors.forename: Eva
authors.initials: E
authors.lastname: Prescott
authors.affiliation: Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark.
authors.forename: Steen Zabell
authors.initials: SZ
authors.lastname: Abildstrøm
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Aziz
authors.affiliation: Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA.
authors.forename: Noel Bairey
authors.initials: NB
authors.lastname: Merz
authors.affiliation: Department of Cardiology, Hvidovre University Hospital, Copenhagen, Denmark.
authors.forename: Ida
authors.initials: I
authors.lastname: Gustafsson
authors.affiliation: Cardiovascular Research Group Cymru, Cardiff University, Cardiff, United Kingdom.
authors.forename: Julian
authors.initials: J
authors.lastname: Halcox
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Henrik Steen
authors.initials: HS
authors.lastname: Hansen
authors.affiliation: Department of Cardiology , Gentofte University Hospital, Copenhagen, Denmark.
authors.forename: Peter Riis
authors.initials: PR
authors.lastname: Hansen
authors.affiliation: Department of Cardiology B, Rigshospitalet University Hospital, Copenhagen, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Kastrup
authors.affiliation: Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark.
authors.forename: Marie
authors.initials: M
authors.lastname: Michelsen
authors.affiliation: Department of Cardiology B, Rigshospitalet University Hospital, Copenhagen, Denmark.
authors.forename: Naja Dam
authors.initials: ND
authors.lastname: Mygind
authors.affiliation: Department of Cardiology , Robert Bosch Krankenhaus, Stuttgart, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Ong
authors.affiliation: Department of Cardiology , Gentofte University Hospital, Copenhagen, Denmark.
authors.forename: Adam
authors.initials: A
authors.lastname: Pena
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Rosengren
authors.affiliation: Department of Cardiology , Robert Bosch Krankenhaus, Stuttgart, Germany.
authors.forename: Udo
authors.initials: U
authors.lastname: Sechtem
authors.affiliation: Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Søgaard
mesh_terms: D000787:Angina Pectoris / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D017023:Coronary Angiography / Q000639:trends*; D003326:Coronary Circulation / Q000502:physiology*; D015150:Echocardiography, Doppler / Q000639:trends*; D005260:Female; D006801:Humans; D008833:Microcirculation; D015337:Multicenter Studies as Topic / Q000379:methods; D009204:Myocardial Revascularization / Q000379:methods / Q000639:trends*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D012039:Regional Blood Flow