title: Diastolic dysfunction in women with signs and symptoms of ischemia in the absence of obstructive coronary artery disease: a hypothesis-generating study.
abstract: BACKGROUND
  Angina, in the absence of obstructive coronary artery disease, is more common in women, is associated with adverse cardiovascular morbidity and mortality, and is a major burden to the healthcare system. Although advancements have been made to understand the mechanistic underpinning of this disease, the functional consequence remains unclear.
  
  
  RESULTS
  Cardiac magnetic resonance imaging was performed to assess left ventricular function in 20 women with signs and symptoms of ischemia, but no obstructive coronary artery disease (cases), and 15 age- and body mass index-matched reference controls. Functional imaging included standard cinematic imaging to assess left ventricular morphology and global function, along with tissue tagging to assess left ventricular tissue deformation. Systolic function was preserved in both cases and controls, with no differences in ejection fraction (mean±SE: 63.1±8% versus 65±2%), circumferential strain (-20.7±0.6% versus -21.9±0.5%), or systolic circumferential strain rate (-105.9±6.1% versus -109.0±3.8% per second). In contrast, we observed significant differences between cases and controls in diastolic function, as demonstrated by reductions in both diastolic circumferential strain rate (153.8±8.9% versus 191.4±8.9% per second; P<0.05) and peak rate of left ventricular untwisting (-99.4±8.0° versus -129.4±12.8° per second; P<0.05).
  
  
  CONCLUSIONS
  Diastolic function is impaired in women with signs and symptoms of ischemia in the absence of coronary artery disease, as assessed by cardiac magnetic resonance tissue tagging. These results are hypothesis-generating. Larger studies are needed to define the exact mechanism(s) responsible and to establish viable treatment strategies.
authors.affiliation: From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA. michael.nelson@cshs.org.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Nelson
authors.affiliation: From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Lidia S
authors.initials: LS
authors.lastname: Szczepaniak
authors.affiliation: From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Janet
authors.initials: J
authors.lastname: Wei
authors.affiliation: From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Afsaneh
authors.initials: A
authors.lastname: Haftabaradaren
authors.affiliation: From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Meghan
authors.initials: M
authors.lastname: Bharadwaj
authors.affiliation: From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Behzad
authors.initials: B
authors.lastname: Sharif
authors.affiliation: From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Puja
authors.initials: P
authors.lastname: Mehta
authors.affiliation: From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhang
authors.affiliation: From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Louise E
authors.initials: LE
authors.lastname: Thomson
authors.affiliation: From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.affiliation: From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Debiao
authors.initials: D
authors.lastname: Li
authors.affiliation: From the Heart Institute (M.D.N., C.N.B.M.), Biomedical Imaging Research Institute (L.S.S., B.S., D.L.), Diabetes and Obesity Research Institute (L.S.S.), Barbra Streisand Women's Heart Center (J.W., A.H., M.B., P.M., C.N.B.M.), Biostatistics and Bioinformatics Research Center (X.Z.), and S. Mark Taper Foundation Imaging Center (L.E.T., D. S. B.), Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: C Noel
authors.initials: CN
authors.lastname: Bairey Merz
mesh_terms: D003287:Contrast Media; D003324:Coronary Artery Disease; D003971:Diastole; D017352:Echo-Planar Imaging / Q000379:methods; D005260:Female; D019786:Gadolinium DTPA; D006321:Heart / Q000503:physiopathology*; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000503:physiopathology*; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: diastole; magnetic resonance imaging; myocardial ischemia; women