title: Coronary Microvascular Function and Cardiovascular Risk Factors in Women With Angina Pectoris and No Obstructive Coronary Artery Disease: The iPOWER Study.
abstract: BACKGROUND
  The majority of women with angina-like chest pain have no obstructive coronary artery disease when evaluated with coronary angiography. Coronary microvascular dysfunction is a possible explanation and associated with a poor prognosis. This study evaluated the prevalence of coronary microvascular dysfunction and the association with symptoms, cardiovascular risk factors, psychosocial factors, and results from diagnostic stress testing.
  
  
  RESULTS
  After screening 3568 women, 963 women with angina-like chest pain and a diagnostic coronary angiogram without significant coronary artery stenosis (<50%) were consecutively included. Mean age (SD) was 62.1 (9.7). Assessment included demographic and clinical data, blood samples, questionnaires, and transthoracic echocardiography during rest and high-dose dipyridamole (0.84 mg/kg) with measurement of coronary flow velocity reserve (CFVR) by Doppler examination of the left anterior descending coronary artery. CFVR was successfully measured in 919 (95%) women. Median (IQR) CFVR was 2.33 (1.98-2.76), and 241 (26%) had markedly impaired CFVR (<2). In multivariable regression analysis, predictors of impaired CFVR were age (P<0.01), hypertension (P=0.02), current smoking (P<0.01), elevated heart rate (P<0.01), and low high-density lipoprotein cholesterol (P=0.02), but these variables explained only a little of the CFVR variation (r(2)=0.09). CFVR was not associated with chest pain characteristics or results from diagnostic stress testing.
  
  
  CONCLUSIONS
  Impaired CFVR was detected in a substantial proportion, which suggests that coronary microvascular dysfunction plays a role in the development of angina pectoris. CFVR was associated with few cardiovascular risk factors, suggesting that CFVR is an independent parameter in the risk evaluation of these women. Symptom characteristics and results from stress testing did not identify individuals with impaired CFVR.
authors.affiliation: Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark naja.dam.mygind@regionh.dk ndmygind@dadlnet.dk.
authors.forename: Naja Dam
authors.initials: ND
authors.lastname: Mygind
authors.affiliation: Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark.
authors.forename: Marie Mide
authors.initials: MM
authors.lastname: Michelsen
authors.affiliation: Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark.
authors.forename: Adam
authors.initials: A
authors.lastname: Pena
authors.affiliation: Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Denmark.
authors.forename: Daria
authors.initials: D
authors.lastname: Frestad
authors.affiliation: Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark.
authors.forename: Nynne
authors.initials: N
authors.lastname: Dose
authors.affiliation: Department of Cardiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Aziz
authors.affiliation: Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark.
authors.forename: Rebekka
authors.initials: R
authors.lastname: Faber
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Nis
authors.initials: N
authors.lastname: Høst
authors.affiliation: Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Denmark.
authors.forename: Ida
authors.initials: I
authors.lastname: Gustafsson
authors.affiliation: Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark.
authors.forename: Peter Riis
authors.initials: PR
authors.lastname: Hansen
authors.affiliation: Department of Cardiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
authors.forename: Henrik Steen
authors.initials: HS
authors.lastname: Hansen
authors.affiliation: Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA.
authors.forename: C Noel
authors.initials: CN
authors.lastname: Bairey Merz
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Kastrup
authors.affiliation: Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark.
authors.forename: Eva
authors.initials: E
authors.lastname: Prescott
mesh_terms: D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003718:Denmark / Q000453:epidemiology; D004176:Dipyridamole / Q000008:administration & dosage; D015150:Echocardiography, Doppler; D025401:Echocardiography, Stress / Q000379:methods; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008833:Microcirculation; D017566:Microvascular Angina / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D055806:Microvessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D014665:Vasodilator Agents / Q000008:administration & dosage; D016387:Women's Health
chemical_list: D014665:Vasodilator Agents; D004176:Dipyridamole
keywords: angina pectoris; coronary artery disease; echocardiography; microvascular dysfunction; women