Coronary microvascular dysfunction is highly prevalent in women with chest pain in the absence of coronary artery disease: Results from the NHLBI WISE study

Reis, Steven E.; Holubkov, Richard; Smith, A.J.Conrad; Kelsey, Sheryl F.; Sharaf, Barry L.; Reichek, Nathaniel; Rogers, William J.; Merz, C. Noel Bairey; Sopko, George; Pepine, Carl J.

doi:10.1067/mhj.2001.114198

Cited by 486 publications

(327 citation statements)

References 28 publications

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“…Among both women and men, up to 60% of stable INOCA patients have documented CMD defined as the presence of microvascular endothelial‐dependent and/or nonendothelial‐dependent dysfunction 31, 32, 33. Furthermore, while the CMD was shown to be poorly correlated with traditional risk factors, age was found to be an independent predictor of CMD in both women and men 33.…”

Section: Inoca—prevalencementioning

confidence: 97%

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

Herscovici

Sedlak

Wei

et al. 2018

JAHA

Self Cite

140

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Section: Inoca—prevalencementioning

confidence: 97%

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

Herscovici

Sedlak

Wei

et al. 2018

JAHA

Self Cite

140

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“…[20][21][22][27][28][29] Prior studies using CMR perfusion imaging in patients with acute coronary syndrome and nonobstructive CAD did not include stress testing. [16][17][18][19]30,31 Adenosine stress perfusion CMR is highly sensitive, specific, and reproducible for identification of obstructive CAD and has been reported to be superior to other stress imaging methods for this purpose.…”

Section: Cmr Evidence Of Infarction (Lge)mentioning

confidence: 99%

“…[14][15][16][17][18][19] Microvascular coronary disease is a known cause of chest pain with nonobstructive CAD. 20 Abnormal coronary flow reserve is a predictor of adverse outcomes, including death, in stable patients with nonobstructive CAD. 21,22 Microvascular coronary disease has been hypothesized to cause acute coronary syndrome in at least some patients with nonobstructive CAD on angiography, 23 but this mechanism has not been specifically investigated.…”

Section: Introductionmentioning

confidence: 99%

Stress Cardiac MRI in Women With Myocardial Infarction and Nonobstructive Coronary Artery Disease

Mauricio

Srichai

Axel

et al. 2016

Clinical Cardiology

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BackgroundIn a prospective study, cardiac MRI (CMR) and intravascular ultrasound were performed in women with myocardial infarction (MI) and nonobstructive coronary artery disease (MINOCA). Forty participants underwent adenosine‐stress CMR (sCMR).HypothesisAbnormal perfusion may co‐localize with ischemic late gadolinium enhancement (LGE) and T2‐weighted signal hyperintensity (T2+), suggesting microvascular dysfunction contributed to MI.MethodsQualitative perfusion analysis was performed by 2 independent readers. Abnormal myocardial perfusion reserve index (MPRI) was defined as global average ≤1.84.ResultsAbnormal rest perfusion was present in 10 patients (25%) and stress perfusion abnormalities in 25 (63%). Abnormal stress perfusion was not associated with LGE but tended to occur with T2+. Among patients with abnormal perfusion and LGE, the LGE pattern was ischemic in half. The locations of abnormal perfusion and LGE matched in 75%, T2+ in 100%. Abnormal stress perfusion was not associated with plaque disruption and matched in location in 63%. MPRI was abnormal in 10 patients (25%) and was not associated with LGE, T2+ or plaque disruption.ConclusionsAbnormal perfusion on sCMR is common among women with MINOCA. Abnormal perfusion usually co‐localized with LGE and/or T2+ when present. Variability in LGE pattern leads to uncertainty about whether the finding of abnormal perfusion was cause or consequence of the tissue state leading to LGE. Low MPRI, possibly indicating diffuse microvascular disease, was observed with and without LGE and T2+. Multiple mechanisms may lead to abnormal perfusion on sCMR. Microvascular dysfunction may contribute to the pathogenesis of and coexist with other causes of MINOCA.

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“…5 Moreover, endothelial dysfunction of the microvasculature has been implicated in cardiac syndrome X, a condition characterized by typical angina, ST-segment depression during exercise electrocardiogram stress testing and normal coronary arteries by angiography. 32 Patients with cardiac syndrome X have evidence of endothelial dysfunction 33 and showed subendocardial ischemia and chest pain in response to adenosine, 34 which vasodilates the microvasculature in a partially endothelial-dependent manner. 35 The critical role of endothelial cells in relation to atherosclerosis and cardiovascular events is becoming apparent.…”

Section: No-dependent Penile Erectionmentioning

confidence: 99%

“…Coronary vasodilatory reserve also has a class IIb indication for the evaluation of patients with angina without an apparent angiographic lesion to investigate the possibility of cardiac syndrome X. 32,57 In research studies, endothelial function is measured by infusing graded concentrations of acetyl- The endothelial cell in health and disease BG Schwartz et al choline into a coronary artery and measuring changes in vessel diameter with quantitative angiography and measuring changes in blood flow with Doppler flow wires. 57 This method predicts cerebrovascular events 40 and long-term cardiovascular events, [41][42][43][44]49 and is considered the 'gold standard' for evaluating endothelial function.…”

Section: Catheter Basedmentioning

confidence: 99%

The endothelial cell in health and disease: its function, dysfunction, measurement and therapy

et al. 2009

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Endothelial cells have numerous endocrine functions and contribute to a variety of processes, including penile erection and vasodilation. Endothelial dysfunction is associated with cardiovascular risk factors and has been implicated in the pathogenesis of atherosclerosis and ED. This study reviews endothelial function, in addition to endothelial dysfunction and its role in atherosclerosis and ED. Measurement of endothelial function is reviewed, including catheter-based methods, venous occlusion plethysmography, high-frequency ultrasound, peripheral arterial tonometry, digital pulse amplitude tonometry, digital thermal monitoring, the L-arginine test and measurement of compounds released by endothelial cells. Therapy and medications that improve endothelial function are reviewed. As the scientific community learns more about the importance of the endothelium, it is increasingly important for the clinician to understand endothelial function, dysfunction, measurement of endothelial function and therapies that affect this remarkable cell type.

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Coronary microvascular dysfunction is highly prevalent in women with chest pain in the absence of coronary artery disease: Results from the NHLBI WISE study

Cited by 486 publications

References 28 publications

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

Stress Cardiac MRI in Women With Myocardial Infarction and Nonobstructive Coronary Artery Disease

The endothelial cell in health and disease: its function, dysfunction, measurement and therapy

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