Women with Stable Angina Pectoris and No Obstructive Coronary Artery Disease: Closer to a Diagnosis

Michelsen, Marie Mide; Mygind, Naja Dam; Frestad, Daria; Prescott, Eva

doi:10.15420/ecr.2016:33:2

Cited by 16 publications

(11 citation statements)

References 96 publications

(115 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For example, obese, one of the strong cardiovascular risk factor is more common in women (30%) than men (27%) (24). Several female related-factors have been shown to increase cardiac risk in women, such as oestrogen deficiency, polycystic ovary syndrome, premature menopause (26,27).Prior research also has suggested that women with CHD have a poor cardiovascular risk profile, which may contribute to the sex difference in morality after CHD (28). The Scottish Health Survey (24) showed the association between higher prevalence of multiple cardiovascular risk factors were particularly pronounced for women in most deprived quintiles (32%) compared with the least deprived quintiles (17%).…”

Section: Discussionmentioning

confidence: 99%

Impact of area deprivation on the cardiac mortality in the UK between1991 and 2010: evidence from a population-based longitudinal study

Jin

Neubeck²,

Atherton³

2020

European Journal of Cardiovascular Nursing

View full text Add to dashboard Cite

Aims Evidence from longitudinal studies on the influence of area deprivation in cardiac mortality is limited. We aimed to examine the impact of area deprivation on cardiac mortality in a large representative Scottish population. We also examined differences between women and men. Methods and results Retrospective analysis was performed by using linked data from Scottish Longitudinal Study from 1991 to 2010. The main exposure variable was socioeconomic status using the Carstairs deprivation scores, a composite score of area-level factors. Cox proportional-hazards models were constructed to evaluate the hazard ratios (HRs) and 95% confidence intervals (CIs) for cardiac mortality and all-cause mortality associated with area-based deprivation. Subgroup analyses were stratified by sex. In a representative population of 217 965 UK adults, a total of 58 770 deaths occurred over a median of 10 years of follow-up period. The risk of cardiac mortality and all-cause mortality showed a consistent graded increased across the deprived groups. Compared to the least deprived group, the adjusted HR of cardiac mortality in the most deprived group was 1.27 (1.15–1.39, P < 0.000). There was strong evidence that women from more deprived areas had significantly higher cardiac death risk than those from the least deprived areas (HR 1.42, 95% CI 1.22–1.65), while this observation was not strong in men with same background. Conclusion Our study demonstrated area deprivation was the strong predictor of long-term cardiac mortality and all-cause mortality. The inequalities were substantially greater in women from more deprived areas than men from the same background.

show abstract

Section: Discussionmentioning

confidence: 99%

Impact of area deprivation on the cardiac mortality in the UK between1991 and 2010: evidence from a population-based longitudinal study

Jin

Neubeck²,

Atherton³

2020

European Journal of Cardiovascular Nursing

View full text Add to dashboard Cite

show abstract

“…One of the challenges of non-invasive functional imaging of microvascular function is that studies are typically aimed at investigating either the endothelial-dependent or non-endothelial-dependent pathway of CMD (not both pathways), possibly leading to an underestimation of the condition in the studied population. This might contribute to the wide range of reported prevalence of CMD across studied populations (Michelsen, Mygind, Frestad et al, 2017). Using dipyridamole and adenosine, we predominately assessed the non-endothelial-dependent pathway of coronary microvascular function.…”

Section: Association Between Mpr Angina and Cmdmentioning

confidence: 99%

Myocardial CT perfusion compared with transthoracic Doppler echocardiography in evaluation of the coronary microvascular function: An iPOWER substudy

Bechsgaard

Hove

Michelsen

et al. 2020

Clin Physio Funct Imaging

Self Cite

View full text Add to dashboard Cite

Background A significant number of women with angina and no obstructive coronary artery disease (CAD; <50% stenosis) have coronary microvascular dysfunction (CMD) which carries an adverse cardiovascular prognosis. Coronary microvascular function can be evaluated by transthoracic Doppler echocardiography (TTDE) as a coronary flow velocity reserve (CFVR) and by static CT myocardial perfusion (CTP) as a myocardial perfusion reserve (MPR). Whether these methods are correlated is not known. We assessed the correlation between CFVR and MPR and investigated whether women with angina, CMD and no obstructive CAD have reduced MPR compared with asymptomatic women. Methods Static CTP with adenosine‐induced vasodilation and TTDE of the left anterior descending artery with dipyridamole‐induced vasodilation were successfully performed and analysed in 99 women with stable angina and no obstructive CAD and 33 asymptomatic women with no obstructive CAD. CMD was defined as CFVR < 2. Results Correlation between rate‐pressure product corrected MPR and CFVR was weak but significant (r = .23; p = .007). MPR was highest among asymptomatic women with normal CFVR (median [interquartile range; IQR] 158 [145–181] %). Symptomatic women with normal CFVR had reduced MPR (148 [134–162] %; age‐adjusted p < .001); however, the lowest MPR was found in symptomatic women with CMD (140 [129–164] %; age‐adjusted p < .001), independent of cardiovascular risk factors and haemodynamic parameters (p = .017). Conclusion Women with angina, CMD and no obstructive CAD had markedly diminished MPR compared with asymptomatic women. Correlation between CFVR and MPR was weak, suggesting that CTP and TTDE are not interchangeable for detection of CMD.

show abstract

“…Coronary microvascular dysfunction (CMD) is increasingly recognized as a cause of angina pectoris (AP) in patients without obstructive coronary artery disease (CAD) . CMD can be assessed noninvasively by transthoracic Doppler echocardiography (TTDE) with pharmacological stress as a significant reduction of the coronary flow velocity reserve (CFVR) in a major epicardial coronary artery (usually the left anterior descending artery [LAD]), and low CFVR has been shown to be an independent marker of adverse prognosis in a variety of patient subgroups, including in patients with AP without obstructive CAD …”

Section: Introductionmentioning

confidence: 99%

Coronary microvascular dysfunction is associated with cardiac time intervals in women with angina and no obstructive coronary artery disease: An iPOWER substudy

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background Coronary microvascular dysfunction (CMD) may cause angina in the absence of obstructive coronary artery disease (CAD) and increases the risk of future adverse cardiovascular events. Transthoracic Doppler echocardiography (TTDE) with pharmacological stress can assess coronary flow velocity reserve (CFVR), a measure of coronary microvascular function. However, simpler methods would be preferable for diagnosing CMD. Therefore, we examined the relationship between CFVR and cardiac time intervals measured by TTDE in a cohort of women with angina and no obstructive CAD. Methods In a prospective cohort study, we included 389 women with angina, left ventricular ejection fraction > 45%, and no obstructive CAD. CMD was defined as CFVR < 2.0. The study population was divided into three groups according to cutoff values of CFVR < 2, 2 ≤ CFVR ≤ 2.5, and CFVR > 2.5. Isovolumic contraction time (IVCT), ejection time (ET), and isovolumic relaxation time (IVRT) were measured by tissue Doppler M‐mode, and the myocardial performance index (MPI = (IVCT + IVRT)/ET) was calculated. Results Coronary microvascular dysfunction was associated with increasing age, hypertension, higher resting heart rate, and lower diastolic blood pressure. Moreover, CMD was associated with higher E/e′ ratio (P = 0.002) and longer IVCT (P < 0.001), higher MPI (P < 0.001) and shorter ET (P = 0.002), but not with IVRT or conventional measures of left ventricular geometry, mass, and function. In multivariable analysis, longer IVCT (P < 0.001) and higher MPI (P = 0.002) remained associated with CMD. Conclusion In women with angina and no obstructive CAD, CMD is associated with longer IVCT and higher MPI indicating a link between CMD and subtle alternations of systolic and combined measures of cardiac time intervals.

show abstract

Women with Stable Angina Pectoris and No Obstructive Coronary Artery Disease: Closer to a Diagnosis

Cited by 16 publications

References 96 publications

Impact of area deprivation on the cardiac mortality in the UK between1991 and 2010: evidence from a population-based longitudinal study

Impact of area deprivation on the cardiac mortality in the UK between1991 and 2010: evidence from a population-based longitudinal study

Myocardial CT perfusion compared with transthoracic Doppler echocardiography in evaluation of the coronary microvascular function: An iPOWER substudy

Coronary microvascular dysfunction is associated with cardiac time intervals in women with angina and no obstructive coronary artery disease: An iPOWER substudy

Contact Info

Product

Resources

About