Resting coronary velocity and myocardial performance in women with impaired coronary flow reserve: Results from the Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study. (15th June 2020)

• Record Type: Journal Article
• Authors: Suppogu, Nissi; Wei, Janet; Nelson, Michael D.; Cook-Wiens, Galen; Cheng, Susan; Shufelt, Chrisandra L.; Thomson, Louise E.J.; Tamarappoo, Balaji; Berman, Daniel S.; Samuels, Bruce; Azarbal, Babak; Anderson, R. David; Petersen, John W.; Handberg, Eileen M.; Pepine, Carl J.; Merz, C. Noel Bairey
• Is Part Of: International journal of cardiology. Volume 309(2020)
• Page Start: 19
• Page End: 22
• Publication Date: 2020-06-15
• Subjects: Coronary flow reserve -- Heart failure with preserved ejection fraction -- Baseline average peak velocity; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2020.01.053
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Women with evidence of ischemia and no obstructive coronary arteries (INOCA) often have coronary microvascular dysfunction (CMD) indicated by impaired coronary flow reserve (CFR) to adenosine. Low CFR is associated with an adverse prognosis, including incident heart failure. Because the CFR calculation relies on the baseline intrinsic coronary vasomotor flow velocity, a major determinate of CFR and the degree of variation in baseline flow alone may be an important contributor to risk of adverse outcomes in women with CMD. A better understanding of baseline blood flow in the setting of low CFR and its association with myocardial performance would be helpful. Methods: We evaluated 74 women who underwent invasive coronary reactivity testing in the Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study and had impaired CFR (<2.32). We assessed the relationship between coronary artery baseline average peak velocity (bAPV) at rest and cardiac magnetic resonance imaging measures of left ventricular (LV) structure and function. Results: When stratified as low (<22 cm/s) versus high (≥22 cm/s) bAPV, there were no differences in cardiovascular risk factors, coronary plaque burden, or LV structure. However, low bAPV was associated with higher LV end-diastolic filling pressure (P = 0.04), lower LV ejection fraction (P = 0.001), and differences in late systolic and diastolic strain rates (P = 0.01 to 0.05). Conclusions: In women with impaired CFR, low resting coronary flow velocity is associated with more adverse myocardial performance, which may contribute to risk for adverse outcomes and particularly heart failure in women with CMD. Highlights: Our cohort included only women with impaired coronary flow reserve <2.32. Divided into two groups <22 cm/s and ≥22 cm/s baseline average peak velocity Both groups had similar baseline characters and ventricular structural findings. Group with low <22 cm/s had high left ventricular end diastolic pressures. Group with low <22 cm/s had lower diastolic strain rates.