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Coronary microvascular dysfunction is associated with cardiac time intervals in women with angina and no obstructive coronary artery disease: An iPOWER substudy
Author(s) -
Pena Adam,
Michelsen Marie Mide,
Mygind Naja Dam,
Gustafsson Ida,
Høst Nis,
Bech Jan,
Kastrup Jens,
Hansen Henrik Steen,
Hansen Peter Riis,
Prescott Eva
Publication year - 2019
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.14356
Subject(s) - medicine , cardiology , ejection fraction , coronary artery disease , angina , doppler echocardiography , isovolumic relaxation time , coronary flow reserve , diastole , population , fractional flow reserve , blood pressure , heart failure , myocardial infarction , coronary angiography , environmental health
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.