Acute Ischemic Heart DiseaseCoronary microvascular dysfunction is highly prevalent in women with chest pain in the absence of coronary artery disease: Results from the NHLBI WISE study☆,☆☆
Section snippets
Methods
The Women’s Ischemia Evaluation (WISE) study is a 4-center study focused on developing new diagnostic techniques and advancing our understanding of pathophysiologic mechanisms for ischemic heart disease in women.5 Women referred for clinically indicated coronary angiography to evaluate chest pain were candidates for enrollment. As part of WISE, a subgroup of 159 women without obstructive CAD (<50% diameter stenosis in all coronaries) underwent invasive evaluation of the functional integrity of
Results
The 159 women, 85.5% of whom were white, had a mean age of 52.9 ± 10.6 years and were mostly postmenopausal (81.0%). The cohort had a maximum diameter coronary stenosis of 13.7% ± 18.2%. Of these women, 19.6% were current smokers, 17.1% had diabetes, 45.5% and 53.8% reported histories of hyperlipidemia and hypertension, respectively, and 43.6% of all women were using postmenopausal hormones (50.4% of postmenopausal women).
Discussion
Women with chest pain in the absence of obstructive coronary atherosclerosis pose both a diagnostic and a therapeutic challenge. Although many of these women are diagnosed with “noncardiac” chest pain, an alternative mechanism for their symptoms is coronary microvascular dysfunction. Identification of this disorder is important because known treatments provide effective symptom relief, and its diagnosis can limit the need for repeated evaluations of “noncardiac” chest pain.12, 13, 14 The
References (28)
- et al.
Vasotonic angina: a spectrum of ischemic syndromes involving functional abnormalities of the epicardial and microvascular coronary circulation
J Am Coll Cardiol
(1993) - et al.
A new digital electronic caliper for measurement for coronary arterial stenosis: comparison with visual estimates and computer assisted measurements
Am J Cardiol
(1984) - et al.
Noninvasive quantification of myocardial blood flow in human subjects with 15O-labeled water and positron emission tomography
J Am Coll Cardiol
(1989) - et al.
Increased myocardial perfusion at rest and diminished perfusion reserve in patients with angina and angiographically normal coronary arteries
J Am Coll Cardiol
(1990) - et al.
Early impairment of coronary flow reserve in young men with borderline hypertension
J Am Coll Cardiol
(1998) - et al.
Mechanisms of estrogen-induced vasodilatation: in vivo studies in canine coronary conductance and resistance arteries
J Am Coll Cardiol
(1995) - et al.
Regulation of prostacyclin and thromboxane production by human umbilical vessels: the effect of estradiol and progesterone in a superfusion model
Prostaglandins Leukot Mediat
(1982) Noninvasive testing in coronary artery disease: selection of procedures and interpretation of results
Postgrad Med
(1983)- et al.
The anginal syndrome with normal coronary arteriography
Trans Assoc Am Physicians
(1967) - et al.
Left ventricular dysfunction in patients with angina pectoris, normal epicardial coronary arteries, and abnormal vasodilator reserve
Circulation
(1985)
The Women’s Ischemia Syndrome Evaluation (WISE) study: protocol design, methodology and pilot phase report
J Am Coll Cardiol
Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women: the Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial
JAMA
Prospective study of endogenous sex hormones and fatal cardiovascular disease in postmenopausal women
Lancet
Measurements of coronary flow reserve: defining pathophysiology versus making decisions about patient care
Circulation
Cited by (469)
Pericardial fat volume is related to endothelial-mediated coronary blood flow in women with suspected coronary microvascular dysfunction. A report from the Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study
2024, American Heart Journal Plus: Cardiology Research and PracticeCardiovascular Imaging in Women
2024, Seminars in Nuclear MedicineGlobal Longitudinal Strain as Predictor of Inducible Ischemia in No Obstructive Coronary Artery Disease in the CIAO-ISCHEMIA Study
2024, Journal of the American Society of Echocardiography
- ☆
Supported by contracts from the National Heart, Lung, and Blood Institute, contracts N01-HV-68161, N01-HV-68162, N01-HV-68163, and N01-HV-68164 and grants from the Gustavis and Louis Pfeiffer Research Foundation; the Women’s Guild, Cedars-Sinai Medical Center; Ladies Hospital Aid Society of Western Pennsylvania, University of Pittsburgh; and qmed, Inc.
- ☆☆
Reprint requests: Steven E. Reis, MD, c/o WISE Coordinating Center, 127 Parran Hall, 130 DeSoto St, Pittsburgh, PA 15261. E-mail: [email protected]