Abstract 13822: Angina, Myocardial Perfusion, and Left Ventricular Structure Improve in Women With No Obstructive Coronary Artery Disease at 1-year Follow-Up: Findings From the Women’s Ischemia Syndrome Coronary Vascular Dysfunction Study

IntroductionCoronary microvascular dysfunction (CMD) is present in 60% of women with ischemia and no obstructive coronary artery disease (INOCA) but is associated with increased risk of major adverse cardiovascular events.MethodsIn women with suspected INOCA who enrolled in the Women’s Ischemia Synd...

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Published in:Circulation (New York, N.Y.) N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A13822-A13822
Main Authors: Quesada, Odayme, Hermel, Melody, Aldiwani, Haider, Suppogu, Nissi, Shufelt, Chrisandra, Cook-Wiens, Galen, Maughan, Jenna, Mehta, Puja K, Berman, Daniel, Thomson, Louise E, Pepine, Carl, Bairey Merz, Noel, Wei, Janet
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container_issue Suppl_1 Suppl 1
container_start_page A13822
container_title Circulation (New York, N.Y.)
container_volume 140
creator Quesada, Odayme
Hermel, Melody
Aldiwani, Haider
Suppogu, Nissi
Shufelt, Chrisandra
Cook-Wiens, Galen
Maughan, Jenna
Mehta, Puja K
Berman, Daniel
Thomson, Louise E
Pepine, Carl
Bairey Merz, Noel
Wei, Janet
description IntroductionCoronary microvascular dysfunction (CMD) is present in 60% of women with ischemia and no obstructive coronary artery disease (INOCA) but is associated with increased risk of major adverse cardiovascular events.MethodsIn women with suspected INOCA who enrolled in the Women’s Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study and completed baseline and 1-year follow-up stress cardiac magnetic resonance imaging, we evaluated for the presence of CMD (defined as myocardial perfusion reserve index (MPRI)
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We investigated changes in angina (using the Seattle Angina Questionnaire, SAQ), myocardial perfusion in those with and without CMD at baseline, and cardiac structure and associations with anti-ischemic therapies in 181 women. For each class of anti-ischemic therapy, including ACE-I/ARB, nitrates, beta blockers and calcium channel blockers, we compared subjects who were not on medication compared to those started between baseline and follow-up visit.ResultsWe observed improvement in 4/5 SAQ domains, MPRI, stress hemodynamics and LV structure (Table). Improvement in MPRI was seen in women with CMD (n=101) at baseline compared to women without CMD (n=80) (ΔMPRI 0.42 +0.52 vs. -0.07 +0.62, p &lt;0.0001). Initiation of ACE-I/ARB therapy between baseline and follow-up was associated with significant clinical improvement in angina compared to those not on ACE-I/ARB therapy (ΔSAQ-7 20.1 +16.6 vs 6.9 +17.1, p=0.01). No significant improvement in MPRI/SAQ with initiation of other therapies.ConclusionsIn womenwith INOCA, improvement in angina and myocardial perfusion are supported by improvement in stress hemodynamics and LV structure. Interestingly, improvement in MPRI was only seen women with CMD at baseline. Improvement with initiation of ACE-I/ARB therapy supports the mechanistic role of angiotensin II and emphasizes the need for large clinical trials to modify angiotensin II in this population.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/circ.140.suppl_1.13822</identifier><language>eng</language><publisher>by the American College of Cardiology Foundation and the American Heart Association, Inc</publisher><ispartof>Circulation (New York, N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A13822-A13822</ispartof><rights>2019 by the American College of Cardiology Foundation and the American Heart Association, Inc.</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids></links><search><creatorcontrib>Quesada, Odayme</creatorcontrib><creatorcontrib>Hermel, Melody</creatorcontrib><creatorcontrib>Aldiwani, Haider</creatorcontrib><creatorcontrib>Suppogu, Nissi</creatorcontrib><creatorcontrib>Shufelt, Chrisandra</creatorcontrib><creatorcontrib>Cook-Wiens, Galen</creatorcontrib><creatorcontrib>Maughan, Jenna</creatorcontrib><creatorcontrib>Mehta, Puja K</creatorcontrib><creatorcontrib>Berman, Daniel</creatorcontrib><creatorcontrib>Thomson, Louise E</creatorcontrib><creatorcontrib>Pepine, Carl</creatorcontrib><creatorcontrib>Bairey Merz, Noel</creatorcontrib><creatorcontrib>Wei, Janet</creatorcontrib><title>Abstract 13822: Angina, Myocardial Perfusion, and Left Ventricular Structure Improve in Women With No Obstructive Coronary Artery Disease at 1-year Follow-Up: Findings From the Women’s Ischemia Syndrome Coronary Vascular Dysfunction Study</title><title>Circulation (New York, N.Y.)</title><description>IntroductionCoronary microvascular dysfunction (CMD) is present in 60% of women with ischemia and no obstructive coronary artery disease (INOCA) but is associated with increased risk of major adverse cardiovascular events.MethodsIn women with suspected INOCA who enrolled in the Women’s Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study and completed baseline and 1-year follow-up stress cardiac magnetic resonance imaging, we evaluated for the presence of CMD (defined as myocardial perfusion reserve index (MPRI) &lt;1.84). We investigated changes in angina (using the Seattle Angina Questionnaire, SAQ), myocardial perfusion in those with and without CMD at baseline, and cardiac structure and associations with anti-ischemic therapies in 181 women. For each class of anti-ischemic therapy, including ACE-I/ARB, nitrates, beta blockers and calcium channel blockers, we compared subjects who were not on medication compared to those started between baseline and follow-up visit.ResultsWe observed improvement in 4/5 SAQ domains, MPRI, stress hemodynamics and LV structure (Table). Improvement in MPRI was seen in women with CMD (n=101) at baseline compared to women without CMD (n=80) (ΔMPRI 0.42 +0.52 vs. -0.07 +0.62, p &lt;0.0001). Initiation of ACE-I/ARB therapy between baseline and follow-up was associated with significant clinical improvement in angina compared to those not on ACE-I/ARB therapy (ΔSAQ-7 20.1 +16.6 vs 6.9 +17.1, p=0.01). No significant improvement in MPRI/SAQ with initiation of other therapies.ConclusionsIn womenwith INOCA, improvement in angina and myocardial perfusion are supported by improvement in stress hemodynamics and LV structure. Interestingly, improvement in MPRI was only seen women with CMD at baseline. Improvement with initiation of ACE-I/ARB therapy supports the mechanistic role of angiotensin II and emphasizes the need for large clinical trials to modify angiotensin II in this population.</description><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid/><recordid>eNqdUEtOwzAQtRBIlM8V0BygCXaStrS7qhBRiZ9UKMvKJJPG4NiRP1TZcQ2uxwk4AoayYM1i5mn0Zt57GkJOGI0ZG7LTQpgiZhmNrW9buWIxS8-SZIf02CDJomyQjndJj1I6jkZpkuyTA2ufwzhMR4Me-Zw-WWd44eDnagJTtRaK9-G60wU3peAS7tBU3gqt-sBVCVdYOViickYUXnIDC2d84bxBmDet0a8IQsGjbjB04Wq40XD77RKWRCBn2mjFTQdT4zDAubDILQIPGaIOg2CupdSb6KGdQC5UKdTaQm50A67GrfDH27uFuS1qbASHRafKQP-RXnK7zXbe2cqrYKxVyOnL7ojsVVxaPP7FQ5LlF_ezy2ijZYhjX6TfoFnVyKWrV-FPNKVsFCWUjRkLFdEkfCr959kX7gaKiA</recordid><startdate>20191119</startdate><enddate>20191119</enddate><creator>Quesada, Odayme</creator><creator>Hermel, Melody</creator><creator>Aldiwani, Haider</creator><creator>Suppogu, Nissi</creator><creator>Shufelt, Chrisandra</creator><creator>Cook-Wiens, Galen</creator><creator>Maughan, Jenna</creator><creator>Mehta, Puja K</creator><creator>Berman, Daniel</creator><creator>Thomson, Louise E</creator><creator>Pepine, Carl</creator><creator>Bairey Merz, Noel</creator><creator>Wei, Janet</creator><general>by the American College of Cardiology Foundation and the American Heart Association, Inc</general><scope/></search><sort><creationdate>20191119</creationdate><title>Abstract 13822: Angina, Myocardial Perfusion, and Left Ventricular Structure Improve in Women With No Obstructive Coronary Artery Disease at 1-year Follow-Up: Findings From the Women’s Ischemia Syndrome Coronary Vascular Dysfunction Study</title><author>Quesada, Odayme ; Hermel, Melody ; Aldiwani, Haider ; Suppogu, Nissi ; Shufelt, Chrisandra ; Cook-Wiens, Galen ; Maughan, Jenna ; Mehta, Puja K ; Berman, Daniel ; Thomson, Louise E ; Pepine, Carl ; Bairey Merz, Noel ; Wei, Janet</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-wolterskluwer_health_00003017-201911191-021383</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><toplevel>online_resources</toplevel><creatorcontrib>Quesada, Odayme</creatorcontrib><creatorcontrib>Hermel, Melody</creatorcontrib><creatorcontrib>Aldiwani, Haider</creatorcontrib><creatorcontrib>Suppogu, Nissi</creatorcontrib><creatorcontrib>Shufelt, Chrisandra</creatorcontrib><creatorcontrib>Cook-Wiens, Galen</creatorcontrib><creatorcontrib>Maughan, Jenna</creatorcontrib><creatorcontrib>Mehta, Puja K</creatorcontrib><creatorcontrib>Berman, Daniel</creatorcontrib><creatorcontrib>Thomson, Louise E</creatorcontrib><creatorcontrib>Pepine, Carl</creatorcontrib><creatorcontrib>Bairey Merz, Noel</creatorcontrib><creatorcontrib>Wei, Janet</creatorcontrib><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Quesada, Odayme</au><au>Hermel, Melody</au><au>Aldiwani, Haider</au><au>Suppogu, Nissi</au><au>Shufelt, Chrisandra</au><au>Cook-Wiens, Galen</au><au>Maughan, Jenna</au><au>Mehta, Puja K</au><au>Berman, Daniel</au><au>Thomson, Louise E</au><au>Pepine, Carl</au><au>Bairey Merz, Noel</au><au>Wei, Janet</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Abstract 13822: Angina, Myocardial Perfusion, and Left Ventricular Structure Improve in Women With No Obstructive Coronary Artery Disease at 1-year Follow-Up: Findings From the Women’s Ischemia Syndrome Coronary Vascular Dysfunction Study</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><date>2019-11-19</date><risdate>2019</risdate><volume>140</volume><issue>Suppl_1 Suppl 1</issue><spage>A13822</spage><epage>A13822</epage><pages>A13822-A13822</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><abstract>IntroductionCoronary microvascular dysfunction (CMD) is present in 60% of women with ischemia and no obstructive coronary artery disease (INOCA) but is associated with increased risk of major adverse cardiovascular events.MethodsIn women with suspected INOCA who enrolled in the Women’s Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study and completed baseline and 1-year follow-up stress cardiac magnetic resonance imaging, we evaluated for the presence of CMD (defined as myocardial perfusion reserve index (MPRI) &lt;1.84). We investigated changes in angina (using the Seattle Angina Questionnaire, SAQ), myocardial perfusion in those with and without CMD at baseline, and cardiac structure and associations with anti-ischemic therapies in 181 women. For each class of anti-ischemic therapy, including ACE-I/ARB, nitrates, beta blockers and calcium channel blockers, we compared subjects who were not on medication compared to those started between baseline and follow-up visit.ResultsWe observed improvement in 4/5 SAQ domains, MPRI, stress hemodynamics and LV structure (Table). Improvement in MPRI was seen in women with CMD (n=101) at baseline compared to women without CMD (n=80) (ΔMPRI 0.42 +0.52 vs. -0.07 +0.62, p &lt;0.0001). Initiation of ACE-I/ARB therapy between baseline and follow-up was associated with significant clinical improvement in angina compared to those not on ACE-I/ARB therapy (ΔSAQ-7 20.1 +16.6 vs 6.9 +17.1, p=0.01). No significant improvement in MPRI/SAQ with initiation of other therapies.ConclusionsIn womenwith INOCA, improvement in angina and myocardial perfusion are supported by improvement in stress hemodynamics and LV structure. Interestingly, improvement in MPRI was only seen women with CMD at baseline. Improvement with initiation of ACE-I/ARB therapy supports the mechanistic role of angiotensin II and emphasizes the need for large clinical trials to modify angiotensin II in this population.</abstract><pub>by the American College of Cardiology Foundation and the American Heart Association, Inc</pub><doi>10.1161/circ.140.suppl_1.13822</doi></addata></record>
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title Abstract 13822: Angina, Myocardial Perfusion, and Left Ventricular Structure Improve in Women With No Obstructive Coronary Artery Disease at 1-year Follow-Up: Findings From the Women’s Ischemia Syndrome Coronary Vascular Dysfunction Study
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