Peripheral Reactive Hyperemia Index and Coronary Microvascular Function in Women With no Obstructive CAD: The iPOWER Study

TY - JOUR

T1 - Peripheral Reactive Hyperemia Index and Coronary Microvascular Function in Women With no Obstructive CAD

T2 - The iPOWER Study

AU - Michelsen, Marie Mide

AU - Mygind, Naja Dam

AU - Peña, Adam

AU - Aziz, Ahmed

AU - Frestad, Daria

AU - Høst, Nis

AU - Prescott, Eva

AU - Steering Committee of the iPOWER Study

N1 - Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Objectives This study investigated whether digital reactive hyperemia index (RHI) measured by digital pulse amplitude tonometry is a sensitive indicator of coronary microvascular dysfunction (CMD). Background CMD is an early marker of cardiovascular disease. However, CMD is a complex diagnosis and consists of multiple abnormalities of the coronary circulation. Impaired RHI is a noninvasive measure of peripheral vascular dysfunction that can identify individuals with acetylcholine induced coronary vascular dysfunction. It is largely unknown whether there is also an association between RHI and the endothelial-independent aspect of CMD assessed as a coronary flow velocity reserve (CFVR). Methods We included 339 women with chest pain suggestive of angina pectoris and a diagnostic invasive coronary angiogram without significant coronary artery stenosis (<50%). CFVR was measured by transthoracic pulsed wave Doppler echocardiography during dipyridamole infusion (0.84 mg/kg). RHI was assessed by digital pulse amplitude tonometry. Participants were categorized in 3 RHI and 3 CFVR groups. We examined the association between CFVR and RHI and the distribution of cardiovascular risk factors between the CFVR and RHI groups. Results CFVR and RHI were successfully measured in 322 participants. Median CFVR was 2.3 (interquartile range: 2.0 to 2.8) and median RHI was 2.1 (interquartile range: 1.6 to 2.6). No correlation was found between CFVR and RHI (Spearman's rho = -0.067, p = 0.23), and mean RHI did not differ between CFVR categories (p = 0.39). Participants with low CFVR were significantly older and had a significantly greater burden of hypertension, whereas participants with an impaired RHI had a higher body mass index and were more likely to have diabetes and be current smokers. Conclusions RHI does not identify individuals with CMD assessed as impaired CFVR by dipyridamole stress echocardiography in women with no obstructive coronary artery disease. The two methods are likely to identify different aspects of vascular pathology, as indicated by the different association with cardiovascular risk factors.

AB - Objectives This study investigated whether digital reactive hyperemia index (RHI) measured by digital pulse amplitude tonometry is a sensitive indicator of coronary microvascular dysfunction (CMD). Background CMD is an early marker of cardiovascular disease. However, CMD is a complex diagnosis and consists of multiple abnormalities of the coronary circulation. Impaired RHI is a noninvasive measure of peripheral vascular dysfunction that can identify individuals with acetylcholine induced coronary vascular dysfunction. It is largely unknown whether there is also an association between RHI and the endothelial-independent aspect of CMD assessed as a coronary flow velocity reserve (CFVR). Methods We included 339 women with chest pain suggestive of angina pectoris and a diagnostic invasive coronary angiogram without significant coronary artery stenosis (<50%). CFVR was measured by transthoracic pulsed wave Doppler echocardiography during dipyridamole infusion (0.84 mg/kg). RHI was assessed by digital pulse amplitude tonometry. Participants were categorized in 3 RHI and 3 CFVR groups. We examined the association between CFVR and RHI and the distribution of cardiovascular risk factors between the CFVR and RHI groups. Results CFVR and RHI were successfully measured in 322 participants. Median CFVR was 2.3 (interquartile range: 2.0 to 2.8) and median RHI was 2.1 (interquartile range: 1.6 to 2.6). No correlation was found between CFVR and RHI (Spearman's rho = -0.067, p = 0.23), and mean RHI did not differ between CFVR categories (p = 0.39). Participants with low CFVR were significantly older and had a significantly greater burden of hypertension, whereas participants with an impaired RHI had a higher body mass index and were more likely to have diabetes and be current smokers. Conclusions RHI does not identify individuals with CMD assessed as impaired CFVR by dipyridamole stress echocardiography in women with no obstructive coronary artery disease. The two methods are likely to identify different aspects of vascular pathology, as indicated by the different association with cardiovascular risk factors.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Angina Pectoris

KW - Blood Flow Velocity

KW - Coronary Angiography

KW - Coronary Artery Disease

KW - Coronary Circulation

KW - Coronary Vessels

KW - Echocardiography, Doppler, Pulsed

KW - Echocardiography, Stress

KW - Female

KW - Fingers

KW - Humans

KW - Hyperemia

KW - Manometry

KW - Microcirculation

KW - Microvessels

KW - Middle Aged

KW - Peripheral Arterial Disease

KW - Predictive Value of Tests

KW - Regional Blood Flow

KW - Risk Factors

KW - Young Adult

KW - Comparative Study

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1016/j.jcmg.2016.02.005

DO - 10.1016/j.jcmg.2016.02.005

M3 - Journal article

C2 - 27056160

SN - 1936-878X

VL - 9

SP - 411

EP - 417

JO - J A C C: Cardiovascular Imaging

JF - J A C C: Cardiovascular Imaging

IS - 4

ER -