Improving diagnosis and treatment of women with
angina pectoris and microvascular disease: : The iPOWER study design and rationale

Eva Prescott; Steen Zabell Abildstrøm; Ahmed Aziz; Noel Bairey Merz; Ida Gustafsson; Julian Halcox; Henrik Steen Hansen; Peter Riis Hansen; Jens Kastrup; Marie Michelsen; Naja Dam Mygind; Peter Ong; Adam Pena; Annika Rosengren; Udo Sechtem; Peter Søgaard

doi:10.1016/j.ahj.2014.01.003

Improving diagnosis and treatment of women with angina pectoris and microvascular disease: : The iPOWER study design and rationale

Eva Prescott, Steen Zabell Abildstrøm, Ahmed Aziz, Noel Bairey Merz, Ida Gustafsson, Julian Halcox, Henrik Steen Hansen, Peter Riis Hansen, Jens Kastrup, Marie Michelsen, Naja Dam Mygind, Peter Ong, Adam Pena, Annika Rosengren, Udo Sechtem, Peter Søgaard

Department of Clinical Medicine

37 Citations (Scopus)

Abstract

BACKGROUND: The iPOWER study aims at determining whether routine assessment of coronary microvascular dysfunction (CMD) in women with angina and no obstructive coronary artery disease is feasible and identifies women at risk.

METHODS: All women with angina referred to invasive angiographic assessment in Eastern Denmark are invited to join the study according to in- and exclusion criteria. Assessment includes demographic, clinical and psychosocial data, symptoms, electrocardiogram, blood- and urine samples and transthoracic echocardiography during rest and dipyridamol stress with measurement of coronary flow reserve (CFR) by Doppler of the left anterior descending artery. In substudies CMD will be assessed by positron emission tomography, peripheral endothelial function, magnetic resonance imaging-and computed tomography derived myocardial perfusion scans, angiographic corrected TIMI frame counts, advanced echocardiographic modalities at rest and during stress, and invasive measures of CFR and coronary vascular reactivity. The study will include 2000 women who will be followed for 5 years for cardiovascular outcomes.

RESULTS: By May 2013, 1685 women have been screened, 759 eligible patients identified, 530 contacted, and 299 (56%) agreed to participate. Among the first 50 patients, Doppler CFR was successfully measured in 49 (98%).

CONCLUSIONS: Among women with suspected ischemic heart disease and no obstructive coronary artery disease, non-invasive Doppler CFR is feasible as a routine assessment. The study will provide information on methods to diagnose CMD and determine the prognostic value of routine non-invasive assessment of microvascular function. Future study will provide women identified with CMD participation in interventional substudies designed to test treatment strategies.

Original language	English
Journal	American Heart Journal
Volume	167
Issue number	4
Pages (from-to)	452–458
Number of pages	7
ISSN	0002-8703
DOIs	https://doi.org/10.1016/j.ahj.2014.01.003
Publication status	Published - Apr 2014

Keywords

Angina Pectoris
Coronary Angiography
Coronary Circulation
Echocardiography, Doppler
Female
Humans
Microcirculation
Multicenter Studies as Topic
Myocardial Revascularization
Prognosis
Randomized Controlled Trials as Topic
Regional Blood Flow

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Prescott, E., Abildstrøm, S. Z., Aziz, A., Merz, N. B., Gustafsson, I., Halcox, J., Hansen, H. S., Hansen, P. R., Kastrup, J., Michelsen, M., Mygind, N. D., Ong, P., Pena, A., Rosengren, A., Sechtem, U., & Søgaard, P. (2014). Improving diagnosis and treatment of women with angina pectoris and microvascular disease: : The iPOWER study design and rationale. American Heart Journal, 167(4), 452–458. https://doi.org/10.1016/j.ahj.2014.01.003

Prescott, E, Abildstrøm, SZ, Aziz, A, Merz, NB, Gustafsson, I, Halcox, J, Hansen, HS, Hansen, PR, Kastrup, J, Michelsen, M, Mygind, ND, Ong, P, Pena, A, Rosengren, A, Sechtem, U & Søgaard, P 2014, 'Improving diagnosis and treatment of women with angina pectoris and microvascular disease: : The iPOWER study design and rationale', American Heart Journal, vol. 167, no. 4, pp. 452–458. https://doi.org/10.1016/j.ahj.2014.01.003

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title = "Improving diagnosis and treatment of women with angina pectoris and microvascular disease: : The iPOWER study design and rationale",

abstract = "BACKGROUND: The iPOWER study aims at determining whether routine assessment of coronary microvascular dysfunction (CMD) in women with angina and no obstructive coronary artery disease is feasible and identifies women at risk.METHODS: All women with angina referred to invasive angiographic assessment in Eastern Denmark are invited to join the study according to in- and exclusion criteria. Assessment includes demographic, clinical and psychosocial data, symptoms, electrocardiogram, blood- and urine samples and transthoracic echocardiography during rest and dipyridamol stress with measurement of coronary flow reserve (CFR) by Doppler of the left anterior descending artery. In substudies CMD will be assessed by positron emission tomography, peripheral endothelial function, magnetic resonance imaging-and computed tomography derived myocardial perfusion scans, angiographic corrected TIMI frame counts, advanced echocardiographic modalities at rest and during stress, and invasive measures of CFR and coronary vascular reactivity. The study will include 2000 women who will be followed for 5 years for cardiovascular outcomes.RESULTS: By May 2013, 1685 women have been screened, 759 eligible patients identified, 530 contacted, and 299 (56%) agreed to participate. Among the first 50 patients, Doppler CFR was successfully measured in 49 (98%).CONCLUSIONS: Among women with suspected ischemic heart disease and no obstructive coronary artery disease, non-invasive Doppler CFR is feasible as a routine assessment. The study will provide information on methods to diagnose CMD and determine the prognostic value of routine non-invasive assessment of microvascular function. Future study will provide women identified with CMD participation in interventional substudies designed to test treatment strategies.",

keywords = "Angina Pectoris, Coronary Angiography, Coronary Circulation, Echocardiography, Doppler, Female, Humans, Microcirculation, Multicenter Studies as Topic, Myocardial Revascularization, Prognosis, Randomized Controlled Trials as Topic, Regional Blood Flow",

author = "Eva Prescott and Abildstr{\o}m, {Steen Zabell} and Ahmed Aziz and Merz, {Noel Bairey} and Ida Gustafsson and Julian Halcox and Hansen, {Henrik Steen} and Hansen, {Peter Riis} and Jens Kastrup and Marie Michelsen and Mygind, {Naja Dam} and Peter Ong and Adam Pena and Annika Rosengren and Udo Sechtem and Peter S{\o}gaard",

year = "2014",

month = apr,

doi = "10.1016/j.ahj.2014.01.003",

language = "English",

volume = "167",

pages = "452–458",

journal = "American Heart Journal",

issn = "0002-8703",

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T1 - Improving diagnosis and treatment of women with angina pectoris and microvascular disease:

T2 - The iPOWER study design and rationale

AU - Prescott, Eva

AU - Abildstrøm, Steen Zabell

AU - Aziz, Ahmed

AU - Merz, Noel Bairey

AU - Gustafsson, Ida

AU - Halcox, Julian

AU - Hansen, Henrik Steen

AU - Hansen, Peter Riis

AU - Kastrup, Jens

AU - Michelsen, Marie

AU - Mygind, Naja Dam

AU - Ong, Peter

AU - Pena, Adam

AU - Rosengren, Annika

AU - Sechtem, Udo

AU - Søgaard, Peter

PY - 2014/4

Y1 - 2014/4

N2 - BACKGROUND: The iPOWER study aims at determining whether routine assessment of coronary microvascular dysfunction (CMD) in women with angina and no obstructive coronary artery disease is feasible and identifies women at risk.METHODS: All women with angina referred to invasive angiographic assessment in Eastern Denmark are invited to join the study according to in- and exclusion criteria. Assessment includes demographic, clinical and psychosocial data, symptoms, electrocardiogram, blood- and urine samples and transthoracic echocardiography during rest and dipyridamol stress with measurement of coronary flow reserve (CFR) by Doppler of the left anterior descending artery. In substudies CMD will be assessed by positron emission tomography, peripheral endothelial function, magnetic resonance imaging-and computed tomography derived myocardial perfusion scans, angiographic corrected TIMI frame counts, advanced echocardiographic modalities at rest and during stress, and invasive measures of CFR and coronary vascular reactivity. The study will include 2000 women who will be followed for 5 years for cardiovascular outcomes.RESULTS: By May 2013, 1685 women have been screened, 759 eligible patients identified, 530 contacted, and 299 (56%) agreed to participate. Among the first 50 patients, Doppler CFR was successfully measured in 49 (98%).CONCLUSIONS: Among women with suspected ischemic heart disease and no obstructive coronary artery disease, non-invasive Doppler CFR is feasible as a routine assessment. The study will provide information on methods to diagnose CMD and determine the prognostic value of routine non-invasive assessment of microvascular function. Future study will provide women identified with CMD participation in interventional substudies designed to test treatment strategies.

AB - BACKGROUND: The iPOWER study aims at determining whether routine assessment of coronary microvascular dysfunction (CMD) in women with angina and no obstructive coronary artery disease is feasible and identifies women at risk.METHODS: All women with angina referred to invasive angiographic assessment in Eastern Denmark are invited to join the study according to in- and exclusion criteria. Assessment includes demographic, clinical and psychosocial data, symptoms, electrocardiogram, blood- and urine samples and transthoracic echocardiography during rest and dipyridamol stress with measurement of coronary flow reserve (CFR) by Doppler of the left anterior descending artery. In substudies CMD will be assessed by positron emission tomography, peripheral endothelial function, magnetic resonance imaging-and computed tomography derived myocardial perfusion scans, angiographic corrected TIMI frame counts, advanced echocardiographic modalities at rest and during stress, and invasive measures of CFR and coronary vascular reactivity. The study will include 2000 women who will be followed for 5 years for cardiovascular outcomes.RESULTS: By May 2013, 1685 women have been screened, 759 eligible patients identified, 530 contacted, and 299 (56%) agreed to participate. Among the first 50 patients, Doppler CFR was successfully measured in 49 (98%).CONCLUSIONS: Among women with suspected ischemic heart disease and no obstructive coronary artery disease, non-invasive Doppler CFR is feasible as a routine assessment. The study will provide information on methods to diagnose CMD and determine the prognostic value of routine non-invasive assessment of microvascular function. Future study will provide women identified with CMD participation in interventional substudies designed to test treatment strategies.

KW - Angina Pectoris

KW - Coronary Angiography

KW - Coronary Circulation

KW - Echocardiography, Doppler

KW - Female

KW - Humans

KW - Microcirculation

KW - Multicenter Studies as Topic

KW - Myocardial Revascularization

KW - Prognosis

KW - Randomized Controlled Trials as Topic

KW - Regional Blood Flow

U2 - 10.1016/j.ahj.2014.01.003

DO - 10.1016/j.ahj.2014.01.003

M3 - Journal article

C2 - 24655692

SN - 0002-8703

VL - 167

SP - 452

EP - 458

JO - American Heart Journal

JF - American Heart Journal

IS - 4

ER -

Improving diagnosis and treatment of women with angina pectoris and microvascular disease: : The iPOWER study design and rationale

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Keywords

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