Abstract 17055: A New Cohort Confirms the High Prevalence and Severity of Endothelial and Microvascular Dysfunction Among Women with Symptoms of Ischemia and No Obstructive Coronary Artery Disease: the NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE)

Abstract

Background: Previous evaluations in women studied in 1997-2001 with symptoms/signs of ischemia without obstructive coronary artery disease demonstrated a relatively high prevalence of both endothelial and microvascular dysfunction: these abnormalities were then shown to predict adverse events in follow-up. Coronary reactivity testing (CRT) with flow reserve (CFR <2.5), vasoconstriction to acetycholine (ACH), or <20% vasodilation to nitroglycerin (NTG) were taken as abnormal responses. To our knowledge, the prevalence of these disorders has not been reassessed in a more contemporary population of women. Methods: Accordingly, we studied a contemporary (2009-2011) WISE cohort with symptoms/signs of ischemia but without obstructive CAD undergoing CRT and compared their findings to those from the original WISE cohort. Following demonstration of no obstructive CAD, defined as <50% epicardial stenosis in any coronary artery, patients underwent CRT. Using a Doppler transducer-tipped guide wire (Volcano ®FloWire 300cm) in a left coronary artery, CFR was measured after intracoronary (IC) adenosine, followed by sequentially IC ACH and IC NTG with quantitative angiography and Doppler flow measurement evaluated by core labs. Results: Among the 94 women who underwent CRT, the mean age was 53 (23-73 years), 37% were non-Caucasian. Of these 33% had hypertension, 41% hyperlipidemia, 6% diabetes, 18% used hormone replacement, and 49% had a history of smoking. Coronary reactivity data for the two cohorts is shown in the Table. Conclusion: Compared with our prior WISE cohort of women with signs and symptoms of ischemia but without obstructive CAD, both endothelial and microvascular dysfunction remain highly prevalent and similar in degree in a contemporary cohort. Because these abnormalities have been linked to prediction of major adverse cardiac events, clinical trials targeting these pathways appear to be indicated.