Noninvasive evaluation of dynamic microvascular dysfunction in ischemia and no obstructive coronary artery disease patients with suspected vasospasm.
J Cardiovasc Med (Hagerstown)
; 25(2): 123-131, 2024 02 01.
Article
en En
| MEDLINE
| ID: mdl-38064348
ABSTRACT
INTRODUCTION:
In patients with ischemia and no obstructive coronary artery disease (INOCA), a dynamic coronary microvascular dysfunction (CMD) is frequent but difficult to capture by noninvasive means.The aim of our study was to assess dynamic CMD in INOCA patients with stress echocardiography after vasoconstrictive and vasodilator stimuli.METHODS:
In this prospective single-center study, we have enrolled 40 INOCA patients (age 56.3â±â13âyears, 32 women). All participants underwent stress echocardiography with hyperventilation (HYP), followed by supine bicycle exercise (HYP+EXE) and adenosine (ADO). Stress echocardiography included an assessment of regional wall motion abnormality (RWMA) and coronary flow velocity (CFV) in the distal left anterior descending (LAD) coronary artery.RESULTS:
HYP induced a 30% increase in rate pressure product (restâ=â10â244â±â2353 vs. HYPâ=â13â214â±â3266âmmHg x bpm, P â<â0.001) accompanied by a paradoxical reduction in CFV (HYP< rest) in 21 patients (52%). HYP alone was less effective than HYP+EXE in inducing anginal pain (6/40, 15% vs. 10/40, 25%, P â=â0.046), ST segment changes (6/40, 15% vs. 24/40, 60%, P â<â0.001), and RWMA (6/40, 15% vs. 13/40, 32.5%, P â=â0.008). ADO-induced vasodilation was preserved (≥2.0) in all patients.CONCLUSION:
In patients with INOCA, a coronary vasoconstriction after HYP is common, in absence of structural CMD detectable with ADO. HYP+EXE test represents a more powerful ischemia inducer than HYP alone. Stress echocardiography with LAD-CFV may allow the noninvasive assessment of dynamic and structural coronary microcirculation during stress.
Texto completo:
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Banco de datos:
MEDLINE
Asunto principal:
Enfermedad de la Arteria Coronaria
Límite:
Adult
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Aged
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Female
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Humans
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Middle aged
Idioma:
En
Año:
2024
Tipo del documento:
Article