Author + information
Abnormally low coronary flow reserve (CFR) in the absence of obstructive macrovascular coronary artery disease (M-CAD) identifies microvascular coronary dysfunction. CFR also correlates inversely with the forward aortic pressure waveform (AoPW) and “functional” aortic stiffness. However, the relation between CFR and reflected wave characteristics of the AoPW is unknown.
In 46 women (age 54±10 years) with symptoms and signs of myocardial ischemia but no obstructive M-CAD participating in the Women's Ischemia Syndrome Evaluation (WISE), CFR was measured using a 0.014” Doppler flow wire and intracoronary adenosine. Radial artery pressure waveforms were recorded noninvasively by applanation tonometry and ascending AoPW derived using a mathematical transfer function. Data were analyzed using pulse wave analysis (PWA) of the AoPW.
Mean CFR was 2.66±0.48. Women with CFR ≤2.5 (n=19) compared with CFR >2.5 (n=27) were well matched for age, height, weight, body mass index and heart rate. However, women with CFR ≤2.5 had higher aortic pulse wave velocity (892±126 vs 742±106 cm/sec; P=0.008) and greater aortic systolic pressure (130±17 vs 118±12 mmHg; P=0.02), augmented pressure (15±6.1 vs 11±3.9 mmHg; P=0.03), aortic augmentation index (32±7.5 vs 27±6.9%; P=0.03) and wasted left ventricular pressure energy (29±14 vs 21±8.8 dyne-sec/cm2; P=0.04), respectively. Other PWA variables were similar.
Among WISE women without obstructive M-CAD, CFR was inversely related to aortic stiffness and reflected wave amplitude, possibly resulting from an association between microvascular coronary dysfunction and stiffness of the arterial tree, increasing wave reflection amplitude and coronary blood flow. Applicability to the general population remains to be determined.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Chronic CAD: Genetics and Biomarkers
Abstract Category: 9. Chronic CAD/Stable Ischemic Heart Disease: Basic
Presentation Number: 1282-68
- 2013 American College of Cardiology Foundation