Marie Mide Michelsen1, Naja Dam Mygind2, Adam Pena3, Ahmed Aziz4, Daria Frestad5, Nis Høst6, Eva Prescott6. 1. Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark. Electronic address: marie.mide.michelsen@regionh.dk. 2. Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark. 3. Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark. 4. Department of Cardiology, Odense University Hospital, Denmark. 5. Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Denmark. 6. Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark.
Abstract
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.
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.
Authors: Naja Dam Mygind; Marie Mide Michelsen; Adam Pena; Abbas Ali Qayyum; Daria Frestad; Thomas Emil Christensen; Adam Ali Ghotbi; Nynne Dose; Rebekka Faber; Niels Vejlstrup; Philip Hasbak; Andreas Kjaer; Eva Prescott; Jens Kastrup Journal: J Cardiovasc Magn Reson Date: 2016-11-04 Impact factor: 5.364
Authors: Nathan F Johnson; Brian T Gold; Christopher A Brown; Emily F Anggelis; Alison L Bailey; Jody L Clasey; David K Powell Journal: Front Aging Neurosci Date: 2017-08-02 Impact factor: 5.750
Authors: Ulf Neisius; Erin Olson; Sabrina H Rossi; Hagar A Ibrahim; Gemma Currie; Anna F Dominiczak; Christian Delles Journal: PLoS One Date: 2017-05-25 Impact factor: 3.240
Authors: Puja K Mehta; Melody Hermel; Michael D Nelson; Galen Cook-Wiens; Elizabeth A Martin; Ayman A Alkhoder; Janet Wei; Margo Minissian; Chrisandra L Shufelt; Sailaja Marpuri; David Hermel; Amit Shah; Michael R Irwin; David S Krantz; Amir Lerman; C Noel Bairey Merz Journal: Int J Cardiol Date: 2017-10-22 Impact factor: 4.039