BACKGROUND: Ischemia with no obstructive coronary artery disease (INOCA) is prevalent in women and is associated with increased risk of developing heart failure with preserved ejection fraction (HFpEF); however, the mechanism(s) contributing to this progression remains unclear. Given that diastolic dysfunction is common in women with INOCA, defining mechanisms related to diastolic dysfunction in INOCA could identify therapeutic targets to prevent HFpEF. METHODS: Cardiac MRI was performed in 65 women with INOCA and 12 reference controls. Diastolic function was defined by left ventricular early diastolic circumferential strain rate (eCSRd). Contributors to diastolic dysfunction were chosen a priori as coronary vascular dysfunction (myocardial perfusion reserve index [MPRI]), diffuse myocardial fibrosis (extracellular volume [ECV]), and aortic stiffness (aortic pulse wave velocity [aPWV]). RESULTS: Compared to controls, eCSRd was lower in INOCA (1.61 ± 0.33/s vs. 1.36 ± 0.31/s, P = 0.016); however, this difference was not exaggerated when the INOCA group was sub-divided by low and high MPRI (P > 0.05) nor was ECV elevated in INOCA (29.0 ± 1.9% vs. 28.0 ± 3.2%, control vs. INOCA; P = 0.38). However, aPWV was higher in INOCA vs. controls (8.1 ± 3.2 m/s vs. 6.1 ± 1.5 m/s; P = 0.045), and was associated with eCSRd (r = -0.50, P < 0.001). By multivariable linear regression analysis, aPWV was an independent predictor of decreased eCSRd (standardized β = -0.39, P = 0.003), as was having an elevated left ventricular mass index (standardized β = -0.25, P = 0.024) and lower ECV (standardized β = 0.30, P = 0.003). CONCLUSIONS: These data provide mechanistic insight into diastolic dysfunction in women with INOCA, identifying aortic stiffness and ventricular remodeling as putative therapeutic targets.
BACKGROUND: Ischemia with no obstructive coronary artery disease (INOCA) is prevalent in women and is associated with increased risk of developing heart failure with preserved ejection fraction (HFpEF); however, the mechanism(s) contributing to this progression remains unclear. Given that diastolic dysfunction is common in women with INOCA, defining mechanisms related to diastolic dysfunction in INOCA could identify therapeutic targets to prevent HFpEF. METHODS: Cardiac MRI was performed in 65 women with INOCA and 12 reference controls. Diastolic function was defined by left ventricular early diastolic circumferential strain rate (eCSRd). Contributors to diastolic dysfunction were chosen a priori as coronary vascular dysfunction (myocardial perfusion reserve index [MPRI]), diffuse myocardial fibrosis (extracellular volume [ECV]), and aortic stiffness (aortic pulse wave velocity [aPWV]). RESULTS: Compared to controls, eCSRd was lower in INOCA (1.61 ± 0.33/s vs. 1.36 ± 0.31/s, P = 0.016); however, this difference was not exaggerated when the INOCA group was sub-divided by low and high MPRI (P > 0.05) nor was ECV elevated in INOCA (29.0 ± 1.9% vs. 28.0 ± 3.2%, control vs. INOCA; P = 0.38). However, aPWV was higher in INOCA vs. controls (8.1 ± 3.2 m/s vs. 6.1 ± 1.5 m/s; P = 0.045), and was associated with eCSRd (r = -0.50, P < 0.001). By multivariable linear regression analysis, aPWV was an independent predictor of decreased eCSRd (standardized β = -0.39, P = 0.003), as was having an elevated left ventricular mass index (standardized β = -0.25, P = 0.024) and lower ECV (standardized β = 0.30, P = 0.003). CONCLUSIONS: These data provide mechanistic insight into diastolic dysfunction in women with INOCA, identifying aortic stiffness and ventricular remodeling as putative therapeutic targets.
Authors: Charalambos Vlachopoulos; Panagiotis Xaplanteris; Victor Aboyans; Marianne Brodmann; Renata Cífková; Francesco Cosentino; Marco De Carlo; Augusto Gallino; Ulf Landmesser; Stéphane Laurent; John Lekakis; Dimitri P Mikhailidis; Katerina K Naka; Athanasios D Protogerou; Damiano Rizzoni; Arno Schmidt-Trucksäss; Luc Van Bortel; Thomas Weber; Akira Yamashina; Reuven Zimlichman; Pierre Boutouyrie; John Cockcroft; Michael O'Rourke; Jeong Bae Park; Giuseppe Schillaci; Henrik Sillesen; Raymond R Townsend Journal: Atherosclerosis Date: 2015-05-16 Impact factor: 5.162
Authors: Michael D Nelson; Lidia S Szczepaniak; Janet Wei; Afsaneh Haftabaradaren; Meghan Bharadwaj; Behzad Sharif; Puja Mehta; Xiao Zhang; Louise E Thomson; Daniel S Berman; Debiao Li; C Noel Bairey Merz Journal: Circ Cardiovasc Imaging Date: 2014-03-14 Impact factor: 7.792
Authors: Janet Wei; Michael D Nelson; Edward W Szczepaniak; Laura Smith; Puja K Mehta; Louise E J Thomson; Daniel S Berman; Debiao Li; C Noel Bairey Merz; Lidia S Szczepaniak Journal: Am J Physiol Heart Circ Physiol Date: 2015-10-30 Impact factor: 4.733
Authors: Viviany R Taqueti; Scott D Solomon; Amil M Shah; Akshay S Desai; John D Groarke; Michael T Osborne; Jon Hainer; Courtney F Bibbo; Sharmila Dorbala; Ron Blankstein; Marcelo F Di Carli Journal: Eur Heart J Date: 2018-03-07 Impact factor: 29.983
Authors: S D Buchthal; J A den Hollander; C N Merz; W J Rogers; C J Pepine; N Reichek; B L Sharaf; S Reis; S F Kelsey; G M Pohost Journal: N Engl J Med Date: 2000-03-23 Impact factor: 91.245
Authors: Raymond R Townsend; Ian B Wilkinson; Ernesto L Schiffrin; Alberto P Avolio; Julio A Chirinos; John R Cockcroft; Kevin S Heffernan; Edward G Lakatta; Carmel M McEniery; Gary F Mitchell; Samer S Najjar; Wilmer W Nichols; Elaine M Urbina; Thomas Weber Journal: Hypertension Date: 2015-07-09 Impact factor: 10.190
Authors: Rajasree Roy; Haider Aldiwani; Navid Darouian; Shilpa Sharma; Tina Torbati; Janet Wei; Michael D Nelson; Chrisandra Shufelt; Margo B Minissian; Lian Li; C Noel Bairey Merz; Puja K Mehta Journal: Int J Cardiol Date: 2020-04-19 Impact factor: 4.039
Authors: Adam K McDiarmid; Peter P Swoboda; Bara Erhayiem; Rosalind E Lancaster; Gemma K Lyall; David A Broadbent; Laura E Dobson; Tarique A Musa; David P Ripley; Pankaj Garg; John P Greenwood; Carrie Ferguson; Sven Plein Journal: Circ Cardiovasc Imaging Date: 2016-04 Impact factor: 7.792