Christopher L Schumann1, Roshin C Mathew1, John-Henry L Dean1, Yang Yang2, Pelbreton C Balfour3, Peter W Shaw4, Austin A Robinson1, Michael Salerno5, Christopher M Kramer6, Jamieson M Bourque7. 1. Division of Cardiovascular Medicine and the Cardiac Imaging Center, University of Virginia Health System, Charlottesville, Virginia, USA. 2. Division of Cardiovascular Medicine and the Cardiac Imaging Center, University of Virginia Health System, Charlottesville, Virginia, USA; Biomedical Engineering and Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 3. Baptist Heart & Vascular Institute and Cardiology Consultants, Pensacola, Florida, USA. 4. Berkshire Medical Center, Pittsfield, Massachusetts, USA. 5. Division of Cardiovascular Medicine and the Cardiac Imaging Center, University of Virginia Health System, Charlottesville, Virginia, USA; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA; Department of Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, Virginia, USA. 6. Division of Cardiovascular Medicine and the Cardiac Imaging Center, University of Virginia Health System, Charlottesville, Virginia, USA; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA. 7. Division of Cardiovascular Medicine and the Cardiac Imaging Center, University of Virginia Health System, Charlottesville, Virginia, USA; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA. Electronic address: JMB8T@virginia.edu.
Abstract
OBJECTIVES: This study sought to better characterize the quality of life and economic impact in patients with symptoms of ischemia and no obstructive coronary disease (INOCA) and to identify the influence of coronary microvascular dysfunction (CMD). BACKGROUND: Patients with INOCA have a high symptom burden and an increased incidence of major adverse cardiac events. CMD is a frequent cause of INOCA. The morbidity associated with INOCA and CMD has not been well-characterized. METHODS: Sixty-six patients with INOCA underwent stress cardiac magnetic resonance with calculation of myocardial perfusion reserve (MPR); MPR 2.0 to 2.4 was considered borderline-reduced (possible CMD) and MPR <2.0 was defined as reduced (definite CMD). Subjects completed quality of life questionnaires to assess the morbidity and economic impact of INOCA. Questionnaire results were compared between INOCA patients with and without CMD. In addition, logistic regression was used to determine the predictors of CMD within the INOCA population. RESULTS: The prevalence of definite CMD was 24%. Definite or borderline CMD was present in 59% (MPR ≤2.4). Patients with INOCA reported greater physical limitation, angina frequency, and reduced quality of life compared to referent stable coronary artery disease and acute myocardial infarction populations. In addition, Patients with INOCA reported frequent time missed from work and work limitations, suggesting a substantial economic impact. No difference was observed in reported symptoms between INOCA patients with and without CMD. Glomerular filtration rate and body-mass index were significant predictors of CMD in multivariable regression analysis. CONCLUSIONS: INOCA is associated with high morbidity similar to other high-risk cardiac populations, and work limitations reported by Patients with INOCA suggest a substantial economic impact. CMD is a common cause of INOCA but is not associated with increased morbidity. These results suggest that there is significant symptom burden in the INOCA population regardless of etiology.
OBJECTIVES: This study sought to better characterize the quality of life and economic impact in patients with symptoms of ischemia and no obstructive coronary disease (INOCA) and to identify the influence of coronary microvascular dysfunction (CMD). BACKGROUND: Patients with INOCA have a high symptom burden and an increased incidence of major adverse cardiac events. CMD is a frequent cause of INOCA. The morbidity associated with INOCA and CMD has not been well-characterized. METHODS: Sixty-six patients with INOCA underwent stress cardiac magnetic resonance with calculation of myocardial perfusion reserve (MPR); MPR 2.0 to 2.4 was considered borderline-reduced (possible CMD) and MPR <2.0 was defined as reduced (definite CMD). Subjects completed quality of life questionnaires to assess the morbidity and economic impact of INOCA. Questionnaire results were compared between INOCA patients with and without CMD. In addition, logistic regression was used to determine the predictors of CMD within the INOCA population. RESULTS: The prevalence of definite CMD was 24%. Definite or borderline CMD was present in 59% (MPR ≤2.4). Patients with INOCA reported greater physical limitation, angina frequency, and reduced quality of life compared to referent stable coronary artery disease and acute myocardial infarction populations. In addition, Patients with INOCA reported frequent time missed from work and work limitations, suggesting a substantial economic impact. No difference was observed in reported symptoms between INOCA patients with and without CMD. Glomerular filtration rate and body-mass index were significant predictors of CMD in multivariable regression analysis. CONCLUSIONS: INOCA is associated with high morbidity similar to other high-risk cardiac populations, and work limitations reported by Patients with INOCA suggest a substantial economic impact. CMD is a common cause of INOCA but is not associated with increased morbidity. These results suggest that there is significant symptom burden in the INOCA population regardless of etiology.
Authors: Mark A Marinescu; Adrián I Löffler; Michelle Ouellette; Lavone Smith; Christopher M Kramer; Jamieson M Bourque Journal: JACC Cardiovasc Imaging Date: 2015-02
Authors: Daria Frestad Bechsgaard; Jens Dahlgaard Hove; Hannah Elena Suhrs; Kira Bang Bové; Persia Shahriari; Ida Gustafsson; Eva Prescott Journal: Int J Cardiol Date: 2019-07-17 Impact factor: 4.164
Authors: Peter Ong; Paolo G Camici; John F Beltrame; Filippo Crea; Hiroaki Shimokawa; Udo Sechtem; Juan Carlos Kaski; C Noel Bairey Merz Journal: Int J Cardiol Date: 2017-09-08 Impact factor: 4.164
Authors: Venkatesh L Murthy; Masanao Naya; Viviany R Taqueti; Courtney R Foster; Mariya Gaber; Jon Hainer; Sharmila Dorbala; Ron Blankstein; Ornella Rimoldi; Paolo G Camici; Marcelo F Di Carli Journal: Circulation Date: 2014-04-30 Impact factor: 29.690
Authors: Manesh R Patel; Eric D Peterson; David Dai; J Matthew Brennan; Rita F Redberg; H Vernon Anderson; Ralph G Brindis; Pamela S Douglas Journal: N Engl J Med Date: 2010-03-11 Impact factor: 91.245
Authors: Adam L Gordois; Peter P Toth; Ruben Gw Quek; Emma M Proudfoot; Carly J Paoli; Shravanthi R Gandra Journal: Expert Rev Pharmacoecon Outcomes Res Date: 2016-11-21 Impact factor: 2.217
Authors: Maria H C T van Beek; Richard C Oude Voshaar; Femke M van Deelen; Anton J L M van Balkom; Gheorghe Pop; Anne E M Speckens Journal: J Cardiovasc Nurs Date: 2014 Sep-Oct Impact factor: 2.083
Authors: Henrik Engblom; Hui Xue; Shahnaz Akil; Marcus Carlsson; Cecilia Hindorf; Jenny Oddstig; Fredrik Hedeer; Michael S Hansen; Anthony H Aletras; Peter Kellman; Håkan Arheden Journal: J Cardiovasc Magn Reson Date: 2017-10-19 Impact factor: 5.364