Temporal Trends in Angina, Myocardial Perfusion, and Left Ventricular Remodeling in Women With No Obstructive Coronary Artery Disease Over 1-Year Follow-Up: Results From WISE-CVD

Odayme Quesada, Melody Hermel, Nissi Suppogu, Haider Aldiwani, Chrisandra Shufelt, Puja K Mehta, Galen Cook-Wiens, Jenna Maughan, Daniel S Berman, Louise E J Thomson, Eileen M Handberg, Carl J Pepine, C Noel Bairey Merz, Janet Wei, Odayme Quesada, Melody Hermel, Nissi Suppogu, Haider Aldiwani, Chrisandra Shufelt, Puja K Mehta, Galen Cook-Wiens, Jenna Maughan, Daniel S Berman, Louise E J Thomson, Eileen M Handberg, Carl J Pepine, C Noel Bairey Merz, Janet Wei

Abstract

Background Women with ischemia and no obstructive coronary artery disease are increasingly recognized and found to be at risk for major adverse cardiovascular events. Methods and Results In 214 women with suspected ischemia and no obstructive coronary artery disease who completed baseline and 1-year follow-up vasodilatory stress cardiac magnetic resonance imaging, we investigated temporal trends in angina (Seattle Angina Questionnaire [SAQ]), myocardial perfusion reserve index, blood pressure, and left ventricular (LV) remodeling and function from baseline to 1-year follow-up and explored associations between these different parameters. We observed concordant positive trends in 4/5 SAQ domains, SAQ-7, myocardial perfusion reserve index, blood pressure, LV mass, and LV mass-to-volume ratio. There was no association between SAQ-7 improvement and myocardial perfusion reserve index improvement over 1-year follow-up (P=0.1). Higher indexed LV end-diastolic volume and time to peak filling rate at baseline were associated with increased odds of clinically relevant SAQ-7 improvement (odds ratio [OR], 1.05; 95% CI, 1.0-1.1; and OR, 2.40; 95% CI, 1.1-5.0, respectively). Hypertension was associated with decreased odds of SAQ-7 improvement (OR, 0.41; 95% CI, 0.19-0.91). Conclusions In women with ischemia and no obstructive coronary artery disease clinically treated with cardiac medications over 1 year, we observed concurrent temporal trends toward improvement in SAQ, myocardial perfusion reserve index, blood pressure, LV mass, and LV mass-to volume ratio. We showed that abnormalities in LV morphology and diastolic function at baseline were predictive of clinically significant improvement in angina at follow-up, whereas history of hypertension was associated with lower odds. Future studies are needed to assess the mechanisms and treatments responsible for the improvements we observed. Registration URL: https://www.clini​caltr​ials.gov; Unique identifier: NCT02582021.

Keywords: angina; cardiovascular magnetic resonance imaging; ischemic heart disease; left ventricular remodeling; quality of life.

Figures

Figure 1. WISE‐CVD flowchart.
Figure 1. WISE‐CVD flowchart.
CMRI indicates cardiac magnetic resonance imaging; CSMC, Cedars‐Sinai Medical Center; UF, University of Florida; and WISE‐CVD, Women's Ischemia Syndrome Evaluation–Coronary Vascular Dysfunction.
Figure 2. Change in angina, myocardial perfusion,…
Figure 2. Change in angina, myocardial perfusion, stress hemodynamics, and LV morphology over 1 year (N=214).
LV indicates left ventricular; MPRI, myocardial perfusion reserve index; SAQ, Seattle Angina Questionnaire; and SBP, systolic blood pressure.

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