BACKGROUND Women with evidence of ischemia and no obstructive coronary arteries (INOCA) often have coronary microvascular dysfunction (CMD) indicated by impaired coronary flow reserve (CFR) to adenosine. Low CFR is associated with an adverse prognosis, including incident heart failure. Because the CFR calculation relies on the baseline intrinsic coronary vasomotor flow velocity, a major determinate of CFR and the degree of variation in baseline flow alone may be an important contributor to risk of adverse outcomes in women with CMD. A better understanding of baseline blood flow in the setting of low CFR and its association with myocardial performance would be helpful. METHODS We evaluated 74 women who underwent invasive coronary reactivity testing in the Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study and had impaired CFR (<2.32). We assessed the relationship between coronary artery baseline average peak velocity (bAPV) at rest and cardiac magnetic resonance imaging measures of left ventricular (LV) structure and function. RESULTS When stratified as low (<22 cm/s) versus high (≥22 cm/s) bAPV, there were no differences in cardiovascular risk factors, coronary plaque burden, or LV structure. However, low bAPV was associated with higher LV end-diastolic filling pressure (P = 0.04), lower LV ejection fraction (P = 0.001), and differences in late systolic and diastolic strain rates (P = 0.01 to 0.05). CONCLUSIONS In women with impaired CFR, low resting coronary flow velocity is associated with more adverse myocardial performance, which may contribute to risk for adverse outcomes and particularly heart failure in women with CMD.

中文翻译：

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冠状动脉血流储备受损女性的静息冠状动脉速度和心肌性能：女性缺血综合征评估-冠状血管功能障碍 (WISE-CVD) 研究的结果。


背景 具有缺血证据但无阻塞性冠状动脉 (INOCA) 的女性通常患有冠状动脉微血管功能障碍 (CMD)，表现为冠状动脉血流储备 (CFR) 腺苷受损。低 CFR 与不良预后相关，包括发生心力衰竭。由于 CFR 计算依赖于基线内在冠状动脉血管舒缩血流速度，因此 CFR 的主要决定因素和基线血流的变化程度可能是导致 CMD 女性不良后果风险的重要因素。更好地了解低 CFR 情况下的基线血流及其与心肌性能的关系将有所帮助。方法 我们评估了 74 名在女性缺血综合征评估-冠状动脉血管功能障碍 (WISE-CVD) 研究中接受侵入性冠状动脉反应性测试且 CFR 受损 (<2.32) 的女性。我们评估了静息时冠状动脉基线平均峰值速度 (bAPV) 与左心室 (LV) 结构和功能的心脏磁共振成像测量值之间的关系。结果 当按低 bAPV (<22 cm/s) 与高 bAPV (≥22 cm/s) 进行分层时，心血管危险因素、冠状动脉斑块负荷或左心室结构没有差异。然而，低 bAPV 与较高的 LV 舒张末充盈压 (P = 0.04)、较低的 LV 射血分数 (P = 0.001) 以及收缩末期和舒张期应变率的差异 (P = 0.01 至 0.05) 相关。结论 在 CFR 受损的女性中，低静息冠状动脉血流速度与更不良的心肌性能相关，这可能会增加 CMD 女性不良结局的风险，尤其是心力衰竭。