Background More than half of women with symptoms suggestive of myocardial ischaemia have no obstructive coronary artery disease (CAD), yet they face a higher risk of cardiovascular mortality and morbidity. Both vital exhaustion (VE) and depression have been linked to adverse cardiovascular prognosis in patients with CAD. We aimed to assess whether symptomatic women with no obstructive CAD are more vitally exhausted compared with asymptomatic women. Furthermore, we investigated the overlap between the constructs of VE and depression. Methods Prevalence and burden of VE was assessed in symptomatic women with no obstructive CAD (n=1.266) and asymptomatic women (n=2.390). Among symptomatic women, we also assessed chest pain characteristics and symptoms of Hospital Anxiety and Depression Questionnaire. Findings Median (IQR) VE score was 4 (1-9) and 2 (0–5) in symptomatic and asymptomatic women, respectively (age adjusted, p<0.001). The risk of severe VE was significantly higher in symptomatic women compared with asymptomatic women (OR 3.3, 95% CI 2.5 to 4.4), independent of age and risk factors, and was associated with symptom severity. VE and depression scores were correlated but principal component cluster analysis (PCCA) showed clear distinctiveness between the two constructs. Conclusions Women with chest pain and no obstructive CAD are more vitally exhausted compared with asymptomatic women. PCCA showed that VE is distinct from depression in symptomatic women. Clinical implications Mental health screening focusing on depressive symptomatology in women with chest pain presenting with symptoms of mental and physical exhaustion may overlook VE in these patients. Data are available on reasonable request. Data will be made available on reasonable request.

中文翻译：

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患有胸痛且无阻塞性冠状动脉疾病的女性会出现生命力衰竭：iPOWER 研究

背景 超过一半出现心肌缺血症状的女性没有阻塞性冠状动脉疾病 (CAD)，但她们面临较高的心血管死亡和发病风险。生命力衰竭（VE）和抑郁都与 CAD 患者心血管预后不良有关。我们的目的是评估有症状且无阻塞性 CAD 的女性与无症状的女性相比是否更加疲惫不堪。此外，我们还研究了 VE 和抑郁症结构之间的重叠。方法 对有症状但无阻塞性 CAD 的女性 (n=1.266) 和无症状女性 (n=2.390) 的 VE 患病率和负担进行评估。在有症状的女性中，我们还评估了胸痛特征以及医院焦虑和抑郁问卷的症状。结果 有症状和无症状女性的中位 (IQR) VE 评分分别为 4 (1-9) 和 2 (0-5)（年龄调整后，p<0.001）。与无症状女性相比，有症状女性发生严重 VE 的风险显着较高（OR 3.3，95% CI 2.5 至 4.4），与年龄和危险因素无关，并且与症状严重程度相关。VE 和抑郁评分相关，但主成分聚类分析 (PCCA) 显示两种结构之间存在明显的区别。结论 与无症状的女性相比，有胸痛且无阻塞性 CAD 的女性更加疲惫不堪。PCCA 表明 VE 与有症状女性的抑郁症不同。临床意义 对于出现精神和身体疲惫症状的胸痛女性，重点关注抑郁症状的心理健康筛查可能会忽视这些患者的 VE。可根据合理要求提供数据。将根据合理要求提供数据。