Background Women with signs and symptoms of ischemia and no obstructive coronary artery disease often have coronary microvascular dysfunction (CMD), diagnosed by invasive coronary reactivity testing (CRT). While traditional noninvasive stress imaging is often normal in CMD, cardiac magnetic resonance imaging (CMRI) may be able to detect CMD in this population. Methods and Results Vasodilator stress CMRI was performed in 118 women with suspected CMD who had undergone CRT and 21 asymptomatic reference subjects. Semi quantitative evaluation of the first-pass perfusion images was completed to determine myocardial perfusion reserve index (MPRI). The relationship between CRT findings and MPRI was examined by Pearson correlations, logistic regression and sensitivity/specificity. Symptomatic women had lower mean pharmacologic stress MPRI compared to reference subjects (1.71±0.43 vs. 2.23±0.37, p<0.0001). Lower MPRI was predictive of one or more abnormal CRT variables (OR = 0.78 [0.70, 0.88], p<0.0001, c-statistic 0.78 [0.68, 0.88]). An MPRI threshold of 1.84 predicted CRT abnormality with sensitivity 73% and specificity 74%. Conclusions Noninvasive CMRI MPRI can detect CMD defined by invasive CRT. Further work is aimed to optimize the non-invasive identification and management of CMD patients.
Background The Women’s Ischemia Syndrome Evaluation (WISE) was a prospective cohort study of 936 clinically stable symptomatic women who underwent coronary angiography to evaluate symptoms and signs of ischemia. Long-term mortality data for such women are limited. Methods and Results Obstructive coronary artery disease (CAD) was defined as ≥50% stenosis on angiography by core lab. We conducted a National Death Index search to assess the mortality of women who were alive at their final WISE contact date. Death certificates were obtained. All deaths were adjudicated as cardiovascular (CV) or non-CV by a panel of WISE cardiologists masked to angiographic data. Multivariate Cox proportional hazards regression was used to identify significant independent predictors of mortality. At baseline, mean age was 58±12 years; 176 (19%) were non-white, primarily African American; 25% had a history of diabetes, 59% hypertension, 55% dyslipidemia, and 59% had a body mass index (BMI) ≥30. Over a median follow-up of 9.5 years (range 0.2 to 11.5 years) a total of 184 (20%) died. Of these, 115 (62%) were CV deaths; 31% of all CV deaths occurred in women without obstructive CAD (<50% stenosis). Independent predictors of mortality were obstructive CAD, age, baseline systolic blood pressure, history of diabetes, history of smoking, elevated triglycerides and estimated glomerular filtration rate. Conclusions Among women referred for coronary angiography for signs and symptoms of ischemia one in five died from predominantly cardiac etiologies within 9 years of angiographic evaluation. A majority of the factors contributing to the risk of death appear to be modifiable by existing therapies. Of note, one in three of the deaths in this cohort occurred in women without obstructive CAD, a condition often considered benign and without guideline-recommend treatments. Clinical trials are needed to provide treatment guidance for the group without obstructive CAD.
ࡗ Income Allocation in Marital and Cohabiting Unions:The Case of Mainland Puerto RicansThe rise of cohabitation and the growing share of births to cohabiting couples have led to speculation that the boundary between marriage and cohabitation is blurring. We examine this issue with an analysis of the financial arrangements of fathers of mainland Puerto Rican children. The analysis shows that married fathers are more likely than cohabiting fathers to pool their income, but this difference does not result from socioeconomic and demographic factors that foster uncertainty. The analysis also demonstrates that income allocation methods are generally stable over time after differences in union dissolution by allocation method are considered. The discussion emphasizes the need for research on the ways that financial ties reflect and reinforce the bonds between partners.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.