Ischemia in women with angina and normal coronary angiograms

Abstract

Stress-induced ischemia is associated with poststress left ventricular ejection fraction reduction in postmenopausal women with typical angina, normal coronary angiography, and a trend toward abnormal endothelial-mediated vasodilation.

Coronary microvascular dysfunction in women: an overview of diagnostic strategies

“…They found perfusion abnormalities in 97% of patients, with reverse redistribution in a significant proportion of patients which they suggested was due to inhomogeneous perfusion [52]. Another study examining myocardial function and perfusion using technetium-99m methoxy-isobutyl-isonitrile (99mTc-MIBI) gated-SPECT (exercise-rest protocol using an exercise bicycle) in 59 post-menopausal women with angina and normal coronaries found perfusion defects in approximately 35% of patients [53]. Such patients were more likely to also have reduced post-stress left ventricular ejection fraction (LVEF) and endothelial dysfunction as measured by brachial artery ultrasound.…”

Left Ventricular Dysfunction Secondary to Ischemia in Women with Angina and Normal Coronary Angiograms

“…[28][29][30] It has been shown that in ischemic patients, exercise-induced LV dysfunction (myocardial stunning) continues for at least 1 hour and that the extent of LVEF reduction is determined by the severity of the ischemia. 31 Preliminary results showing a poststress LVEF reduction in syndrome X patients, more evident in those with myocardial perfusion defects, 10 have led us to investigate if this poststress stunning could further prove the presence of ischemia in cardiac syndrome X, comparing these patients with those with epicardial coronary lesions and a control group. Poststress LVEF, measured by gated SPECT, slightly but significantly decreases after an ischemic insult; it remains mostly unchanged, however, with a tendency to increase if there is no ischemia.…”

Posicionamento sobre Doença Isquêmica do Coração – A Mulher no Centro do Cuidado – 2023

“…Dado o potencial do TCPE para inferir disfunção do VE de forma não invasiva e custo-eficaz, a implementação desse exame na investigação da DIC microvascular aumenta o potencial diagnóstico em relação ao TE. 102 , 103 O TCPE pode ser também uma ferramenta importante na avaliação de pacientes com bloqueio de ramo esquerdo (BRE) em virtude da limitação do TE nessa população. Curvas normais de VO 2 e PO 2 poderiam descartar estenose coronariana significativa como causa do BRE.…”

“…Considering the CPET potential to infer LV dysfunction in a noninvasive and cost-effective way, the CPET implementation, as compared to that of ET, in the microvascular IHD investigation increases the diagnostic potential. 102 , 103 In addition, CPET can be an important tool to assess patients with left bundle branch block (LBBB) because of the limitation of ET in that population. Normal VO 2 and oxygen pulse curves could rule out significant coronary stenosis as the cause of LBBB.…”