TY - JOUR
T1 - Resting coronary flow drives the daily pattern in coronary flow reserve in patients with chest pain without obstructive epicardial stenosis
AU - Thosar, Saurabh S.
AU - Taqui, Sahar
AU - Davidson, Brian
AU - Belcik, Todd
AU - Hodovan, James
AU - Rice, Sean P.M.
AU - Lindner, Jonathan R.
N1 - Publisher Copyright:
Copyright © 2023 Thosar, Taqui, Davidson, Belcik, Hodovan, Rice and Lindner.
PY - 2023/1/25
Y1 - 2023/1/25
N2 - Objectives: Ischemia with no obstructive coronary artery disease (INOCA) is a risk factor for major adverse cardiovascular events and is characterized by abnormal coronary microvascular tone. In patients with INOCA, adverse cardiovascular events most commonly occur in the morning compared to other times of the day and night. Materials and methods: We tested whether coronary microvascular function varies diurnally with attenuation in the morning in patients with symptomatic coronary artery disease without significant (>50%) epicardial stenosis. We evaluated data from 17 patients studied in the AM (700–1159 h) and 11 patients in the PM (1200–1800 h). Coronary microvascular function was measured using perfusion contrast imaging at rest and after infusion of intravenous regadenoson. We calculated microvascular flow reserve as the ratio of hyperemic to resting flow. Along with independent sample t-tests, we performed bootstrapping procedures to test mean differences between AM and PM groups, using the bias-corrected and accelerated method with 5,000 bootstrapped samples. Results and conclusion: The AM and PM groups were matched for demographic and existing risk factors. Coronary microvascular flow reserve was ∼33% higher in the AM compared to the PM (P = 0.025, BCa 95% CI [0.25, 1.64]; Hedge’s g = 0.89, 95% CI [0.11, 1.66]) as a result of significantly lower resting flow (∼50%) in the AM compared to the PM (P = 0.03, MDiff = −56.65, BCa 95% CI [−118.59, −2.12]; Hedge’s g = −0.86, 95% CI [−1.60, −0.06]). Our observations are of clinical value and can influence diagnosis and treatment in the clinic based on the time of day of measurements.
AB - Objectives: Ischemia with no obstructive coronary artery disease (INOCA) is a risk factor for major adverse cardiovascular events and is characterized by abnormal coronary microvascular tone. In patients with INOCA, adverse cardiovascular events most commonly occur in the morning compared to other times of the day and night. Materials and methods: We tested whether coronary microvascular function varies diurnally with attenuation in the morning in patients with symptomatic coronary artery disease without significant (>50%) epicardial stenosis. We evaluated data from 17 patients studied in the AM (700–1159 h) and 11 patients in the PM (1200–1800 h). Coronary microvascular function was measured using perfusion contrast imaging at rest and after infusion of intravenous regadenoson. We calculated microvascular flow reserve as the ratio of hyperemic to resting flow. Along with independent sample t-tests, we performed bootstrapping procedures to test mean differences between AM and PM groups, using the bias-corrected and accelerated method with 5,000 bootstrapped samples. Results and conclusion: The AM and PM groups were matched for demographic and existing risk factors. Coronary microvascular flow reserve was ∼33% higher in the AM compared to the PM (P = 0.025, BCa 95% CI [0.25, 1.64]; Hedge’s g = 0.89, 95% CI [0.11, 1.66]) as a result of significantly lower resting flow (∼50%) in the AM compared to the PM (P = 0.03, MDiff = −56.65, BCa 95% CI [−118.59, −2.12]; Hedge’s g = −0.86, 95% CI [−1.60, −0.06]). Our observations are of clinical value and can influence diagnosis and treatment in the clinic based on the time of day of measurements.
KW - coronary flow reserve
KW - diurnal variation
KW - ischemia and non-obstructive coronary artery disease
KW - microvascular dysfunction
KW - myocardial contrast echocardiography
KW - perfusion imaging
KW - regadenoson stress
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U2 - 10.3389/fcvm.2023.1057692
DO - 10.3389/fcvm.2023.1057692
M3 - Article
AN - SCOPUS:85147690887
SN - 2297-055X
VL - 10
JO - Frontiers in Cardiovascular Medicine
JF - Frontiers in Cardiovascular Medicine
M1 - 1057692
ER -