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Heart rate reserve during pharmacological stress is a significant negative predictor of impaired coronary flow reserve in women.

Abstract：

PURPOSE:Evidence to date has failed to adequately explore determinants of cardiovascular risk in women with coronary microvascular dysfunction (CMVD). Heart rate responses to adenosine mirror autonomic activity and may carry important prognostic information for the diagnosis of CMVD. METHODS:Hemodynamic changes during adenosine stress were analyzed in a propensity-matched cohort of 404 patients (202 women, mean age 65.9 ± 11.0) who underwent clinically indicated myocardial perfusion 13N-ammonia Positron-Emission-Tomography (PET) at our institution between September 2013 and May 2017. RESULTS:Baseline heart rate (HR) was significantly higher in patients with abnormal coronary flow reserve (CFR, p < 0.001 vs normal CFR). Accordingly, a blunted HR response to adenosine (=reduced heart rate reserve, %HRR) was seen in patients with abnormal CFR, with a most pronounced effect being observed in female patients free of myocardial ischemia (45.9 ± 34.9 vs 26.5 ± 18.0, p < 0.001 in women and 29.1 ± 16.9 vs 24.3 ± 21.7, p = 0.15 in men). Hence, a fully-adjusted multivariate logistic regression model identified HRR as the strongest negative predictor of reduced CFR in women free of myocardial ischemia, but not in men. Accordingly, receiver operating characteristics (ROC) curves for the presence of reduced CFR revealed that a %HRR <35 was a powerful predictor for abnormal CFR with a sensitivity of 81% and a specificity of 60% in women. CONCLUSION:A blunted HRR <35% is associated with abnormal CFR in women. Taking into account HR responses during stress test in women may help to risk stratify the heterogeneous female population of patients with non-obstructive coronary artery disease (CAD).

journal_name

Eur J Nucl Med Mol Imaging

journal_title

European journal of nuclear medicine and molecular imaging

authors

Haider A,Bengs S,Maredziak M,Messerli M,Fiechter M,Giannopoulos AA,Treyer V,Schwyzer M,Kamani CH,Patriki D,von Felten E,Benz DC,Fuchs TA,Gräni C,Pazhenkottil AP,Kaufmann PA,Buechel RR,Gebhard C

doi

10.1007/s00259-019-4265-7

subject

Has Abstract

pub_date

2019-06-01 00:00:00

pages

1257-1267

issue

eissn

1619-7070

issn

1619-7089

pii

10.1007/s00259-019-4265-7

journal_volume

pub_type

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Heart rate reserve during pharmacological stress is a significant negative predictor of impaired coronary flow reserve in women.