Document Detail


Increased wave reflection and ejection duration in women with chest pain and nonobstructive coronary artery disease: ancillary study from the Women's Ischemia Syndrome Evaluation.
MedLine Citation:
PMID:  23615325     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Wave reflections augment central aortic SBP and increase systolic pressure time integral (SPTI) thereby increasing left ventricular (LV) afterload and myocardial oxygen (MVO2) demand. When increased, such changes may contribute to myocardial ischemia and angina pectoris, especially when aortic diastolic time is decreased and myocardial perfusion pressure jeopardized. Accordingly, we examined pulse wave reflection characteristics and diastolic timing in a subgroup of women with chest pain (Women's Ischemia Syndrome Evaluation, WISE) and no obstructive coronary artery disease (CAD).
METHODS: Radial artery BP waveforms were recorded by applanation tonometry, and aortic BP waveforms derived. Data from WISE participants were compared with data from asymptomatic women (reference group) without chest pain matched for age, height, BMI, mean arterial BP, and heart rate.
RESULTS: Compared with the reference group, WISE participants had higher aortic SBP and pulse BP and ejection duration. These differences were associated with increased augmentation index and reflected pressure wave systolic duration. These modifications in wave reflection characteristics were associated with increased SPTI and wasted LV energy (Ew) and a decrease in pulse pressure amplification, myocardial viability ratio, and diastolic pressure time fraction.
CONCLUSION: WISE participants with no obstructive CAD have changes in systolic wave reflections and diastolic timing that increase LV afterload, MVO2 demand, and Ew with the potential to reduce coronary artery perfusion. These alterations in cardiovascular function contribute to an undesirable mismatch in the MVO2 supply/demand that promotes ischemia and chest pain and may contribute to, or increase the severity of, future adverse cardiovascular events.
Authors:
Wilmer W Nichols; Scott J Denardo; B Delia Johnson; Barry L Sharaf; C Noel Bairey Merz; Carl J Pepine
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of hypertension     Volume:  31     ISSN:  1473-5598     ISO Abbreviation:  J. Hypertens.     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-09-05     Completed Date:  2014-02-10     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  8306882     Medline TA:  J Hypertens     Country:  England    
Other Details:
Languages:  eng     Pagination:  1447-54; discussion 1454-5     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Chest Pain / physiopathology*
Coronary Artery Disease / physiopathology*
Female
Humans
Middle Aged
Stroke Volume*
Grant Support
ID/Acronym/Agency:
1R03AG032631/AG/NIA NIH HHS; M01 RR000425/RR/NCRR NIH HHS; MO1-RR00425/RR/NCRR NIH HHS; N01 HV068161/HV/NHLBI NIH HHS; N01 HV068162/HV/NHLBI NIH HHS; N01 HV068163/HV/NHLBI NIH HHS; N01 HV068164/HV/NHLBI NIH HHS; N01-HV-68161/HV/NHLBI NIH HHS; N01-HV-68162/HV/NHLBI NIH HHS; N01-HV-68163/HV/NHLBI NIH HHS; N01-HV-68164/HV/NHLBI NIH HHS; R03 AG032631/AG/NIA NIH HHS; T32 HL069751/HL/NHLBI NIH HHS; T32HL69751/HL/NHLBI NIH HHS; U01 HL064829/HL/NHLBI NIH HHS; U01 HL064914/HL/NHLBI NIH HHS; U01 HL064924/HL/NHLBI NIH HHS; U01 HL649141/HL/NHLBI NIH HHS; U01 HL649241/HL/NHLBI NIH HHS; U0164829//PHS HHS; UL1 TR000064/TR/NCATS NIH HHS; UL1 TR000064/TR/NCATS NIH HHS
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