Hyperventilation combined with exercise induced regional wall motion abnormalities more frequently than hyperventilation alone (32.5% vs 15%, P=0.008) in patients with INOCA.
Observational (n=40)
No
Does stress echocardiography with hyperventilation and exercise improve the noninvasive detection of dynamic coronary microvascular dysfunction in patients with INOCA?
Stress echocardiography combining hyperventilation and exercise is a powerful noninvasive tool for detecting dynamic coronary microvascular dysfunction in patients with INOCA.
Absolute Event Rate: 32.5% vs 15%
p-value: p=0.008
INTRODUCTION: In patients with ischemia and no obstructive coronary artery disease (INOCA), a dynamic coronary microvascular dysfunction (CMD) is frequent but difficult to capture by noninvasive means.The aim of our study was to assess dynamic CMD in INOCA patients with stress echocardiography after vasoconstrictive and vasodilator stimuli. METHODS: In this prospective single-center study, we have enrolled 40 INOCA patients (age 56.3 ± 13 years, 32 women). All participants underwent stress echocardiography with hyperventilation (HYP), followed by supine bicycle exercise (HYP+EXE) and adenosine (ADO). Stress echocardiography included an assessment of regional wall motion abnormality (RWMA) and coronary flow velocity (CFV) in the distal left anterior descending (LAD) coronary artery. RESULTS: HYP induced a 30% increase in rate pressure product (rest = 10 244 ± 2353 vs. HYP = 13 214 ± 3266 mmHg x bpm, P < 0.001) accompanied by a paradoxical reduction in CFV (HYP< rest) in 21 patients (52%). HYP alone was less effective than HYP+EXE in inducing anginal pain (6/40, 15% vs. 10/40, 25%, P = 0.046), ST segment changes (6/40, 15% vs. 24/40, 60%, P < 0.001), and RWMA (6/40, 15% vs. 13/40, 32.5%, P = 0.008). ADO-induced vasodilation was preserved (≥2.0) in all patients. CONCLUSION: In patients with INOCA, a coronary vasoconstriction after HYP is common, in absence of structural CMD detectable with ADO. HYP+EXE test represents a more powerful ischemia inducer than HYP alone. Stress echocardiography with LAD-CFV may allow the noninvasive assessment of dynamic and structural coronary microcirculation during stress.
Dikić et al. (Fri,) conducted a observational in Ischemia and no obstructive coronary artery disease (INOCA) (n=40). Hyperventilation followed by supine bicycle exercise (HYP+EXE) vs. Hyperventilation (HYP) alone was evaluated on Regional wall motion abnormality (RWMA) (p=0.008). Hyperventilation combined with exercise induced regional wall motion abnormalities more frequently than hyperventilation alone (32.5% vs 15%, P=0.008) in patients with INOCA.
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