Latest from the WISE: Contributions to the Understanding of Ischemia and Heart Failure among Women with No Obstructive Coronary Arteries

Fig. 1.. Abnormal coronary microvascular and macrovascular function in women with INOCA. In women with signs and symptoms of INOCA, invasive coronary function testing identifies abnormalities in coronary microvascular and macrovascular function that predict adverse cardiovascular outcomes. INOCA, ischemic with no obstructive coronary arteries (Reprinted with permission [20]).

Fig. 2.. The Chicken or the Egg? Studies from the WISE are evaluating mechanisms contributing to higher risk of HFpEF in patients with INOCA. Prior WISE studies suggest that myocardial cellular damage and myocardial steatosis may contribute to myocardial remodeling and dysfunction in women with INOCA, but significant knowledge gaps exist regarding potential therapies. While traditional cardiovascular risk factors such as hypertension and obesity are common in patients with INOCA and known to contribute to myocardial remodeling, emerging evidence suggest that CMD is associated with subclinical functional and structural abnormalities. However, causal mechanistic links and the sequence of causality remain unknown. Does CMD lead to left ventricular remodeling and dysfunction or is ventricular modeling and dysfunction causal for CMD? Future work is needed to fill key knowledge gaps. CMD, coronary microvascular dysfunction; IHD, ischemic heart disease; INOCA, ischemia with no obstructive coronary arteries; HFpEF, heart failure with preserved ejection fraction; TG, triglycerides; WISE, Women’s Ischemia Syndrome Evaluation (Reprinted with permission [90]).