Diastolic Dysfunction in Women with Signs and Symptoms of Ischemia in the Absence of Obstructive Coronary Artery Disease: A Hypothesis-Generating Study
Background—Angina, in the absence of obstructive CAD is more common in women, is associated with adverse cardiovascular morbidity and mortality, and is a major burden to the healthcare system. While advancements have been made to understand the mechanistic underpinning of this disease, the functional consequence remains unclear.
Methods and Results—Cardiac magnetic resonance imaging was performed to assess left ventricular (LV) function in 20 women with signs and symptoms of ischemia, but no obstructive CAD (cases), and 15 age and body mass index-matched reference controls. Functional imaging included standard cinematic imaging to assess LV morphology and global function, along with tissue tagging to assess LV tissue deformation. Systolic function was preserved in both cases and controls, with no differences in ejection fraction (mean + SE: 63.1 + 8% vs. 65 + 2%), circumferential strain (-20.7+0.6 vs. -21.9+0.5%) or systolic circumferential strain rate (-105.9+6.1 vs. -109.0+3.8%/s), respectively. In contrast, we observed significant differences between cases and controls in diastolic function, as demonstrated by reductions in both diastolic circumferential strain rate (153.8 + 8.9 vs. 191.4 + 8.9 %/s, P < 0.05) and the peak rate of left ventricular untwisting (-99.4 + 8.0 vs. -129.4 + 12.8 °/s, P < 0.05), respectively.
Conclusions—Diastolic function is impaired in women with signs and symptoms of ischemia in the absence of CAD, as assessed by cardiac magnetic resonance tissue tagging. These results are hypothesis generating— larger studies are needed in order to define the exact mechanism(s) responsible, and to establish viable treatment strategies.
- Received November 27, 2013.
- Accepted March 10, 2014.