Microvascular Dysfunction as Opposed to Conduit Artery Disease Explains Sex-specific Chest Pain in Emergency Department Patients With Low to Moderate Cardiac Risk
Abstract
Chest pain is a common emergency department (ED) presentation that is often unexplained. Recent evidence suggests that disease of the microvessels (arterioles) as opposed to the coronary artery (conduit artery) could explain one third of these cases, particularly in women. Brachial artery reactivity (BAR) is a validated surrogate measure of coronary artery vasomotion. The goal of this study was to compare brachial artery conduit vessel function (BAR) and microvascular function (postischemic peak reactive hyperemia [RH]) in subjects with and without chest pain and grouped according to sex. This prospective cohort study was conducted from January through March 2010. Cases were patients admitted to an ED chest pain center with low to moderate risk of acute coronary syndrome; they were eligible for study if their creatinine level was <2.0 mg/dL and systolic blood pressure was >100 mm Hg or <180 mm Hg. Asymptomatic healthy volunteers on no medications were recruited as control subjects. BAR as a change in brachial artery diameter in response to transient forearm ischemia (endothelium-dependent vasodilation) and RH as a change in flow velocities were measured with a high-resolution ultrasound. Telephone follow-up visits were made at ...Continue Reading
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