{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T04:15:08Z","timestamp":1780546508227,"version":"3.54.1"},"reference-count":43,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,9,9]],"date-time":"2020-09-09T00:00:00Z","timestamp":1599609600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006939","name":"Emory University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006939","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23HL105787"],"award-info":[{"award-number":["K23HL105787"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Patients without obstructive coronary artery disease (CAD) may have epicardial or microvascular dysfunction. The purpose of this study was to characterize patterns of epicardial and microvascular dysfunction in men and women with stable and unstable angina undergoing functional coronary angiography to inform medical therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>163 symptomatic patients with \u226450% diameter stenosis and fractional flow reserve (FFR)\u2009&gt;\u20090.8 underwent endothelium\u2010dependent epicardial and microvascular function after intracoronary acetylcholine (10<jats:sup>\u22124<\/jats:sup>\u00a0M, 81 mcg over 3\u00a0minutes). Endothelium\u2010independent function was assessed using coronary flow reserve (CFR) and hyperemic microvascular resistance (HMR) after intravenous adenosine (140\u00a0ug\/kg\/min). Coronary microvascular dysfunction (CMD) was defined as CFR\u2009&lt;\u20092.5, HMR \u22652, or\u2009\u226450% change in coronary blood flow with acetylcholine (CBF<jats:sub>ACH<\/jats:sub>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy\u2010two percent had endothelial\u2010dependent epicardial dysfunction (response to ACH: % \u2206 in coronary artery diameter and \u2206%CBF<jats:sub>ACH<\/jats:sub>) and 92% had CMD. Among CMD patients, 65% had CFR\u2009&lt;\u20092.5, 35% had HMR \u22652, and 60% had CBF<jats:sub>ACH<\/jats:sub> change \u226450%. CFR modestly correlated with HMR (r\u00a0=\u00a0\u22120.38, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001). Among patients with normal CFR, 26% had abnormal epicardial and 20% had abnormal microvascular endothelial dysfunction. Women had a lower CFR (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.02), higher FFR (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.03) compared to men. There were no differences in epicardial and microvascular function between patients with stable and unstable angina.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In patients with no obstructive CAD: CMD is prevalent, abnormal CFR does not correlate with epicardial or microvascular endothelial dysfunction, women have lower CFR, higher FFR but similar endothelial function compared to men.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.29237","type":"journal-article","created":{"date-parts":[[2020,9,10]],"date-time":"2020-09-10T07:47:23Z","timestamp":1599724043000},"page":"827-835","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Functional coronary angiography in symptomatic patients with no obstructive coronary artery disease"],"prefix":"10.1002","volume":"98","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3416-5087","authenticated-orcid":false,"given":"Sonali","family":"Kumar","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine Emory Women's Heart Center  Atlanta Georgia USA"},{"name":"Division of Cardiology, Department of Internal Medicine Andreas Gruentzig Cardiovascular Center  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Puja K.","family":"Mehta","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine Emory Women's Heart Center  Atlanta Georgia USA"},{"name":"Division of Cardiology, Department of Internal Medicine Emory Clinical Cardiovascular Research Institute  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parham","family":"Eshtehardi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine Andreas Gruentzig Cardiovascular Center  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia Y.","family":"Hung","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine Andreas Gruentzig Cardiovascular Center  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin\u2010Sin","family":"Koh","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine Andreas Gruentzig Cardiovascular Center  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnav","family":"Kumar","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine Emory Clinical Cardiovascular Research Institute  Atlanta Georgia USA"},{"name":"Division of Cardiology, Department of Internal Medicine Andreas Gruentzig Cardiovascular Center  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Al\u2010Badri","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine Emory Clinical Cardiovascular Research Institute  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rani","family":"Rabah","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine Andreas Gruentzig Cardiovascular Center  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melroy","family":"D'Souza","sequence":"additional","affiliation":[{"name":"J. 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