Trial DesignImproving diagnosis and treatment of women with angina pectoris and microvascular disease: The iPOWER study design and rationale
Section snippets
Background
Angina is the most common symptom of ischemic heart disease (IHD) among women but the correlation between luminal obstruction at coronary angiography (CAG) and angina is lower than among men.1., 2., 3., 4. More than half of women with angina have no obstructive coronary artery disease (CAD) (>50% luminal diameter stenosis in ≥1 epicardial coronary artery), twice as often as in men.4 Recent studies emphasize that contrary to previous understanding, many of these women have a poor prognosis in
Study objectives
The aim of the iPOWER study is to assess the prevalence of CMD and the value of clinically applicable diagnostic methods for its identification, to determine the prognostic importance of CMD, and, ultimately, to improve treatment of women with angina and no obstructive CAD.
Study design overview
This is a comprehensive multicentre study designed to improve diagnosis and treatment of women with angina and no obstructive coronary vessel disease. The study has 3 parts: a diagnostic component, a prognostic component, and a third component focusing on intervention. Through an alliance between departments of cardiology in Denmark we will apply combinations of functional, anatomical and biochemical methods to develop safe, accurate and cost-effective diagnostic approaches aimed at
Discussion
The preliminary iPOWER results indicate that the transthoracic echocardiographic Doppler-derived CFR is feasible as a routine assessment in women with angina and no angiographic epicardial stenosis. The current speed of patient inclusion in iPOWER is sufficient to reach the study goal of 2000 women included in the prospective study with an inclusion period of 3 years.
The clinical strategies currently pursued in diagnosis, risk stratification and treatment of patients with IHD focus on
Conclusion
The iPOWER study will be the largest study to date to systematically assess coronary microvascular function in women with angina and no obstructive IHD and will establish the role of CMD in risk stratification.
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2019, International Journal of CardiologyPro-inflammatory biomarkers in women with non-obstructive angina pectoris and coronary microvascular dysfunction
2019, IJC Heart and VasculatureCitation Excerpt :In the present study we analyzed a range of CVD biomarkers with the aim of identifying common internal patterns representing pathophysiologic pathways which may be activated in patients with CMD. Participants with angina-like symptoms and no significant obstructive coronary artery disease (<50% coronary artery stenosis) were enrolled between March 2012 and September 2014, according to the inclusion criteria for the iPOWER study [4] (see Supplemental materials). A subgroup of the iPOWER cohort was randomly selected for protein biomarker evaluation in this study.
Effect of liraglutide on body weight and microvascular function in non-diabetic overweight women with coronary microvascular dysfunction
2019, International Journal of CardiologyProtein biomarkers and coronary microvascular dilatation assessed by rubidium-82 PET in women with angina pectoris and no obstructive coronary artery disease
2018, AtherosclerosisCitation Excerpt :Patients were also excluded if any known cardiac or non-cardiac cause of chest discomfort was deemed highly likely. Standard assessment included demographic data, symptom questionnaires, physical examination, electrocardiogram, blood samples and echocardiography [11,12]. A subgroup of the iPOWER cohort was randomly selected for evaluation with PET [13].
The prognostic value of coronary endothelial and microvascular dysfunction in subjects with normal or non-obstructive coronary artery disease: A systematic review and meta-analysis
2018, International Journal of CardiologyCitation Excerpt :Echocardiographic assessment, which in all but one study [24] was done on the LAD, represents regional microvascular function. This modality can be technically challenging, in particular in overweight and obese patients and is operator dependent, however, a few studies have reported a good correlation between TTDE and invasively derived CFVR [87,88]. Most PET studies used 82Rubidium [28,59–63] as a tracer while the remaining used 13N-ammonia [55–58].