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CLINICAL RESEARCH

Impaired Coronary Vascular Reactivity and Functional Capacity in Women

Results From the NHLBI Women’s Ischemia Syndrome Evaluation (WISE) Study

Eileen Handberg, PhD^_*,_*, B. Delia Johnson, PhD, Christopher B. Arant, MD^_*, Timothy R. Wessel, MD^_*, Richard A. Kerensky, MD, FACC^_*, Gregory von Mering, MD^_*, Marian B. Olson, MS, Steven E. Reis, MD, Leslee Shaw, PhD, C. Noel Bairey Merz, MD, FACC^||, Barry L. Sharaf, MD, FACC^¶, George Sopko, MD^# and Carl J. Pepine, MD, MACC^_*

^_* Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida
Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Atlanta Cardiovascular Research Institute, Atlanta, Georgia
^|| Division of Cardiology, Department of Medicine, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
^¶ Division of Cardiology, Rhode Island Hospital, Providence, Rhode Island
^# Division of Heart and Vascular Disease, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland

Manuscript received September 28, 2004; revised manuscript received January 11, 2005, accepted January 17, 2005.

^_* Reprint requests and correspondence: Dr. Eileen Handberg, Division of Cardiovascular Medicine, University of Florida College of Medicine, P.O. Box 100277, Gainesville, Florida 32610-0277 (Email: handbem{at}medicine.ufl.edu).

OBJECTIVES: We investigated the relationship between coronary vascular reactivity and functional capacity as assessed from the Duke Activity Status Index (DASI) in a cohort of women evaluated for suspected ischemia.

BACKGROUND: Reduced functional capacity and impaired vascular reactivity are associated with poor prognosis, but an association between vascular reactivity and functional capacity is unknown.

METHODS: A total of 190 women enrolled in the National Heart, Lung, and Blood Institute (NHLBI)-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study had baseline clinical assessment and coronary artery flow velocity response to adenosine (CFVR_ado). We compared these results with self-reported DASI metabolic equivalents (METs).

RESULTS: Mean age was 55 ± 11 years (range 21 to 83 years), and only 18% had coronary stenosis 50%. Women with a CFVR_ado <2.5 (n = 98) had mean DASI of 15.1 ± 13.6, compared to women (n = 92) with CFVR_ado 2.5, whose mean DASI was 21.0 ± 15.2 (p = 0.004). This relationship was maintained after adjusting for age and presence of coronary artery disease. CFVR_ado of 2.5 was associated with a DASI of >20 (odds ratio 3.03, 95% confidence interval 1.56 to 5.90, p = 0.001).

CONCLUSIONS: Women with reduced CFVR_ado were significantly more likely to have reduced functional capacity. Impairment in coronary vascular function and reduced levels of activity may both play a role in the poorer prognosis observed in the WISE study women; however, the relationship between the two is still unclear.

Abbreviations and Acronyms   CAD = coronary artery disease   CFVRado = coronary flow velocity response to adenosine   CI = confidence interval   DASI = Duke Activity Status Index   METs = metabolic equivalents   NHLBI = National Heart, Lung, and Blood Institute   WISE = Women’s Ischemia Syndrome Evaluation

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