Prevalence of coronary blood flow reserve abnormalities among patients with nonobstructive coronary artery disease and chest pain

Objective: To determine the prevalence of abnormalities in endothelium- dependent and endothelium-independent coronary flow reserve among patients with non-obstructive coronary artery disease and chest pain. Material and Methods: We studied endothelium-dependent (after infusion of 10^-6 M to 10^{- 4} M of acetylcholine) and endothelium-independent (after administration of 18 to 36 μg of adenosine) coronary flow reserve among patients with nonobstructive coronary artery disease and chest pain who were undergoing assessment at Mayo Clinic Rochester. Coronary blood flow was derived from coronary artery diameter assessed by quantitative angiography and Doppler flow velocities. Results: The cohort consisted of 203 patients (158 female and 45 male patients), who ranged in age from 17 to 78 years (mean, 51). Most patients (92%) had at least one risk factor for atherosclerosis; a substantial proportion had undergone extensive cardiac and noncardiac evaluation. Whereas 41.5% of the patients had normal coronary flow reserve, 58.5% had an abnormal response: 11.3% an impaired response to adenosine (flow velocity ratio of 2.5 or less), 29.2% an impaired response to acetylcholine (flow reserve ratio of 1.5 or less), and 18% a combined abnormality. No correlation (r² = 0.03) was noted between endothelium-dependent and endothelium-independent flow reserve. Conclusion: Most study patients with chest pain and nonobstructive coronary artery disease undergoing coronary vasomotor evaluation had risk factors for coronary artery disease and diverse abnormalities in endothelium-dependent or endothelium-independent coronary flow reserve (or both). These findings underscore the need for a comprehensive assessment.