Article Text


Original research article
Coronary endothelial function testing may improve long-term quality of life in subjects with microvascular coronary endothelial dysfunction
  1. Martin Reriani1,2,
  2. Andreas J Flammer1,
  3. Jessica Duhé1,
  4. Jing Li1,
  5. Rajiv Gulati1,
  6. Charanjit S Rihal1,
  7. Ryan Lennon3,
  8. Jonella M Tilford1,
  9. Abhiram Prasad1,
  10. Lilach O Lerman4 and
  11. Amir Lerman1
  1. 1 Division of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  2. 2 Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  3. 3 Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  4. 4 Division of Nephrology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  1. Correspondence to Dr Amir Lerman; lerman.amir{at}


Aim Angina pectoris in the absence of obstructive coronary artery disease (CAD) is common and is associated with poor quality of life (QOL). Coronary microvascular endothelial dysfunction is associated with myocardial ischaemia and is a common cause of angina. We hypothesise that evaluation of coronary endothelial function, its diagnosis and treatment will favourably impact QOL in patients with angina symptoms and non-obstructive CAD.

Methods and results Follow-up was done on 457 patients with chest pain and non-obstructive coronary arteries who had undergone coronary vascular reactivity evaluation by administration of intracoronary acetylcholine at the time of diagnostic study. After a mean follow-up of 8.4±4.7 years, QOL was assessed by administration of the SF-36 QOL survey. Patients diagnosed and treated for microvascular endothelial dysfunction had a higher (better) overall mental composite score (44.8 vs 40.9, p=0.036) and mental health score (44.2 vs 40.7, p=0.047), and a trend towards higher vitality scores (39.1 vs 35.9, p=0.053) and role emotional scores (43.6 vs 40.4, p=0.073), compared with patients with normal endothelial function.

Conclusion Among patients with chest pain and normal coronaries, diagnosis and treatment of coronary microvascular endothelial dysfunction in those with angina pectoris and non-obstructive CAD are associated with better QOL compared with patients with normal endothelial function.

  • microvascular endothelial function
  • quality of life
  • angina

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  • Contributors The authors of the paper take full responsibility.

  • Funding The study was supported by grants from the NIH (NIH K24 HL-69840, NIH R01 HL-63911, HL-77131, HL 92954, HL 085307, DK 73608) and the Mayo Foundation.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval The Mayo Clinic Institutional Review Board approved the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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