A Single Center Diagnostic, Cross-sectional Study of Coronary Microvascular Dysfunction

The objectives of this study are to

1. Investigate platelet activity and inflammation in patients with and without coronary
microvascular disease who are referred for coronary angiography for the evaluation of
stable ischemic heart disease and are found to have non-obstructuve epicardial CAD

2. To identify correlates of coronary microvascular dysfunction in non coronary
microvascular beds that can be characterized in vivo.

Inclusion Criteria:

- Adult women age ≥18 years referred for coronary angiography

- Stable ischemic heart disease, defined by ischemic symptoms and/or myocardial ischemia
by stress testing

- Administration of aspirin therapy prior to cardiac catheterization

Exclusion Criteria:

Pre-Cath Exclusion criteria:

- Active bleeding and/or bleeding diathesis

- Anemia (hemoglobin <9 mg/dl)

- Known thrombocytosis (platelet count >500,000)

- Know thrombocytopenia (platelet count <100,000)

- NSAIDs (e.g., ibuprofen, naproxen) within 3 days

- Platelet antagonists other than aspirin and thienopyridines, within 7 days

- Prior percutaneous coronary intervention or coronary artery bypass grafting

- Acute myocardial infarction within 3 months

- Severe valvular heart disease

- Cardiogenic shock or mechanical circulatory support

- New York Heart Association (NYHA) Functional Class III or IV heart failure

- Ejection Fraction <40%

- Hypertrophic obstructive cardiomyopathy or severe left ventricular hypertrophy

- Pregnancy

- Contraindication to intravenous infusion of adenosine during coronary angiography, due
to known hypersensitivity to adenosine, known or suspected bronchoconstrictive or
bronchospastic lung disease (severe asthma), second- or third-degree AV block (except
in patients with a functioning artificial pacemaker), or sinus node disease, such as
sick sinus syndrome or symptomatic bradycardia,

Angiographic Exclusion criteria:

- Obstructive CAD (≥50% luminal obstruction in ≥1 major epicardial coronary arteries by
invasive coronary angiography)

- Unfavorable coronary artery anatomy for guidewire positioning (as determined by the
angiographer or PI)