Renin Angiotensin for Coronary Microvascular Dysfunction

描述（匹兹堡大学申请摘要） 这一重新申请建议延长妇女缺血的随访时间， 综合征评估（WISE）患者至少5年， 与申请书一并提交的，“改变的肾素血管紧张素系统作为 女性冠状动脉微血管功能障碍的机制”（C。Pepine PI） 和“女性冠状动脉疾病的免疫学基础”（S.Reis OI）。智者 合同开始于1996年9月，作为一项4中心研究，以1）优化症状 女性缺血性心脏病的评估和诊断测试：2） 探索在没有心肌缺血的情况下症状和心肌缺血的机制 心外膜冠状动脉狭窄：和3）评估的影响， 生殖激素对症状和诊断测试反应的影响。 一个广泛 当代数据库已收集了936名妇女转介冠状动脉 因为怀疑局部缺血而进行血管造影。 数据包括人口统计数据， 临床、症状、功能和心理社会变量。 冠状 血管造影和心室造影数据、肱动脉反应性试验、ECG 监测和血液测定都由核心实验室评估， 针对具体地点的创新技术已被用于开发潜力 心肌缺血的标志物。 我们寻求1）确定增量长期- 在WISE中开发的新测试的长期预后价值：2）开发性别- 特定的增量结果模型，以评估女性患者的预后价值 生殖变量：3）评估增量成本效益， WISE创新测试技术的资源， 传统测试：4）继续进行分析和辅助项目， 与其他WISE研究者在此集群中提交的R 01合作， 维护WISE数据库和基础设施，以进一步促进 研究女性缺血综合征的潜在机制。到 为了实现这些目标，需要更长的后续行动。 后续行动将包括 由经验丰富的现场协调员进行年度电话联系。 WISE将 继续使用已建立的方法进行研究协调， 数据管理、质量控制、统计分析和手稿 准备. 将使用考克斯回归模型分析事件， 人口统计学风险因素、诊断检测和生殖因素 作为解释变量。 将使用混合决策模型 比较资源使用模式并计算成本资产。 的结果 这些研究将使我们更好地了解 女性缺血性心脏病的病理生理学，并作为基础 用于旨在减少疾病的诊断和治疗临床试验- 相关的发病率和死亡率。

DESCRIPTION (Abstract from University of Pittsburgh application) This reapplication proposes to extend the follow-up of the Women's Ischemia Syndrome Evaluation (WISE) patients for a minimum of 5 years and is being submitted jointly with the applications, "Altered Renin Angiotensin System as a Mechanism for Coronary Microvascular Dysfunction in Women" (C. Pepine PI) and "Immunologic Basis For Coronary Disease in Women" (S.Reis OI). The WISE contract began in September 1996 as a 4-center study to 1) optimize symptom evaluation and diagnostic testing for ischemic heart disease in women: 2) explore mechanisms for symptoms and myocardial ischemia in the absence of epicardial coronary artery stenoses: and 3) evaluate the influence of reproductive hormones on symptoms and diagnostic test response. An extensive contemporary database has been assembled on 936 women referred for coronary angiography because of suspected ischemia. Data include demographic, clinical, symptomatic, functional, and psychosocial variables. Coronary angiography and ventriculography data, brachial artery reactivity testing, ECG monitoring, and blood determinations are all assessed by core laboratories, Site-specific-innovative technologies have been used to develop potential markers of myocardial ischemia. We seek to 1) Determine the incremental long- term prognostic value of novel testing developed in WISE: 2) Develop sex- specific incremental outcome models to evaluate the prognostic value of female reproductive variables: 3) Assess the incremental cost effectiveness and resource of the WISE innovative testing techniques as compared with traditional tests: 4) Continue ongoing analyses and ancillary projects, collaborate with other WISE investigators' R01s submitted in this cluster and maintain a WISE database and infrastructure to facilitate further investigations into the mechanisms underlying ischemia syndromes in women. To address these aims, a longer follow-up is necessary. Follow-up will consist of annual telephone contacts by experienced site coordinators. WISE will continue to use the well-established methods to implement study coordination, data management, quality control, statistical analyses, and manuscript preparation. Cox regression models will be used to analysis events with demographics risk factors, diagnostic testing and reproductive factors considered as explanatory variables. A hybrid decision model will be used that compares resource use patterns and sums cost estates. The results of these studies will enhance our understanding of both the significance and pathophysiology of ischemic heart disease in women and serve as a foundation for diagnostic and therapeutic clinical trials aimed at reducing disease- related morbidity and mortality.