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Published on: August 17, 2022
Abnormal coronary microvascular endothelial function in humans with asymptomatic left ventricular dysfunction
Abhiram Prasad1, Stuart T Higano, Jassim Al Suwaidi
1Division of Cardiovascular Diseases and Department of Internal Medicine, Center for Coronary Physiology and Imaging, Mayo Clinic and Mayo Foundation, Rochester, Minn 55905, USA.
Insights
Coronary microvascular endothelial dysfunction is present in patients with asymptomatic left ventricular dysfunction (ALVD). This suggests endothelial dysfunction may be an early indicator in heart failure development.
Area of Science:
- Cardiology
- Vascular Biology
- Heart Failure Research
Background:
- Coronary endothelial dysfunction is linked to myocardial ischemia and heart failure progression.
- The temporal relationship between endothelial dysfunction and heart failure remains unclear.
- This study investigated endothelial function in asymptomatic left ventricular dysfunction (ALVD).
Purpose of the Study:
- To determine if coronary endothelial dysfunction exists in patients with asymptomatic left ventricular dysfunction (ALVD).
- To explore the role of endothelial dysfunction in the early stages of heart failure.
Main Methods:
- Evaluated coronary vascular reactivity in 300 patients using intracoronary adenosine, acetylcholine (ACH), and nitroglycerin.
- Grouped patients into ALVD (ejection fraction <45%) and controls (ejection fraction >=45%).
- Assessed changes in epicardial diameter and coronary blood flow in response to ACH.
Main Results:
- Patients with ALVD showed significantly attenuated coronary blood flow response to ACH compared to controls (P <.013).
- No significant difference in epicardial diameter response to ACH between groups.
- Left ventricular ejection fraction was an independent predictor of coronary microvascular dilation with ACH (P <.001).
Conclusions:
- Coronary microvascular endothelial dysfunction is present in patients with ALVD.
- Endothelial dysfunction may represent an early pathophysiological event in heart failure.
Background:
Coronary endothelial dysfunction may potentially lead to myocardial ischemia and to the progression of heart failure. Though endothelial dysfunction is associated with advanced heart failure in humans, relatively little is known regarding their temporal relationship. Thus, the current study was designed to test the hypothesis that coronary endothelial dysfunction is present in patients with asymptomatic left ventricular dysfunction.
Methods And Results:
Three hundred patients without symptoms of heart failure, with normal or mildly diseased coronary arteries at angiography underwent coronary vascular reactivity evaluation using intracoronary adenosine, acetylcholine (ACH) and nitroglycerin. Patients were divided into 2 groups based on the left ventricular ejection fraction (EF): patients with asymptomatic left ventricular dysfunction (ALVD), EF <45% (n = 11); and patients with EF > or =45% (n = 289, controls). Except for a lower high-density lipoprotein level in patients with ALVD, there were no significant differences between the groups in regards to conventional cardiovascular risk factors. There was no difference in the change (mean +/- SE) in epicardial diameter in response to ACH (-21.7% +/- 7.2% vs -13.8% +/- 1.5%, P =.3). The change in coronary blood flow in response to ACH was significantly attenuated in the patients with ALVD when compared to the controls (-18.5% +/- 14.9% vs 74.0% +/- 7.2%, P <.013). By multivariate analysis, EF was an independent predictor of coronary microvascular dilation with ACH (P <.001).
Conclusion:
The current study demonstrates that coronary microvascular endothelial dysfunction is present in ALVD. Thus, coronary endothelial dysfunction may be an early event in the pathophysiology of heart failure.
